Fernandez Renae C, Moore Vivienne, Boyle Jacqueline, Rumbold Alice R, Davies Michael, Mazza Danielle, Grzeskowiak Luke E
Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Open. 2025 Feb 2;15(2):e085149. doi: 10.1136/bmjopen-2024-085149.
To examine longitudinal trends in infertility management in women attending general practice.
Cohort study using the national general practice dataset, MedicineInsight.
Australian general practice.
Not applicable.
The cohort included 2 552 339 women aged 18-49 years with one or more general practice clinical encounters between January 2011 and December 2021.
The primary outcome assessed was the proportion of women who had a clinical encounter related to infertility, stratified by year and age group. Second, the proportions of women receiving relevant clinical management actions, including selected pathology tests, imaging ordered and selected medications, were calculated. Univariable logistic regression analyses compared the likelihood of women having a documented clinical encounter related to infertility and receiving selected management actions based on individual characteristics. We also examined practice-level variation in the proportion receiving selected management for infertility by stratifying proportions based on practice site.
A total of 2 552 339 women had one or more clinical encounters with their general practitioner (GP) between January 2011 and December 2021, of which 27 671 (1.1%) had a clinical encounter related to infertility management. The rate of infertility encounters increased from 3.4 per 1000 in 2011 to 5.7 per 1000 in 2021. Over episodes of care, half (50.9%) of women presenting for an infertility encounter had at least one specified pathology test, and almost a quarter (23.1%) had a specified imaging test. A relatively small proportion of infertility encounters (5.4%) resulted in prescribing of a selected infertility medication by the GP.Large variation in clinical management (pathology, imaging and medication prescribing) was evident according to both individual characteristics and also at the clinical-practice level. Factors associated with increased likelihood of being provided infertility medications included younger age, holding a Commonwealth concession card (indicating low income), lower socioeconomic status and living outside a major city.
Clinical encounters related to infertility are increasing in primary care, with large variation evident in corresponding clinical management. These findings support the development of clinical practice guidelines to enhance standardised and equitable approaches towards the management of infertility in primary care.
研究在普通全科医疗就诊的女性不孕管理的纵向趋势。
使用全国普通全科医疗数据集MedicineInsight进行队列研究。
澳大利亚普通全科医疗。
不适用。
该队列包括2552339名年龄在18至49岁之间的女性，她们在2011年1月至2021年12月期间有一次或多次普通全科医疗临床诊疗记录。
评估的主要结局是与不孕相关临床诊疗记录的女性比例，按年份和年龄组分层。其次，计算接受相关临床管理措施的女性比例，包括选定的病理检查、影像学检查和选定药物。单变量逻辑回归分析比较了女性有不孕相关临床诊疗记录以及根据个体特征接受选定管理措施的可能性。我们还通过根据医疗机构地点对比例进行分层，研究了在接受不孕选定管理措施比例方面的医疗机构层面差异。
在2011年1月至2021年12月期间，共有2552339名女性与她们的全科医生（GP）有一次或多次临床诊疗记录，其中27671名（1.1%）有与不孕管理相关的临床诊疗记录。不孕诊疗记录的发生率从2011年的每1000人3.4例增加到2021年的每1000人5.7例。在整个诊疗过程中，因不孕就诊的女性中有一半（50.9%）至少进行了一项特定的病理检查，近四分之一（23.1%）进行了特定的影像学检查。相对较小比例的不孕诊疗记录（5.4%）导致全科医生开具了选定的不孕药物。根据个体特征以及临床实践层面，临床管理（病理检查、影像学检查和药物处方）存在明显差异。与开具不孕药物可能性增加相关的因素包括年龄较小、持有联邦优惠卡（表明低收入）、社会经济地位较低以及居住在大城市以外。
基层医疗中与不孕相关的临床诊疗记录正在增加，相应的临床管理存在明显差异。这些发现支持制定临床实践指南，以加强基层医疗中不孕管理的标准化和公平方法。
