Finnish health centre physicians' participation in family planning.

Abstract

A liberal act on induced abortion came into force in Finland in 1970. Contraception and quick processing of matters concerning induced abortion were strongly stressed. In 1972, the Primary Health Care Act reinforced the role of family planning services in primary health care. The National Board of Health also gave guidelines for family planning at the beginning of 1970s. These guidelines emphasized that family planning is an essential part of health services (1). Both general practitioners and health care teams o¡er family planning services, e.g. in consultation, maternity health care, school and student health care and occupational health care. Some health centres have organized special family planning counselling units. Gynaecologists have been responsible for specialist consultations and induced abortions in secondary care. People have also opportunity to access gynaecological services in the private sector; such services are available mostly in cities. We have studied the extent to which Finnish GPs are actually involved in family planning issues. In 1996, a postal questionnaire was sent to randomly selected Finnish health centre doctors (n ì351). Their names and addresses were drawn from the ¢les of the Finnish Medical Association, which include every Finnish physician. Besides questions concerning practical family planning work, physicians were asked to evaluate statements concerning general practice and family planning on a visual analogue scale (VAS) (2). The response rate was 69%; 243 physicians returned the questionnaire. Of all respondents, 57% were females. The ages of respondents ranged between 27 ^ 63 years (mean 41 years). Working experience ranged from 1 ^ 35 years (mean 14 years). With respect to phase of career, 41%were non-specialists, 16% vocational trainees in general practice and 34% specialists in general practice. Three percent were vocational trainees in other specialities and 6% were quali¢ed in other specialities. For our purposes those two latter groups were unnecessary and so they were excluded, leaving 219 respondents whose data were used in this study. The statistical methods used were frequency distributions, variance analysis and cross-tabulations. The signi¢cance of di¡erence was tested using the t-test for independent samples assuming unequal variances, and the chi-square test. If the p-value was less than 0.05, it was considered statistically signi¢cant. The number of hours of family planning work among all respondents ranged from 0 ^ 40 per month, the median being two hours (Table I). The mean volume of family planning among non-specialist respondents was twice the volume of specialists in general practice. The proportion of gynaecological patients varied between 0 ^ 100% among all respondents (mean 10%). The mean proportion of gynaecological patients among female respondents was 15% and for male respondents it was 5%. Most female respondents (98%) had a gynaecological couch which they used in practise, the corresponding ¢gure among males being 93%. Of female and male physicians, 99% and 94%, respectively, had gynaecological instruments at their personal disposal. For these three questionnaire items, there were statistically signi¢cant di¡erences by gender, but not by age, working experience or phase of career. Respondents agreed with the statement ``Family planning should be an essential part of my work as a doctor'' (mean VAS valueì69). Female respondents agreed more strongly than males (mean VAS valuesì77 and 60, respectively; p ì0.001) with this statement. Respondents had similar opinions about the statement ``The general practitioner is competent to take care of family planning'' (mean VAS Scand J Soc Med, Vol. 26, No. 4