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Biomedical subjects

A Krasnik

Publications and source records attributed to A Krasnik.

At least 37 records · Page 2Linked to original sources
PubMed1993

Doctor and patient characteristics as modifiers of the effect of a changing remuneration system in general practice.

The objectives of the study was to investigate the effects on general practitioners' activities of a change in their remuneration system from a capitation-based system to a mixed fee-per-item and capitation-based system. It was our hypothesis that the effect of the change in remuneration varied between subgroups of doctors and patients as a result of the modifying effect of the doctors' age, sex, practice facilities, assistance, side jobs, and size of practice as well as patients' age, sex, and diagnostic group. The study was carried out as a follow-up with data collected from contact sheets completed by general practitioners in one period before a change in remuneration and two periods after. These data were supplemented by a questionnaire on doctors' characteristics as well as by health insurance data on population characteristics. The general increases in diagnostic and curative activities and reductions in referrals by general practitioners as a result of the change were found to be quite similar across subgroups of doctors and patients. While, total contact rates changed little, the sex of doctors showed a modifying effect: male doctors tended to increase their contact rates compared to female doctors. This tendency was most prominent among female patients with non-infectious diseases.

Age Factors↗
PubMed1992

Patients in the care of private psychiatric practitioners. Comparison with public hospital patients and the background districts' population.

In Western societies, the number of psychiatric hospital beds has decreased markedly in the past decades. The reduction in hospital beds has resulted in a relatively large number of mentally ill individuals residing in the community. They experience varying degrees of success. One form of treatment available to such patients is private psychiatric consultation. In Denmark and England (two countries with public supported health care systems) the number of psychiatrists in private practice (PPPs) has increased in recent years. These private practioners may offer a mode of treatment which may meet the needs of a subgroup of the psychiatric patients in the community. The fees of the PPPs are paid by the National Health Service. In this study we report on the characteristics of the patients attending the consultation of private psychiatrists and the treatment which they are offered. We compare the patients of the PPPs with 1. psychiatric patients residing in the same districts who are cared for by the public hospital system and 2. the background populations of these same districts. The results suggest that the patients in private psychiatric practice are distinct in a number of ways. Neurosis is the dominant diagnosis. Of the patients, 71% are women; the patients tend to be younger than the background districts population; after controlling for age, the marital status of the patients in PPPs' care does not differ significantly from that of the background population, and they are comparable to the background population in level of employment. These patients are more able to care for themselves than the psychiatric patients treated in the public hospital system. The results suggest that PPP is a means of caring for a subgroup of the psychiatric patients in urban settings.

Adult↗
PubMed1992

Sexual behaviour related to psycho-social factors in a population of Danish homosexual and bisexual men.

An anonymous self-administered questionnaire was distributed to (1) male members of the Danish Gay and Lesbian Association (2) through a gay magazine and (3) to readers of a gay pornographic magazine. For the purpose of this study sexual practices were classified into three categories taking into account the HIV-status of the respondent and his partner(s): safe sex (mutual masturbation, sex with condoms, sex without condoms between two HIV-positives), potentially safe sex (oral-genital sex without condoms irrespective of HIV-status, anal-genital sex without condoms between two HIV-negatives), unsafe sex (anal-genital sex without condoms between discordant partners or partners of unknown HIV status). Of the 2058 respondents 29.7% had had unsafe sex in the last 12 months. Multivariate analysis by recursive graphical models showed that sexual practice was directly related (that is conditionally dependent given the rest of the variables) to having a steady partner. Among men without a steady partner sexual practice was also directly related to age and number of partners showing an increase in unsafe sex with number of partners and a decrease with age. Thus of the men 16-19 years of age 43.5% had had unsafe sex irrespective of number of partners vs 5.7% of men older than 44 years and with one to two partners. Sexual practice was not directly related to any other demographic or psychosocial factor in the study. The adopted classification of sexual practice preclude that the high occurrence of unsafe sex could be explained by unsafe sex taking place among partners of concordant HIV status. The results emphasize the need for further preventive efforts to reduce transmission of HIV among homosexual men.

Adolescent↗
PubMed1991

General practitioners' attitudes to a recent change in their remuneration system.

The study examines the attitudes of general practitioners in Copenhagen to a recent change in their remuneration system from capitation to a mixed capitation and fee-for-service system. The study was based on two questionnaires, one before and one 18 months after the change, distributed to a primarily self-selected sample of 100 general practioners in Copenhagen City. The questionnaires provided information about certain basic characteristics of the respondents, attitudes to the new remuneration system as compared with the former, and possible changes in attitudes towards professional competence and responsibilities in secondary versus primary care. The majority of the respondents did not feel any changes under the new remuneration system in terms of diagnostic and curative possibilities and their relations to colleagues and patients. Attitudes to secondary versus primary care responsibilities also changed little. The majority felt that there had been an increase in their total work load, but also an improved economic situation in their practice. 21% felt that there was more competition with colleagues and 30% that doctor-patient relationships had suffered as a result of the introduction of a fee-for-service.

Adult↗
PubMed1990

[Information about safe sex for homosexual men--a consumer assessment of the efforts hitherto made in Denmark].

Self-administered anonymous questionnaires were included in the nationwide gay magazines "Pan" and "Cock" with the object of revealing the needs and possibilities of improved health educational effort in prevention of sexually transmitted HIV infection among homosexual and bisexual men. This was undertaken in March 1988 to illustrate the utilization and satisfaction of various sources of safe sex. The investigation reveals that campaigns about safe sex have been of great interest among the section of the target group which an investigation of this type could attract. In particular, the general efforts made by the Danish Health Board have attracted attention in a very broad section of men with homosexual contacts. Among those who employ the offers specifically made for the target gay group, considerable satisfaction is expressed. Compared with this, the employment of and satisfaction with medical help are considerably less. The significance of connections with a series of sociodemographic and subcultural subgroups are illustrated. Only where the gay-specific information is concerned was a significant association observed between receipt of information and the replier's reproduction of the given information about the risks involved in use of condoms. As regards the significance of single sources for sexual behaviour, a non-significant tendency was observed for persons who had received gay-specific written information to have a lower sex risk than those who had not received this information. It is recommended that the campaign hitherto initiated should be continued with intensification of AIDS prevention among the hidden homosexual men and men with sexual contacts with both sexes.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Changing remuneration systems: effects on activity in general practice.

OBJECTIVE: To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN: Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING: General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS: 265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES: Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS: Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105.3, 107.6 and curative services 106.0, 115.0) whereas referral rates to secondary care fell (specialist referrals 90.1 (80.7 to 100.6) and 77.0 (68.6 to 86.4) and hospital referrals 87.4 (71.1 to 107.5) and 68.4 (54.7 to 85.4] in doctors in the city. CONCLUSIONS: Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Capitation Fee↗
PubMed1990

Health workers and AIDS: knowledge, attitudes and experiences as determinants of anxiety.

The objective of the study was to measure the level of HIV/AIDS related anxiety among health care workers and identify its determinants. Data were obtained by means of a mailed, anonymous, self-administered questionnaire distributed to 2561 Danish medical doctors, nurses and nursing aides drawn randomly from the lists of members of the respective national associations. The data were analysed on the basis of a pre-study model including 12 variables hypothesizing a hierarchy of causal dependencies with anxiety at the top. 44% of the participants expressed HIV/AIDS related anxiety--hospital workers more than primary care workers, the older less than the younger. Anxiety was significantly associated with negative/restrictive attitudes towards HIV positives and gay men and with low levels of knowledge about HIV transmission and less education about HIV/AIDS. Negative/restrictive attitudes towards HIV positives were associated both with less knowledge regarding HIV transmission and fewer contacts with HIV positives. Similar associations were found regarding gay men. It is suggested that new kinds of training programmes be established which focus much more on attitudes and norms concerning HIV/AIDS--especially among health care workers with only occasional contact with HIV patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

AIDS and Danish adolescents--knowledge, attitudes, and behaviour relevant to the prevention of HIV-infection.

To evaluate the effect of previous AIDS education on AIDS knowledge and sex behaviour among Danish adolescents, a survey was carried out in April-May 1988 amongst 15-16 year-old school children of 9th grade elementary school. Through a cluster-sampling procedure, 45 school classes in nine geographical areas around the country were selected representing various degrees of urbanisation. A questionnaire was handed out and collected by the local school physician during a class session. The 728 pupils responding corresponded to a response rate of 89% of the pupils enlisted and 99% of the pupils present. The results demonstrate that AIDS education has been widely introduced in Danish schools and is well accepted. However, school health services have only rarely been involved. The educational activities seem to have a positive effect on knowledge about HIV-transmission and AIDS, attitudes towards the use of condoms and actual sexual behaviour, although risk-behaviour is still prevalent. The respondents express positive attitudes towards more AIDS education--especially among those with very little or no previous educational experiences.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Money or life].

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Decision Making↗