Wilkes Scott, Hall Nicola, Crosland Ann, Murdoch Alison, Rubin Greg
Centre for Primary and Community Care, School of Health Natural and Social Sciences, University of Sunderland, Sunderland, UK.
J Eval Clin Pract. 2007 Jun;13(3):358-63. doi: 10.1111/j.1365-2753.2006.00705.x.
Infertility management in primary care is variable. National Institute of Clinical Excellence have recommended hysterosalpingography (HSG) as a first-line investigation for tubal assessment. Aim To explore general practitioners' (GPs) perceptions of, and attitudes to, the initial management of the infertile couple and their views on open access to HSG.
Qualitative study using three focus groups.
Seven general practices in Newcastle upon Tyne and Northumberland.
We purposively selected the three focus groups to provide a range of GPs' views. In total 13 practitioners participated: 11 GPs, one GP registrar and one nurse practitioner.
The key themes to emerge were: (1) perceived professional responsibilities, (2) uncertainty and lack of knowledge, (3) consistency of approach to the initial management of infertility, and (4) access to infertility services. Some GPs felt that they should do all they possibly could, while others felt it was the responsibility of the infertility specialist. Uncertainty and lack of knowledge was linked to the relative infrequency of primary care infertility consultations and the difficulty 'keeping up to date' with rapidly advancing reproductive technologies in tertiary care. Some GPs subscribed to the notion of one suitably trained clinician delivering the service on behalf of a group of GPs. Some were unsure where HSG fitted into the overall management plan, but they were comfortable with following recommended guidelines.
GPs recognize an advocacy role and many take on a significant degree of clinical responsibility welcoming the introduction of a new technology in primary care. Nevertheless, GPs feel that they lack proficiency and have little opportunity to rehearse the necessary skills. These findings contribute to an understanding of the management of infertility, an infrequently presenting problem in primary care.
基层医疗中不孕不育的管理方式各不相同。英国国家临床优化研究所推荐子宫输卵管造影术（HSG）作为输卵管评估的一线检查方法。目的：探讨全科医生（GPs）对不孕不育夫妇初始管理的看法和态度，以及他们对HSG开放获取的观点。
采用三个焦点小组的定性研究。
泰恩河畔纽卡斯尔和诺森伯兰的七家全科诊所。
我们有目的地选择了三个焦点小组，以提供一系列全科医生的观点。共有13名从业者参与：11名全科医生、1名全科医生注册员和1名执业护士。
出现的关键主题有：（1）感知到的职业责任，（2）不确定性和知识欠缺，（3）不孕不育初始管理方法的一致性，以及（4）获得不孕不育服务的机会。一些全科医生认为他们应该尽其所能，而另一些人则认为这是不孕不育专科医生的责任。不确定性和知识欠缺与基层医疗中不孕不育咨询的相对较少频率以及在三级医疗中跟上快速发展的生殖技术的难度有关。一些全科医生赞同由一名经过适当培训的临床医生代表一组全科医生提供服务的理念。一些人不确定HSG在整体管理计划中的位置，但他们乐于遵循推荐的指南。
全科医生认识到倡导作用，许多人承担了很大程度的临床责任，并欢迎在基层医疗中引入新技术。然而，全科医生觉得他们缺乏熟练度，几乎没有机会演练必要的技能。这些发现有助于理解不孕不育的管理，这是基层医疗中不常出现的问题。
