Abstract

PIP: The use of paramedical personnel in family planning services within the structure of the 5-year Plan for Family Planning Services and Population Research Programs submitted to Congress by the Secretary of HEW in 1971 was explored. The Plan works within the existing health care system through the basic module of a 4-hr 8-times weekly clinic session. The paramedical family planning specialist can perform breast and pelvic examinations, counsel, perform specialized gynecological procedures, and recognize a normal physical examination. In a series of 6000 comparative physical examinations, the family planning specialist demonstrates an acceptable level of accuracy in the description of physical examination findings of the breast and pelvis. Over 3000 IUDs were inserted by family planning specialists with no major complications. In a series of 10,582 patients, 43.8% preferred the specialists, 55.6% had no preferrence, .6% preferred care by a physician. In a series of 11,373 patients, family planning specialists provided care to 80% of the patients without the need for the involvement of a physician. Registered nurses had a consultation rate of 11.4%, nonregistered nurses, 19.6%. An optional distribution of of patients per specialist per session is 3 new patients, 4 returning patients with examination, 2 returning without examination (total 3 hr 10 min for patient card during a 4-hr clinic). The optimal patient load and the expected proportion of return visits (63% will require examination, 37% will not) are similar. The various possibilities of the system with variation of physician time per clinic, number of nonregistered/registered nurses, and number of patients, or with supervision of nonregistered nurse family planning specialists by registered nurse specialists, with time required for care of patients by type of patient visit constant is explored.