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

Abstract

BackgroundThe 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).MethodsThe 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.ResultsThe multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5–9 years and ≥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%).ConclusionIt 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.

Family physicians’ attitude and practice of infertility management at primary care - Suez Canal University, Egypt

“…More than 3 quarters of family physicians (77%) included within this study viewed the PHC as an appropriate place for infertility management. The present results were better than that found by Hassa et al [ 14 ] about attitudes to and management of fertility among primary health care physicians in Turkey and in the study by Ittner et al [ 8 ] about German family physicians' attitudes toward care of involuntarily childless patients (38.9% and 27.0%) respectively. The different results could be related to the perceived importance of infertility management by the studied sample, as it is a main topic in the curriculum of family medicine.…”

“…Regarding treatment and providing information to infertile cases, physicians could perform from (44.0%) for treatment of sexually transmitted diseases to (91.0%) for appropriate referral while their practice ranged from (20.0%) for treatment of hyperandrogenemia to (85.3%) for appropriate referral. These results were not similar to that of the Turkey study [ 14 ] as physicians reported the ability to perform from (26.2%) for hormonal treatment for male factor to (92.2%) for treatment of sexually transmitted diseases. This means underperformance in the present study than in the turkey study which could be related to inadequate training in intervention processes by the studied physicians.…”

“…In the present study, (75%) of family physicians previously practiced infertility management in primary care. This was in contrast to the study by Hassa et al [ 14 ], which found that more than half of the physicians had been involved in cases of infertility (57.6%), and reported that they directly referred infertile patients to a higher-level healthcare provider. These findings could be related to the favorable attitude towards PHC as an appropriate place for the management of infertility.…”

“…In the turkey study, the physicians could able to request between (43.0%) for performing U/S to (83.7%) for semen analysis). In the present study and the turkey study [ 14 ] investigation of semen analysis showed the consideration of male factor in assessment of infertility cases even if not meeting the couple which is supported in the guidelines for managing infertility.…”

“…The questionnaire was developed depending on the designed questionnaire by Hassa et al (2005) [ 14 ] and modified by the researcher according to the National Institute of Clinical Excellence NICE guideline - Fertility (2004) [ 15 ]. Modifications were applied to physicians′ opinions by substituting the first item (about rubella vaccination as it was not included in the Egyptian premarital examination program) by meeting the couple.…”