J Sundby1, A Olsen, B Schei. 1. Department of epidemiology National Institute of Publich Health Oslo, Norway.
Abstract
AIM OF STUDY: In this study we assessed the quality of health care for infertile patients as expressed by the patients themselves. The implementation of the existing structured plan for infertility investigation and treatment was also reviewed. DESIGN AND DATA: The sample consisted of all 361 women registered with an infertility diagnosis during 1982 at Rikshospitalet. Their medical records were reviewed in 1988. The process and outcome of the investigation as it appeared was analyzed for each individual patient. A structured questionnaire was distributed to the patients in 1988 and 72.6% responded. The questions included several items on outcome and personal experience of the treatment in the hospital. RESULTS: Data from the medical records show that the medical investigation lasted three years on average. The records often showed evidence of discontinuity of the process. The mean number of consultations was eight (range 1-28). An average of one new doctor for each consultation was involved in the investigation. One third of the patients left the investigation without a noted definite termination of the treatment process. According to the questionnaire around 40% had delivered at least one child, while 30% had adopted. Of those who got a biological child, two thirds were satisfied with the clinical treatment efforts of the medical staff. Less than half of those who did not become pregnant were satisfied. Independent of outcome, 70% were dissatisfied with the emotional support during the investigations, and nearly 90% felt that waiting lists were too long. More than half expressed a need for professional psychological counselling. CONCLUSIONS: The study shows that medical records and service organizations do not meet the need for continuity in treatment nor research and evaluation requirements. We suggest that more emphasis should be devoted to planning of the services. They should be improved with regard to quality in medical handling as well as emotional counselling.
AIM OF STUDY: In this study we assessed the quality of health care for infertilepatients as expressed by the patients themselves. The implementation of the existing structured plan for infertility investigation and treatment was also reviewed. DESIGN AND DATA: The sample consisted of all 361 women registered with an infertility diagnosis during 1982 at Rikshospitalet. Their medical records were reviewed in 1988. The process and outcome of the investigation as it appeared was analyzed for each individual patient. A structured questionnaire was distributed to the patients in 1988 and 72.6% responded. The questions included several items on outcome and personal experience of the treatment in the hospital. RESULTS: Data from the medical records show that the medical investigation lasted three years on average. The records often showed evidence of discontinuity of the process. The mean number of consultations was eight (range 1-28). An average of one new doctor for each consultation was involved in the investigation. One third of the patients left the investigation without a noted definite termination of the treatment process. According to the questionnaire around 40% had delivered at least one child, while 30% had adopted. Of those who got a biological child, two thirds were satisfied with the clinical treatment efforts of the medical staff. Less than half of those who did not become pregnant were satisfied. Independent of outcome, 70% were dissatisfied with the emotional support during the investigations, and nearly 90% felt that waiting lists were too long. More than half expressed a need for professional psychological counselling. CONCLUSIONS: The study shows that medical records and service organizations do not meet the need for continuity in treatment nor research and evaluation requirements. We suggest that more emphasis should be devoted to planning of the services. They should be improved with regard to quality in medical handling as well as emotional counselling.