Attitudes to and management of fertility among primary health care physicians in Turkey: an epidemiological study

Hikmet Hassa, Unal Ayranci, Ilhami Unluoglu, Selma Metintas, Alaeddin Unsal, Hikmet Hassa, Unal Ayranci, Ilhami Unluoglu, Selma Metintas, Alaeddin Unsal

Abstract

Background: The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries. The aim of this study was to determine primary care physicians' opinions about the approach to infertility cases and their place within primary health care services (PHCSs).

Methods: The study was conducted between October 2003 and April 2004. The study group comprised 748 physicians working in PHCSs. They were asked to fill in a questionnaire with questions pertaining to infertility support, laboratory and treatment algorithms, as well as the demographic characteristics. The data was evaluated using the chi square test, percentage rates and a logistic regression model.

Results: The multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5-9 years and > or = 10 years were the variables that most positively influenced them in their approach to cases of infertility (p < 0.05, each one). Just 28.7% of the physicians indicated that they believed cases of infertility could be evaluated at the primary care level. The most frequently proposed reason for indicating 'difficulty in practice' (n = 533) was inadequate provision of equipment in PHCSs (55.7%). The physicians reported that they were able to perform most of the supportive treatments and proposals (between 64.6%-87.7%). The most requested laboratory investigations were the instruction of patients in taking basal body temperatures and semen analysis (89.7% and 88.7%, respectively). The most preferential course of treatment was that of sexually transmitted diseases (95.5%).

Conclusion: It is clear that not enough importance is attached to the provision of care to infertile couples within PHCSs. This leads us to conclude that an integration of infertility services in primary care would be appropriate after strengthening the PHCSs.

References

    1. World Health Organization . Report of the Meeting on the Prevention of Infertility at the Primary Health Care Level. WHO, Geneva; 1984. 12–16 December 1983. WHO/MCH/84.4.
    1. Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. Fertil Steril. 1997;68:637–43. doi: 10.1016/S0015-0282(97)00269-0.
    1. Whitman-Elia GF. A primary care approach to the infertile couple. J Am Board Fam Pract. 2001;14:33–45.
    1. Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: is Africa different? Lancet. 1985;2:596–598. doi: 10.1016/S0140-6736(85)90594-X.
    1. Jones HW, Tomer JP. The infertile couple. N Engl J Med. 1993;329:1710–5. doi: 10.1056/NEJM199312023292307.
    1. Meniru GI, Hetcht BR, Hopkins MP. Comprehensive preventive health care in female-factor infertility: issues, problems and proposals. Prim Care Update Ob/Gyns. 2002;9:44–50. doi: 10.1016/S1068-607X(01)00102-0.
    1. Collins JA. A couple with infertility. JAMA. 1995;274:1159–64. doi: 10.1001/jama.274.14.1159.
    1. Grimshaw J, Emslie C. Managing infertility-the GP's role. Practitioner. 1994;238:586–90.
    1. Hanson MA, Dumesic DA. Initial evaluation and treatment of infertility in a primary care setting. Mayo Clin Proc. 1998;73:681–5.
    1. Schenker JG, Ezra Y. Complications of assisted reproductive techniques. Fertil Steril. 1994;61:411–22.
    1. Wilkes S, Jones K. Retrospective review of the prevalence and management of infertility in women on one practice over a 5-year period. Br J Gen Pract. 1995;45:75–7.
    1. Brundage SC. Preconception health care. Am Fam Physician. 2002;65:2507–14. 1521-2.
    1. World Health Organization. Twenty-first World Health Assembly, Part I-Resolotions and decisions, annexes. WHA21:43-Health aspects of populationdynamics. Official Records of the World Health Organization. 1968. pp. 21–22.
    1. World Health Organization Primary health care. International Conference on Primary health care. International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. A joint report by the World Health Organization and the Executive Director of the United Nations Children's Fund, Geneva. 1978.
    1. Rowe PJ. Clinical aspects of infertility and the role of health care services. Reproductive Health Matters. 1999;7:103–111. doi: 10.1016/S0968-8080(99)90119-2.
    1. Whitman-Elia GF, Baxley EG. A primary care approach to the infertile couple. J Am Board Fam Pract. 2001;14:33–45.
    1. Elstein M, Vaughan Williams CA, Shalet SM. Clinical algorithms: infertility. BMJ. 1987;294:1550.
    1. Emslie C, Grimshaw J, Templeton A. Do clinical guideliness improve general practice management and referral of infertile couples. BMJ. 1993;306:1728–31.
    1. Blackwell RE. A proposed algorithm for evaluation and treatment of infertility: update. Infertil Reprod Med. 1995;7:1–8.
    1. Morell V. Basic infertility assessment. Prim Care. 1997;24:195–204.
    1. Ittner E, Himmel W, Kochen M. German Family Physicians' attitudes toward care of involuntarily childless patients. Fam Med. 2000;32:119–25.
    1. Heyes T, Long S, Mathers N. Preconception Care. Fam Prac. 2004;21:22–27. doi: 10.1093/fampra/cmh106.
    1. Cakici C, Aka N, Yorulmaz S, Acar N, Gokmen B. Gebelerde Rutin Olarak Toksoplazma, Rubella ve Sitomegalovirus Taramasý Yapilmali midir? Jinekoloji-Obstetrik. 1995;5:14–18.
    1. Belisle S. In: Introduction. CFAS Consensus document for the investigation of infertility by first-line physicians. Belisle S, Pierson R, editor. Montreal, Que: Canadian Fertility and Andrology Society; 2002. pp. 8–9. Accessed 2003 September 12.
    1. Smith LF. The role of primary care in infertility management. Hum Fertil (Camb) 2003;6:S9–S12.
    1. Weingarten MA, Reinitz A, Hart J. Attitudes to primary care gynaecology among family physicians and gynaecologists in Israel. Scand J Prim Health Care. 1992;10:36–41.
    1. Bagshawe A, Taylor A. ABC of subfertility. Counselling. BMJ. 2003;327:1038–40. doi: 10.1136/bmj.327.7422.1038.
    1. Marvel MK, Morphew PK. Levels of family involvement by resident and attending physicians. Fam Med. 1993;25:26–30.
    1. Wallace M, Hurwitz B. Preconception care: who needs it, who wants it, and how should it be provided? Br J Gen Pract. 1998;48:963–966.
    1. Smilkstein G. The family in family medicine revisited, again. J Fam Pract. 1994;39:527–31.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner