婦女關懷研究資訊之擴散對更年期婦女使用荷爾蒙藥物之影響 The Effect of the Diffusion of the Women’s Health Initiative Report on the Utilization of Hormonal Therapy among Menopausal Women
中文摘要
美國在2002 年 7 月發表之婦女健康關懷研究( Women Health Initiative; WHI)中 指出，更年期婦女長期使用荷爾蒙藥物所面臨風險可能會大於其帶來的效益，
使得醫師和婦女對於利用荷爾蒙療法作為治療與預防疾病之適當性與安全性產 生相當程度的質疑。由於更年期為每位婦女一生中必經階段，且在此期間所發生 之停經症狀常常對許多婦女帶來長期的不適困擾及痛苦，特別是對於停經疾病 嚴重程度高之婦女而言，故瞭解規律使用荷爾蒙療法之婦女對荷爾蒙藥物使用 之改變情形及影響其改變之因素是很重要的議題。
研究目的：探討在WHI 報告發表後荷爾蒙規律使用者對荷爾蒙藥物持續或停止
利用之情形，進而探討WHI 報告對在不同層級別醫院就醫之婦女服用荷爾蒙藥
物之影響，以及荷爾蒙藥物劑量和劑型利用之改變情形。
研究方法：採用二手資料進行世代研究分析，資料來源為全民健康保險研究資
料庫，研究對象為在WHI 前期規律服用荷爾蒙藥物及規律就診於同一醫師之
40-69 歲婦女共 57,958 位，分析其在 WHI 前後期之停經門診、荷爾蒙藥物之利 用情形。
研究結果：WHI 報告發表後，婦女平均停經門診次數相較於前期下降 31.62%，
只有69.76%的婦女會持續服用荷爾蒙藥物，且其在荷爾蒙藥物劑量上有減量使 用之情形，相較於WHI 前期，WHI 後期之荷爾蒙藥物平均年度總使用劑量下降 38.67%。荷爾蒙藥物持續使用者多為年紀較輕、合併患有骨質疏鬆症、給予年齡 較高之醫師就診、在東部地區醫院、較低層級別醫院就醫之婦女，且相較於單用 型藥物使用者，合併型藥物使用者較傾向停止服用藥物(OR=0.53) ，在 WHI 報 告發表後，停經門診、荷爾蒙藥物年度總劑量之使用皆有下降情形，且有減少口 服劑型藥物使用，而增加外用型藥物來治療停經症狀之情形。另外，在越高層級
別醫院就醫或是看診醫師年齡越低之婦女，在WHI 報告之後，其停經門診年度
總次數、雌激素與黃體素年度總使用劑量皆為顯著較低。
結論：美國WHI 報告使台灣婦女及醫師減少對於荷爾蒙藥物之利用，表示健康
傳播與用藥安全資訊對於民眾影響力甚鉅，且資訊傳遞對於醫院處方行為之改 變與影響之大小，有由醫院層級別高至低以及醫師年齡低至高遞減之情形。
英文摘要 Objectives
Findings from the Women’s Health Initiative (WHI) gave rise to the concerns of risk of hormone therapy (HT). This study aimed to compare physicians’ prescribing behavior before and after the release of WHI report in Taiwan.
Methods
The data source for this study comes from the outpatient claims records of the National Health Insurance (NHI). A cohort of 57,958 women aged 40-69 who were regular estrogen users for menopausal symptom were identified during January 1, 2001 to June 30, 2001. Proportion of estrogen use, number of outpatient visits with estrogen prescription, and dosage of estrogen were compared on an annual basis, between the pre-WHI period (July 1, 2001-June 30, 2002), and the post-WHI period (Januray 1, 2003-December 31, 2003). Multiple logistic regressions and generalize estimating equation (GEE) were performed, to examine the effects of physicians’
characteristics on the changes in HT prescribing behavior.
Results
Probability of prescribing estrogen, number of outpatient visits with estrogen
prescriptions and total dosage of estrogen prescription were significantly reduced after WHI. However, the extents to which this consulting and prescribing behavior changes varied by physicians’ characteristics: physicians of younger ages, affiliated with medical centers, and located in urban areas were less likely to prescribe estrogen, less frequently to be consulted at outpatient visits with estrogen prescription, and
prescribed less dosages of estrogen, compared to their counterparts.
Conclusion
The dissemination of information on drug safety seems to be varied by physicians’
characteristics. Strategies on improving the dissemination of information on drug safety,speficially targeting on less informed physician groups, were warranted to avoid the misuse of drug with safety concerns.
