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PubMed2002

Comparison of orthodontic treatment outcomes in educational and private practice settings.

An accredited graduate orthodontic program provides advanced specialty education to meet standards of care mandated by the ADA, including both didactic and clinical components with defined outcome measures. To quantify these measures, the quality of care provided by graduate orthodontic students was compared to that of orthodontists in private practice. The quality of care was studied in two different delivery settings in the Columbus, Ohio, area-private practice orthodontists (PPO) and the OSU graduate orthodontic clinic (GOC). The Peer Assessment Rating (PAR) Occlusal Index was used as a measure of malocclusion severity and post-treatment occlusal outcome. Quality of care was measured using post-treatment PAR, percent PAR reduction, and treatment duration. At baseline, no differences were seen in the gender and pre-PAR scores of patients treated by the PPO and GOC, but statistically significant differences were seen in patients' pre-treatment age, race, and starting dentition. When the post-treatment occlusal results were compared, no statistically significant differences were seen in post-PAR scores and percent PAR reduction between the PPO and GOC. A statistically significant difference was seen in treatment duration (p = 0.002), which was longer in the PPO even after controlling for confounding factors such as pre-treatment age, gender, race, starting dentition, and treatment stages. Our conclusion is that there was no statistically significant difference in the occlusal outcome between the PPO and GOC, but there was a significant difference in the treatment duration.

Analysis of Variance↗
PubMed2002

Longitudinal periodontal treatment outcomes in private practice.

The majority of studies evaluating the efficacy of periodontal therapy have been conducted in university-based clinical trials under ideal and well-controlled conditions, where time (and cost) effectiveness was not an overriding factor. In Australia, where the larger proportion of dental treatment is provided by the private sector, there are no clinical studies which provide information on the efficacy of periodontal treatment in general or specialist private practice. The overall purpose of this study was to evaluate the efficacy of periodontal therapy in a specialist private practice over an initial period of 5.3 years in a group of 100 patients, and subsequently on the remaining 70 patients followed over a period 13.5 years. Hence the total observation period extended over nearly two decades. Using frequency distributions of site data, and statistical inferences based on the patient as the experimental unit, the results indicated an overall improvement and subsequent stability in clinical attachment in all categories of Initial Probing Depths, for both single- and multi-rooted teeth, for teeth treated with root planing alone and those that required adjunctive surgical intervention, and for younger and older patients. It was also noted that very few teeth were lost over the extended observation period. These positive results were achieved in a most favourable time in the initial phase of treatment (1.5-2.0 hours) as compared with the protracted time frame (5-8 hours) recorded in university-based clinical trials. Similarly, professional maintenance therapy took an average of around two appointments per year (1 hour) compared with an average of 3-4 hours per year in the university-based studies. The results therefore proved not only satisfactory from the standpoint of clinical parameters measured but also on the basis of time efficiency.

Adult↗
PubMed1999

Frequency of sepsis after local corticosteroid injection (an inquiry on 1160000 injections in rheumatological private practice in France).

OBJECTIVES: The principal aims of this study were to determine the frequency of sepsis after local corticosteroid injection (SALCSI), to compare the results with those of the literature and to determine the main factors leading to a decrease in the frequency of SALCSI. METHODS: A retrospective study was conducted among 69 rheumatologists in private practice. Sixteen items were studied and are reported. RESULTS: The mean number of years of private practice in rheumatology was 20.9. The total number of CS injections (CSI) was 1160000 for an average of 809 CSI per year and per therapist. The mean number of CSI performed by one rheumatologist was 16 800. Fifteen SALCSI had occurred, which corresponds to a frequency of 1/77300 CSI. The rate of SALCSI for the older rheumatologists was lower than that of their younger colleagues. The frequency of use of corticosteroid packaged in a sterile syringe (CSPSS) was approximately 85%. Nine out of the 15 cases of sepsis had occurred after the use of CS not packaged in a sterile syringe and six after the use of CSPSS. Thus, the frequency of SALCSI was 1/162000 after the use of CSPSS and 1/21000 after the use of CS not packaged in a sterile syringe. CONCLUSIONS: The mean frequency of SALCSI in Paris and the surrounding area was 1/77300 during the last 21 yr, a decrease since the 1960s and 1970s. This decreased incidence is in part due to the greater experience of the rheumatologist, but even more to the use of CSPSS.

Adrenal Cortex Hormones↗
PubMed1994

Selection of patients for management of attention deficit hyperactivity disorder in a private practice setting.

Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by age-inappropriate levels of motor activity, impulsivity, and inattention. A system of triage was developed to select an ADHD patient population which was manageable in a private practice setting. Seventy-four subjects with symptoms suggestive of ADHD were evaluated and diagnosed with ADHD and followed for 2 years. All subjects included in the study were shown a teaching videotape, received a full physical examination, and were counseled for approximately 1 hour. The diagnosis of ADHD was made based on the presence of eight of 14 criteria described in DSM-III, elevated Connors Rating Scale (CRS) scores, physical examination, observation, and historical information. A treatment plan involving behavioral therapy and medication was implemented with frequent follow-up. Ninety-six percent of the patients showed improvement in behavior (parental report and decreased CRS scores) and/or grades (one letter grade in two classes for 12 weeks). Fifteen percent of the treated subjects were suspected of having coexistent disorders and 4% did not respond to treatment. By implementing a simple triage system and protocol for diagnosis, treatment, and follow-up, a manageable patient population with ADHD and similar disorders was selected and successfully treated in a private practice setting.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

A five-year life-table analysis on wide neck ITI implants with prosthetic evaluation and radiographic analysis: results from a private practice.

This paper reports a 5-year life-table analysis on wide neck (WN) ITI implants placed in a private practice. In 212 patients, 263 implants were placed in the posterior region; 97% rehabilitated the molar area. Implants in the mandible and in the maxilla were 61.2% and 38.8%, respectively; the mean implant length was 9.7 and 8.9 mm, respectively. Eighty-nine percent sites had both vestibular and buccal bone lamellae > or =1 mm, 9.1% had one of them <1 mm and 1.9% had both lamellae <1 mm. Sinus perforation during surgery occurred in 52% of the maxillary implants. Prosthetic information was available for 249 implants; implants were involved in 157 single crowns (SC) and 80 fixed partial dentures (FPD). Radiographic analysis was performed on 102 implants that reached the 2-year control, and crestal bone loss (CBL) was measured. Results showed that five implants failed; the 5-year cumulative survival rate was 97.89%. The 1-year survival rate based on 259 implants was 98.8% and the 2-year survival rate based on 174 implants was 97.7%. In this 5-year timeframe, 94.3% of the SCs and 96.2% of the FPDs were free of complication. The mean CBL at the mesial and distal sides was 0.71 and 0.60 mm, respectively; bone losses >1 and >2 mm were recorded for 29.7% and 2.5% of the sides, respectively. This mid-term study showed that the WN ITI implants were highly predictable in private practice and that prosthetic complication in the molar area was an infrequent event.

Adult↗
PubMedDate not supplied

Establishing and administrating a private practice in a hospital setting.

This paper presents specific guidelines for establishing a private practice in an institution. Guidelines are discussed for structuring the practice, establishing the fee schedule, the billing procedures, proposals and contracts, general organization and administration, together with the expansion and termination of the practice for a client/institution.

Accounts Payable and Receivable↗
PubMed1988

Legal requirement of private practice medical records.

The hospital medical record is a critical communication vehicle for the numerous health professionals who provide care to each patient. It is also an essential evidentiary tool in malpractice suits. Even though the medical record is not the sole information upon which the courts will rely in determining negligence liability, it can serve as an important chronology of care. Dietitians entering private practice, whether with a physician or not, should establish a system of record keeping. Although specific standards have not been set for private patient records, it is argued that records kept must meet many of the requisite guidelines for medical records in institutional settings. Additionally, the records must provide documentation that may be absent and difficult to obtain in the private setting. Discussed are legal issues surrounding patient records of the dietitian in private practice.

Defensive Medicine↗
PubMed1991

[Private practice in Switzerland].

Switzerland has 6.7 million inhabitants and 700 practising surgeons, half of whom work in private hospitals. A description is given of the situation in private practices and hospitals including structural and financing problems. The author outlines his range of professional activities and give two examples of frequently performed operations. The relationship of personal trust between patient and doctor is an integral part of this system and is fundamental to the fulfillment of our Hippocratic oath. Belegarzt is defined as specialist/practitioner with hospital affiliation.

Humans↗
PubMed1996

Long-term periodontal maintenance in private practice.

Adult periodontitis is a chronic disease suffered by the mainstream of the world's population. To date, its treatment consists of providing support, control, and stabilization of the disease rather than a cure. Although treatment modalities rely upon a maintenance program to preserve a controlled environment that has been established, it is painstakingly evident that total patient compliance does not exceed 40% in private practice. In addition, there is little evidence that any society is populated by plaque-free patients. The important variables in private practice are the end point goals of treatment, manpower availability, patient behavior, the size of the treatment facility and the economic pressures of the geographic location. Each of these has to be considered in its entirety to appreciate the difficulties encountered in managing this significant issue in a periodontal practice.

Adult↗
PubMedDate not supplied

[Nurses in private practice in France].

In the French health care system, most nurses work in hospitals as salaried, but a number are also salaried in health centers or operate in their private offices. About 48,000 are private practitioners, they provide nearly all the ambulatory nursing care to the population. A survey undertaken in early 2004 shows that on the average, their weekly working time is 40 hours: 10 hours are devoted to injections, 9 to dressings, 17 to nursing care and 4 to other activities. Out of 10 nurses in private practice, 3 think that their workload is too heavy. Moreover, 19% declare that they are willing to leave private practice over the 3 coming years. If all the individual plans become reality, more that 9000 private nurses would disappear during the coming years from a workforce of 48,000:2900 would retire, 2700 would become salaried in hospitals, 3200 would take up an other job and 400 would become temporary workers in interim companies. Will the tasks they let be carried out by their remaining colleagues? No doubt that this will not be the case only 7% of the surveyed professionals declare that they are willing to increase their workload. As nurses shortage in French hospitals is evident nowadays, it seems that shortage in ambulatory care is unavoidable. The surveyed nurses point out 3 important difficulties they are encountering. One nurse out of 4 complain about the heavy administrative procedures i.e. the numerous and complex forms they have to fill out. One out of 6 complains about the lack of locum tenets. Furthermore, one out of 15 are in favour of suppressing the official "Nursing Care Approach" which was promoted recently, precisely to highlight the importance of their professional work.

Adult↗
PubMed1999

Relationship between age and presbyopic addition using a sample of 3,645 examinations from a single private practice.

BACKGROUND: This study uses information collected in a private optometric practice to describe the relationship between age and the add power needed to correct presbyopia. METHODS: Computer-assisted data analysis with a database management program, Q&A, and Microsoft Excel was used to assess the relationship between age and presbyopic addition. Data collected from 3,645 examinations by one practitioner in a single private practice--over a period of approximately 23 years--were entered into the database. The patient base was primarily white and about equally divided between the sexes. The practitioner generally used the fused cross cylinder for the tentative presbyopic addition and refined this by patient preference and best visual acuity at near, all using a carefully determined near working distance. RESULTS: The presbyopic addition increased rapidly in patients from ages 40 to 50 years, the rate at age 40 being about 0.22 diopters per year and the average rate during the 40- to 50-year-old decade being about 0.12 diopters per year, or approximately 0.25 diopters every 2 years. After the patient reaches 50 years of age, the presbyopic addition increased more slowly, at the rate of approximately 0.03 diopters per year--or approximately 0.25 diopters in 8 years. CONCLUSIONS: Quantitative data taken from more than 3,600 refractions showed a nearly parabolic relationship between age and presbyopic addition from approximately the age of 40 to 75 years.

Adult↗
PubMed1996

Establishing a laparoscopic antireflux program: a private practice experience.

Laparoscopic antireflux surgery is an exciting new option in the treatment of gastroesophageal reflux disease. Establishing a successful antireflux program depends on obtaining proper education as well as generating a suitable flow of patients. Being outside a university-based referral center presents the surgeon in private practice with a unique challenge as to how to meet these goals effectively. A personal account of education, training, and patient recruitment methods is presented. Different modalities for stimulating interest in both the medical and lay communities, including methods for direct patient contact, such as advertising are described. This is followed by a review of a series of 57 antireflux procedures performed during the first year of this program in a private practice in a retirement community setting.

Advertising↗
PubMed2000

Assessing immunization coverage in private practice.

To achieve national health objectives of eliminating most childhood vaccine-preventable diseases by the year 2010, all health care providers will have to improve the immunization rates of their patients. Currently, immunization rates of children 19 to 35 months of age are less than national objectives, suggesting a need for optimized immunization services. A key strategy for improving age-appropriate immunization coverage by health care providers is the assessment of immunization coverage. Because most (62%), immunization services in the United States are delivered in the private sector, a concerted effort in private practice is critical to improving immunization rates. Assessment of immunization coverage of patients enrolled in private practice serves 1) to measure the overall performance of the practice in providing the standard of care, 2) to identify strategies for improving coverage, and 3) to document the quality of health services delivered (report card). Assessment of immunization coverage has been demonstrated in several practice settings to be highly effective in improving immunization rates. All types of physicians should benefit from assessing immunization coverage of their patients. Simple assessment tools are available at no cost to the public and can be obtained by contacting the Centers for Disease Control and Prevention. These tools include a manual self-assessment or a computerized software package (CASA) to fit the needs of the practice.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

OBJECTIVE: In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. DESIGN: The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. RESULTS: Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. CONCLUSIONS: These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

Adult↗
PubMed1998

Late-life depression in private practice depressed outpatients: a 203-case study.

OBJECTIVE: To establish the prevalence of late-life depression in unipolar/bipolar depressed outpatients in private practice, to compare it with depression in younger patients and to compare its early/late-onset subtypes. METHODS: Two hundred and three consecutive unipolar/bipolar depressed outpatients presenting for treatment of depression were interviewed with the Comprehensive Assessment of Symptoms and History structured interview and depression severity was assessed with the Montgomery and Asberg Depression Rating Scale and the Global Assessment of Functioning Scale. RESULTS: Prevalence was 21%. Late-life depression had significantly more unipolar/fewer bipolar patients, higher age at onset, longer duration of illness and lower psychiatric comorbidity than depression in younger patients. Severity, psychosis, chronicity and recurrences were not significantly different. Early-onset late-life depression had significantly lower age at baseline, longer duration of illness and more recurrences than late-life depression. CONCLUSIONS: Findings support suggested age subdivisions of depression and provide a picture of private practice late-life depression.

Adult↗
PubMed2006

Incremental validity of the MMPI-2 Restructured Clinical (RC) scales in a private practice sample.

Building on results reported in Sellbom, Graham, and Schenk (2005), in this study, we examined the incremental validity of the newly introduced MMPI-2 (Butcher et al., 2001) Restructured Clinical (RC) scales (Tellegen et al., 2003) over both the Clinical and Content scales. Participants were 647 clients in private practice who were administered the MMPI-2 and the Multiaxial Diagnostic Inventory (Doverspike, 1990) early in therapy. The results indicate that the RC scales had acceptable internal consistency, reduced intercorrelations (compared to the Clinical scales), and promising convergent and discriminant validity. Hierarchical regression analyses revealed that the RC scales added incrementally to both the Clinical and Content scales in predicting self reported clinical symptoms. These findings suggest that the RC scales are relatively homogenous measures of core clinical constructs that can add unique information to the understanding of private practice clients above and beyond the Clinical and Content scales.

Adult↗
PubMed1980

A multivariate analysis of long-term stay in private practice psychotherapy.

Investigated the characteristics predictive of long-term stay in private practice psychotherapy in a population of 64 "long-term" clients (remained longer than 25 sessions, mean = 47 sessions) and 88 "short-term" clients (terminated before 25 sessions, mean = 7 sessions). Data consisted of T-scores on the intake MMPI and two variables (possession of insurance coverage and use of psychoactive medication) on which long and short-term clients had been found to differ in other research. Stepwise multiple regression analysis was performed and revealed that MMPI scales 2 and 0 added to the prediction of length of stay in psychotherapy (p < .01). Insurance and medication were significant predictors only when MMPI data were not used.

Humans↗