The National Association of Nurse Practitioners in Women's Health conducted a national survey of approximately 900 nurse practitioners to explore which external factors affect the type of estrogen therapy prescribed for menopause symptoms.
Studies suggest transdermal ET may have the potential for fewer health risks, and it controls symptoms of menopause as effectively as oral ET. Still, more than half of the survey respondents reported their practice most often prescribes oral ET.
"It appears that personal income and insurance access often drive decisions for the type of hormonal therapy a woman uses," said Susan Wysocki, WHNP-BC, FAANP. president and CEO of the NPWH. "Instead, options for hormonal therapy should allow for what is best for the woman. One size does not fit all."
The survey showed certain factors such as perceived patient income, NP practice setting and NP geographic area can affect the ET formulation prescribed. With recent studies indicating a favorable safety profile for transdermal ET efficacy compared to oral ET or menopause systems, and the added benefit of direct absorption into the bloodstream without having to pass through the liver, the study authors suggested ongoing educational efforts for NPs to ensure all patients receive the most appropriate treatment option.
Among additional findings:
• The vast majority of respondents (96%) were aware the current prescribing guidelines for hormone therapy recommend the lowest effective dose for the shortest duration time, consistent with treatment goals, benefits and risks for the individual patient.
• An overwhelming majority (90%) were aware transdermal ET allows for lower dosing because it avoids first-pass metabolism.
• Armed with that knowledge, 52% of NPs reported their practice prescribes oral ET more often than transdermal ET (36%).
• The majority of NPs (72%) reported they primarily prescribe oral ET if their practice serves patients with an estimated annual income less than $50,000. For patients with an estimated income greater than or equal to $50,000, NPs equally prescribe oral and transdermal ET (49% vs. 51%); patients with an annual income between $100,000 and $350,000 are significantly more likely to be prescribed transdermal ET.
• NPs in rural and urban offices prescribe oral ET significantly more than transdermal ET.
• Significantly more NPs with practices in the Midwest (67%) and in the South (61%) prescribe oral ET compared to their counterparts in the West and Northeast.
The 30-question survey was hosted by NPWH and was available online from Dec. 23, 2009, to Feb. 17, 2010. The initiative was supported by Upsher-Smith Women's Health. For more information about estrogen therapy, visit www.ETIQ.info.
Studies suggest transdermal ET may have the potential for fewer health risks, and it controls symptoms of menopause as effectively as oral ET. Still, more than half of the survey respondents reported their practice most often prescribes oral ET.
"It appears that personal income and insurance access often drive decisions for the type of hormonal therapy a woman uses," said Susan Wysocki, WHNP-BC, FAANP. president and CEO of the NPWH. "Instead, options for hormonal therapy should allow for what is best for the woman. One size does not fit all."
The survey showed certain factors such as perceived patient income, NP practice setting and NP geographic area can affect the ET formulation prescribed. With recent studies indicating a favorable safety profile for transdermal ET efficacy compared to oral ET or menopause systems, and the added benefit of direct absorption into the bloodstream without having to pass through the liver, the study authors suggested ongoing educational efforts for NPs to ensure all patients receive the most appropriate treatment option.
Among additional findings:
• The vast majority of respondents (96%) were aware the current prescribing guidelines for hormone therapy recommend the lowest effective dose for the shortest duration time, consistent with treatment goals, benefits and risks for the individual patient.
• An overwhelming majority (90%) were aware transdermal ET allows for lower dosing because it avoids first-pass metabolism.
• Armed with that knowledge, 52% of NPs reported their practice prescribes oral ET more often than transdermal ET (36%).
• The majority of NPs (72%) reported they primarily prescribe oral ET if their practice serves patients with an estimated annual income less than $50,000. For patients with an estimated income greater than or equal to $50,000, NPs equally prescribe oral and transdermal ET (49% vs. 51%); patients with an annual income between $100,000 and $350,000 are significantly more likely to be prescribed transdermal ET.
• NPs in rural and urban offices prescribe oral ET significantly more than transdermal ET.
• Significantly more NPs with practices in the Midwest (67%) and in the South (61%) prescribe oral ET compared to their counterparts in the West and Northeast.
The 30-question survey was hosted by NPWH and was available online from Dec. 23, 2009, to Feb. 17, 2010. The initiative was supported by Upsher-Smith Women's Health. For more information about estrogen therapy, visit www.ETIQ.info.
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