conformity of physicians' performance with the national guidelines of the Egyptian family planning program

ABSTRACT

Data on adequacy of physicians' performance at family planning clinics in Alexandria is contained in this report. An observational check list was used for monitoring the daily performance of 35 physicians working in the 12 family planning clinics of Alexandria. Clients were intrauterine device users in their initial visits to the clinics. The whole care process was divided into five areas covering interpersonal communication and technical aspects. The percentage score [physicians' performance index] was calculated for total, area and sub-areas of care. The collective performance index combines indices of physicians in both types of facilities together. Fifty percent value of physician performance index was taken as the cut-off point between lower unacceptable performance and higher acceptable one. The collective total performance index was unacceptable [49.37 +/- 8.24] denoting considerable deviation from standards of adequate care. Areas of care related to examination and history taking tasks had the most deficient collective physician performance index [6.72 +/- 6.64 and 25.56 +/- 13.03 respectively]. Negligence of these two areas skips the two basic rationales for right choice of the contraceptive method. The collective performance index for communication was just above the acceptable value [51.20 +/- 13.37]. The two areas with highest performance index were infection control and intrauterine device insertion [63.36 +/- 10.79 and 65.66 +/- 12.08 respectively]. This is an indication of the technical orientation of physicians leaving the total program concepts like informed decision and continuation inadequately implemented. Performance index of physicians in specialized clinics was repeatedly found to be significantly higher than those of integrated clinics in all areas of care. In area of communication, the performance index in specialized clinics was acceptable in contrast to that in integrated ones. However, the performance index in the two types of clinics were found together in either the acceptable or the unacceptable range in all other areas. This may reflect the existence of a dominant atmosphere that enhances or weakens the performance in different areas of care and the priority of importance given to these areas