Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1067 — Veteran Women's Experiences with Discontinuing Hormone Replacement Therapy

Author List:
Haskell SG (VA Connecticut Healthcare System, Division of General Medicine, Yale University)
Bean-Mayberry BA (CHERP, VA Pittsburgh, Division of General Internal Medicine, University of Pittsburgh)
Goulet JL (VA Connecticut Healthcare System)
Good CB (CHERP, VA Pittsburgh, Division of General Internal Medicine, University of Pittsburgh)
Justice AC (VA Connecticut Healthcare System, Division of General Medicine, Yale University)

Objectives:
The 2002 Women’s Health Initiative (WHI) stated that the risks of hormone replacement therapy (HRT) exceeded benefits. This study examined how this reversal impacted HRT use among women veterans nationally. The objectives were to 1) determine the number of women veterans prescribed HRT during 2001, 2) determine the discontinuation rate after the WHI publication, and 3) describe differences in demographic and clinical factors between women who discontinue therapy and women who continue.

Methods:
We identified a national retrospective cohort of women veterans using HRT from VA Pharmacy Benefits Management in 2001 and linked them to the National Patient Care Database (NPCD). We performed bivariate comparisons between the groups along patient demographics and clinical factors. We used multiple logistic regression to explore independent factors associated with HRT discontinuation.

Results:
In 2001, 36,222 women veterans used combination or estrogen only HRT; by 2003, 18,161 (51.1%) had discontinued; and by 2004, 23,924 (66.1%) had discontinued. Discontinuers were older (mean age 58.9 vs. 55.0), used lower estrogen doses in 2001 (0.67 vs. 0.74 mg), frequently used combination HRT in 2001 (31% vs. 10%), less frequently had breast procedures or breast plastic surgery, but had significantly higher frequency of mastectomy. The groups did not differ on income or hysterectomy status. Multiple logistic regression revealed the following significant associations with discontinuation: age (OR 1.02, 95%CI 1.01-1.02), lower estrogen dose in 2001 (OR 0.50, 0.47-0.54), receipt of combination therapy in 2001 (OR 3.74, 3.50-4.00), and receipt of mastectomy (OR 2.64, 1.84-3.79), plastic surgery for the breast (OR 0.78, 0.62-0.99), or hysterectomy (OR 1.36, 1.14-1.62).

Implications:
Two-thirds of women veterans prescribed HRT regimens in 2001 discontinued by 2004. These rates are consistent with smaller studies showing 65-70% discontinuation rates after publication of the WHI results.

Impacts:
Our study provides national quality assurance data about the discontinuation rate for HRT regimens among women who received VA pharmacy benefits. It indicates that clinical factors may contribute to ongoing use versus discontinuation. Further understanding of clinical and demographic factors associated with ongoing HRT regimens is necessary to determine if use is consistent with guideline reversals and overall quality of care.