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


CONCLUSIONS
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.
Hassa
Hikmet
H
Medico-Social Center, Osmangazi University, 26480 Meselik-Eskisehir, Turkey. hikmeth@superonline.com
Ayranci
Unal
U
Unluoglu
Ilhami
I
Metintas
Selma
S
Unsal
Alaeddin
A
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D034121:Reproductive Health Services / Q000592:standards*; D011795:Surveys and Questionnaires; D014421:Turkey