population.
Despite evidence of the effectiveness this study might be shared by other minority
of cardiac rehabilitation programmes,
encouraging attendance at sessions by
individuals from such backgrounds (particularly
women) remains a problem. The objectives of
this study were to:
a) Explore the factors involved in engaging
women from South Asian communities in both
mainstream and specialist cardiac rehabilitation;
b) Describe potential barriers and facilitators for
this process;
c) Identify potential improvements to services
from participants’ perspectives.
Methods
This qualitative study utilised a combination of
semi-structured interviews and a focus group in
order to elicit users’ perceptions of existing
cardiac rehabilitation services. Participants were
Community Health Development Workers and
service users from the Westgate Heartbeat
project in Newcastle-upon-Tyne. All data were
analysed using a thematic approach.
Results
A number of barriers to participation in cardiac
rehabilitation programmes for South Asian
women were identified and these can be divided
into three main categories:
1. Individual barriers, including lack of
knowledge, experience and confidence
2. Cultural barriers, including language, diet and
family commitments.
3. Practical barriers, including timing, location
and transport.
However, several facilitators to participation
were also identified and these centred on whether
the format and content of the rehabilitation
sessions were considered to be ‘appropriate’. For
example, an Asian Women’s Dance Group
proved to be highly successful through the
selection of a familiar venue in the local
community, an enthusiastic session leader of a
similar age to the participants, and an activity
that was felt to be both enjoyable and pitched at
the right level for heart patients to receive
recognisable health benefits.
Conclusions
This study has identified the potential for
engaging women from a difficult-to-reach
minority group in physical activity and cardiac
rehabilitation. Even a relatively short series of
sessions can have tangible benefits in terms of
physical and psychological health, as well as
providing added-value in the form of an
opportunity for the women to socialise with one
another. Further research should be carried out to
determine whether the facilitators identified in
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groups in other areas, and whether the lessons
learned could be successfully incorporated into
mainstream health services.
P01
The initial management of infertility
in general practice: a focus group
study
Scott Wilkes
Centre for Primary and Community Care, School
of Health Natural and Social Sciences, Benedict
Building, St George's Way, Sunderland
University, SR2 7BW
Coauthors: N Hall, A Crosland, A
Murdoch, G Rubin
Keywords: access, female health care
Introduction
Assisted reproduction has advanced rapidly over
that last 2 decades. Historically, primary care has
been a mediator for referral of the infertile
couple. In recent years RCOG guidelines place
an emphasis on the role of primary care for the
initial management of the infertile couple. In
April 2004, NICE further refined the guidance
for the initial management of the infertile couple.
This includes semen analysis, mid-luteal
progesterone, FSH and hysterosalpingography
(HSG) to assess the main causes of infertility.
Seven of the GP’s in this study had access to
open access HSG.
Methods
Design
Qualitative study using three focus groups
Participants
11 General practitioners, 1 GP registrar, 1 Nurse
Practitioner
Setting
Seven general practices in Newcastle upon Tyne
and Northumberland.
Results
The key themes to emerge were; perceived
professional responsibilities, uncertainty and
lack of knowledge, consistency of approach to
the initial management of infertility and access to
infertility services. Enthusiasm, experience,
motivation and up to date knowledge were key
influences on these themes. Some GPs felt that
they should do all they possibly could do whilst
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. Some GPs
subscribed to the notion of one suitably trained
and competent clinician delivering the service on
behalf of a group of GPs. There was an
acknowledgement that there is variation in
clinical practice both in primary and secondary
care. GPs considered that they had a
responsibility to act as the couples’ advocate.
They were unsure where HSG fitted into the
overall management plan, but they were
comfortable with following recommended
guidelines.
Conclusions
In managing the infertile couple, GPs recognise
an advocacy role and some take on a significant
degree of clinical responsibility. Nevertheless,
GPs feel that they lack proficiency, find it
difficult to keep up to date and have little
opportunity to rehearse the necessary skills.
These findings also contribute to an
understanding of the management of infrequently
presenting problems in primary care.
P02
Investigation of infertility
management in primary care with
open access hysterosalpingography
(HSG): a pilot study
Scott Wilkes
Centre for Primary and Community Care, School
of Health Natural and Social Sciences, Benedict
Building, St George’s Way, University of
Sunderland, SR2 7BW
Coauthors: A Murdoch, G Rubin, D
Chinn, J Wilsdon
Keyword: access
Introduction
Infertility affects approximately one in seven
couples in the United Kingdom. The National
Institute for Clinical Excellence (NICE) issued
guidance on the management of the infertile
couple in February 2004, which includes the
statement ‘for the assessment of tubal damage,
women not known to have co-morbidities (pelvic
inflammatory disease, endometriosis or previous
ectopic pregnancy) should be offered
hysterosalpingography (HSG)’. Our aim was to
evaluate open access HSG as an open access
primary care investigation.
87
Methods
Setting: We made HSG available to 6 general
practices in Newcastle upon Tyne as an open
access investigation.
Participants: Using hospital clinical records we
tracked the outcome of all infertile couples from
the 6 pilot practices over a 9-month period.
Design: Descriptive survey.
Outcomes: Our main outcome measures were,
the uptake of open access HSG, speed of access
to specialist services and the quality of the
information recorded in the referral letter.
Results
Of the 39 referrals identified, ten women were
eligible for open access HSG, of which 6 HSGs
were organised by GPs. Open access HSG was
used in 15% of all infertile couples and 60% of
those who fitted the criteria for its use. Couples
who had open access HSG reached a diagnosis
and management plan four weeks earlier than
those who were referred directly (mean
difference 4.0 weeks, 95% confidence interval
(CI) –8.8 to 0.4 weeks). The information
recorded in the referral letter was generally poor.
However, all referrals made via the open access
HSG service had the prerequisite tests done.
Conclusions
Open access HSG allowed prompter access to
specialist services with more complete
information passed on in the referral letter. It
enabled a management plan to be established at
the first specialist consultation, which in turn
gave prompter access to definitive assisted
reproduction. ‘Near-patient testing’ in primary
care such as open access HSG, may reduce the
overall patient journey (from GP referral to
specialist treatment) described in the NHS
Improvement Plan to less than 18 weeks. Open
access HSG together with semen analysis and
endocrine blood tests may allow GPs to make a
diagnosis and manage the initial stages of the
infertile couple.