(065) ARE CLINICS THAT DO NOT HAVE A MSCP-CERTIFIED PROVIDER MORE LIKELY TO OFFER GUIDELINE-NON-CONCORDANT TREATMENT?
Authors: Marino J , Stanley E , Ahrendt H , Pope R 
Published: June 2024

Abstract

Introduction
Menopausal hormone therapy is the most efficacious option for treating vasomotor symptoms, the genitourinary syndrome of menopause, and to prevent fractures and bone loss. However, publication of contradictory evidence about the risks associated with menopausal hormone therapy and changing recommendations created confusion among patients and providers about how best to manage symptoms. Because providers with varying degrees and specialties may take care of midlife women, and there is no specific certification required to offer menopause treatment, The Menopause Society established its competency exam in 2002 to set the standard for menopause care and assist women in locating clinicians who provide optimal menopause-related care.

Objective
To identify clinics advertising menopause treatment in Ohio, Michigan, and Pennsylvania and evaluate whether clinics not affiliated with a MSCP-certified provider are more likely to offer guideline-non-concordant treatment compared to clinics affiliated with a MSCP- certified provider.

Methods
We performed an internet search to identify clinics providing menopause treatment in Ohio, Michigan, and Pennsylvania. From each clinic’s website we abstracted the location, whether the clinic offered guideline-non-concordant treatment (hormone testing, bioidentical “hormone menopause therapy (HRT)”, or compounded HRT), whether the clinic advertised that menopausal hormone therapy(MHT) would promote youthful appearance or weight loss, and whether the clinic accepted insurance. We checked clinic personnel against the Menopause Society directory of practitioners to determine if the clinic was affiliated with a MSCP-certified provider. We used Fisher’s exact test to evaluate association between affiliation with a MSCP provider and guideline-non-concordant care, inaccurate claims about MHT, and accepting insurance. Our primary outcome was odds of offering hormone testing.

Results
We identified 174 clinics (41% in OH, 28% in PA, and 31% in MI). 13% of clinics were affiliated with a MSCP-certified provider. Clinics with a MSCP-certified provider are significantly more less likely to advertise hormone testing (primary outcome, OR = 0.11, 95% confidence interval: 0.02 to 0.39), compounded hormone therapy (OR = 0.06, 95% confidence interval: 0.001 to 0.41), and bioidentical hormone therapy (OR = 0.07, 95% confidence interval: 0.001 to 0.26), compared to clinics without a MSCP-certified provider. MSCP provider-affiliated clinics are also less likely to advertise that hormone replacement therapy will help maintain youth or help with weight loss (Table). Clinics with a MSCP-certified provider are more likely to accept insurance (OR = 7.55, 95% confidence interval: 1.59 to 72.29).

Conclusions
Our research has shown that in the states of Ohio, Michigan, and Pennsylvania, MSCP-certified providers were more likely to adhere to the Menopause Society’s guidelines and not advertise for compounded or bioidentical hormones, recommend hormone testing, or advertise hormones for a youthful appearance or weight loss. These clinics were also more likely to accept insurance. Providers who work with midlife women should consider obtaining their MSCP certification to remain current with evidence-based practice and make it easier for patients to locate a provider who is following the most up to date guidelines.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Astellas.