Communication and Respect for Patient Value as Significant Factors in Patient-Centered Infertility Care: A Survey of Patients' Experiences in Two Infertility Centers.

CONTEXT: The patient-centered infertility care (PCIC) approach emphasizes the patient's role in choosing the most appropriate clinical approach in infertility care. The concept can improve the patient satisfaction with care performed as well as the efficacy of the treatment. In addition, this concept can also lead to improve collaboration between patient and care provider, ultimately supporting a more cost-effective health-care scheme. AIMS: This study was developed in order to determine patients' experience in their PCIC. SETTINGS AND DESIGN: This is a descriptive study. We conducted the study in two fertility care clinics, Clinic A and Clinic B. SUBJECTS AND METHODS: The Patient-Centeredness Questionnaire-Infertility (PCQ-I) was used, consisting of 7 essential themes. The questionnaire was completed by consenting patients in two infertility clinics. STATISTICAL ANALYSIS USED: The questionnaire was analyzed using the Statistical Package for the Social Sciences 21 version statistical software. RESULTS: Eighty-eight Clinic A patients who completed the questionnaire responded that the best element of their treatment received was communication (correlation with global score [CGS]: 0.747), whereas the least acceptable aspect was the low accessibility (CGS: 0.211). A total of 20 Clinic B patients responded that the best element of their treatment received was respect for the patient's value (CGS: 0.866), whereas the least acceptable aspect was also the low level of accessibility (CGS: 0.193). CONCLUSIONS: The PCQ-I can be used to evaluate patients' experience during treatment and may help the health-care provider to improve their performance.

Reproductive knowledge and patient education needs among Indonesian women infertility patients attending three fertility clinics.

OBJECTIVE: This study investigated the reproductive knowledge and patient education needs of 212 female Indonesian infertility patients. METHODS: A cross-sectional survey was conducted from July to September 2011 by married women, 18 to 45 years old, seeking infertility care from clinics in Jakarta, Surabaya and Denpasar. Participants were literate, the sample was highly educated, predominantly urban and primarily middle class or elite. RESULTS: Infertility consultants were cited as the most useful source of information by 65% of respondents, 94% understood that infertility results from male and female factors, 84% could distinguish between infertility and sterility, and 70% could identify their fertility window. However, demand for further knowledge of reproduction and infertility was expressed by 87%. Patients' knowledge of the causes and treatment of infertility was extremely poor. Two key causes of infertility, advanced age and untreated sexually transmissible infections, were not named. Only 19% of patients had received written information. CONCLUSION: The study revealed the need for expanded infertility patient education among women patients accessing fertility care in Indonesian clinics. PRACTICE IMPLICATIONS: Opportunities for education should be maximized within infertility consultations. A standardized infertility patient education curriculum should be developed, incorporating patients' priorities, as well as gaps in existing knowledge.

Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients.

PURPOSE: To determine whether the measurement of serum AMH can be used to diagnose PCOS and as a tool to predict the prognosis of PCOS. METHODS: This is a case-control study. Women of reproductive age (18-35 years) were recruited consecutively at a tertiary academic hospital during the period of March 2009-October 2011 and were divided into case (PCOS patients defined by the Rotterdam criteria) and control groups (non-PCOS patients). Menstrual history, clinical manifestations of hyperandrogenism, ovarian ultrasound assessments, and the levels of AMH, LH, FSH, and estradiol were collected. RESULTS: Seventy-one cases and 71 controls were recruited. AMH serum levels were significantly higher in PCOS patients than in controls. The Area Under the Curve (AUC) of the serum AMH assay in PCOS patients reached a value of 0.870. With a cut-off value of 4.45 ng/ml, the serum AMH level had a sensitivity of 76.1 % and a specificity of 74.6 %. The most common phenotypes of PCOS in this study were anovulation and polycystic ovary (63.4 %). However, the mean level of AMH was highest in the phenotypes of anovulation, polycystic ovaries and hyperandrogenism (11.1 ng/ml). CONCLUSIONS: In Indonesian women, AMH can be used as an alternative diagnostic criteria for PCOS patients with a cut-off value of 4.45 ng/ml. AMH value rise when hyperandrogenism is present therefore serum AMH levels also reflect the phenotype of PCOS. However, these findings must be confirmed with larger clinical studies.

Review of patients admitted to a specialist inpatient parent-infant psychiatric service.

OBJECTIVE: The aim of this paper is to review the clinical, demographic and psychosocial characteristics of consecutive admissions to a specialist inpatient parent-infant psychiatric service during a 2-year period. METHODS: Data from consecutive admissions between January 2006 and December 2007 were evaluated in terms of primary and secondary diagnosis, demographics and psychosocial risk, psychiatric history, referral source, inpatient care and child protection involvement. RESULTS: The majority of admissions (n = 149) recorded during the audit period were for a major depressive disorder (n = 69; 46%), schizophrenia (n = 29; 19%) or postnatal psychosis (n = 19; 13%); the most common comorbidities were a physical health problem (35%), substance abuse (24%) or borderline personality disorder (15%). The average length-of-stay was 23.8 ± 15.5 days; the average baby's age at admission was 15.1 ± 11.6 weeks. There were no statistically significant differences between women with a history of a mood disorder and those with no such history, in any of the demographic or psychosocial variables evaluated. CONCLUSION: This paper provides a unique appraisal of those individuals actively seeking psychiatric assessment and treatment through a specialist perinatal psychiatric service. Such information is useful in promoting better understanding of this population and the complex treatment and management needs of this patient group.

Client evaluation of a specialist inpatient parent-infant psychiatric service.

OBJECTIVE: The aim of this paper was to collect feedback on a specialist parent-infant psychiatric service in terms of client satisfaction with inpatient treatment, and the impact on health outcomes of providing written information about available support options in the community following discharge. METHODS: Women (n = 37) from consecutive admissions between January 2006 and December 2007 were contacted by telephone and administered a service quality evaluation questionnaire. RESULTS: Women were happy with the quality of inpatient care provided but suggested areas of improvement included continuity of staff during the inpatient stay and better communication between inpatient and outpatient services post-discharge. At discharge, women were not confident with their ability in coping with motherhood but confidence with parenting skills increased post-discharge. Use of recommended post-discharge community support and/or health services was poor. CONCLUSION: As adherence with discharge recommendations was less than ideal, greater involvement of primary/community health care professionals, and active participation of clients and carers, in discharge planning is required. Increased emphasis on the practical skills of motherhood as well as opportunities to develop the mother-infant relationship may assist mothers in gaining confidence to interact with their baby and pick up infant cues.