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At least 217 records · Page 12Linked to original sources
PubMed2006

Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial.

INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described. METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis. RESULTS: Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year. Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A. CONCLUSION: The private sector plays a major health-care role in Pakistan. Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building. Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings.

Adolescent↗
PubMed1992

Occupational therapists in private practice.

Although increasing numbers of occupational therapists are choosing to work in private practice, little data exist describing this sector of the profession. In the present study, experienced occupational therapists were asked about their moves into private practice, including (a) their motivation, (b) their preparation, and (c) their perceptions of the move's risks and benefits before and after the move. A survey was sent to a national random sample of 105 occupational therapists, 74 of whom responded. According to the survey, autonomy was the most important motivating factor for occupational therapists moving into private practice. However, once they were in private practice, the occupational therapists noted that increased income was a major benefit. These occupational therapists had planned for the risks of reimbursement, referral sources, and overhead but had not anticipated problems with staffing shortages. Incomes increased for occupational therapists who moved into private practice. The survey compared the incomes of occupational therapists before and after they entered private practice. It also compared their income and educational levels. Other comparisons included income and work experience, income and work role, and income and geographic location. Autonomy and financial considerations appear to be the overriding issues for occupational therapists choosing careers in private practice. Almost unanimously, the survey respondents said that private practice was a good career choice.

Adult↗
PubMedDate not supplied

[Privatization of the Croatian health care system: effect on indicators of health care accessibility in general medicine].

The aim of the privatization of the primary health care is to reduce cost and improve the quality of service by introducing the market-based system. In the Republic of Croatia, the privatization of the primary health care started in 1995. It was based on renting the existing facilities at a moderate price to the practitioner. After that, the practitioner registers the private practice and signs a contract with the obligatory health insurance institution. The aim of this article is to present a part of the project of long-term research of privatization related to the health care accessibility in general practices. The research sample consisted of three groups: privatized general practices, to-be-privatized general practices and non-privatized general practices during 1997 and 1999. Privatized general practices have exhibited a significant improvement in the number of registered patients, the scheduling of first visit appointments during working hours, the possibilities of scheduling follow-up visit appointments during working hours, scheduling visits by telephone, obtaining telephone advice after working hours and visiting the practitioner after working hours. This kind of research is vital in order to bring about the necessary changes in the existing system by scientifically approved methods.

Appointments and Schedules↗
PubMed2003

A comparison of private and public dental students' perceptions of extramural programming.

This project was undertaken to compare the opinions of private and public dental school students' perceptions concerning extramural programming, which is defined as any aspect of the curriculum in which undergraduate dental students provide dental care outside the main dental facility. A survey instrument was used to collect data from undergraduate students at a private (N = 267; 88.4 percent response rate) and at a public (N = 213; 67.2 percent response rate) dental school. When asked to rate the value of various extramural sites in making them a better dentist, both groups rated private dental offices the most valuable and prisons the least valuable. When questioned about the amount of time students should spend each year in extramural programming, private students, overall, desired 34 percent more time than did public students. When asked what percentage of the total time spent in extramural programming students should spend providing various categories of dental care, public school students thought 26 percent more time should be spent rendering preventive services/health education than did the private students. The private students indicated a stronger desire (13 percent more) for rendering clinical services than did public students. Both private and public students were most likely to enter group private practice after graduation. The increasing interest in community-based programs makes the information gained from this study useful for future curriculum planning.

Community Dentistry↗
PubMed1992

The rise of private practice: a growing disquiet with public services?

A survey of 325 national patients attending six private clinics in Port Moresby was carried out to determine the characteristics of those using private medical services. Most patients were employed in professional or clerical occupations. A sizeable proportion of private patients were from low and moderate income categories and over 40% of those interviewed said that they had to borrow the money to pay for the consultation. Education level was positively associated with both attending a private practitioner as first choice of treatment and enrollment in a medical insurance scheme. 15% of patients were medically insured, and they were more likely to choose a private practitioner as first treatment choice. The most common reason given for choosing private sector health care was that it was quicker, but a notable proportion, particularly amongst those who had previously attended government health services for the same complaint, thought that private clinics had better doctors or gave better medicine. The findings are discussed and contrasted with those from other developing countries. Conclusions are drawn regarding the significance of these findings both in relation to the upgrading of the public health services and the regulation and monitoring of private health services.

Adolescent↗
PubMed2004

Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations.

Child↗
PubMed2004

Clinical education in private practice: an interdisciplinary project.

Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

Attitude of Health Personnel↗
PubMed2004

A comparison of prescribing practices between public and private sector physicians in Uganda.

INTRODUCTION: Previous studies in the public sector in Uganda have demonstrated major prescribing problems due to polypharmacy and irrational use of antibiotics and injections. Little is known about prescribing in the private sector although there is little government regulation influencing practice in this sector. The introduction of policies such as the Uganda National Standard Treatment Guidelines (UNSTG) was expected to improve prescribing practices in the public and private sectors. This paper measures appropriateness of prescribing practices in the public and private sectors in Uganda for the treatment of Acute Respiratory Infections (ARI) and malaria in adult patients. DESIGN AND SAMPLING: We combined a prospective survey of treatment for simulated patients presenting with symptoms of malaria and ARI in 119 randomly selected private clinics and a retrospective survey of 600 prescription records for malaria and ARI (300 for each condition) randomly selected from 10 public health units in the Kampala, Masaka, and Jinja urban areas. OUTCOME MEASURES: Percentage of drug appropriately prescribed in each condition, % injection prescription, percentage antibiotic prescription, average number of drugs per case, average standardized cost per prescription, distribution of types of drugs prescribed. RESULTS: The overall appropriateness of prescribing for ARI and malaria was poor in both public and private sectors. Treatment of malaria was significantly less appropriate in the public sector compared to the private sector (14% vs. 27%, p = 0.002), with injectable chloroquine much more commonly prescribed. Prescribing of antibiotics for ARI was nearly universal in both sectors, with some prescriptions containing up to three antibiotics; newer, more expensive antibiotics were more commonly prescribed in the private sector. Polypharmacy and unnecessary prescribing of vitamins were common in both conditions and both sectors. CONCLUSIONS: Prescribing for adult malaria and ARI by both private and public practitioners did not conform to the UNSTGs. Although practitioners were largely the same in both sectors, prescribing practices often differed dramatically. The extent of inappropriate prescribing in both sectors calls for in-depth investigation of the system factors and motivations that underlie problem practices, and the development of interventions that target these causative factors.

Acute Disease↗
PubMedDate not supplied

Urban private practitioners: potential partners in the care of patients with HIV/AIDS.

BACKGROUND: The private medical sector is an important source of healthcare in India. Increasingly, concerns have been raised about its role in the care of patients with HIV/AIDS. Evidence about private practitioners' existing management practices will help to create policies addressing this sector. METHODS: A central urban area of Pune city was selected for its high density of healthcare facilities. Private practitioners in the area were interviewed using a structured interview schedule. Based on a 1-year recall period, the schedule covered different aspects of the practitioners' HIV/AIDS management practices including diagnosis, treatment and referral. RESULTS: Of the 215 practitioners interviewed, 66% had tested and diagnosed HIV infection. Fifty-four per cent had been consulted by HIV-infected clients 'shopping' for alternative diagnoses or treatment. Overall, 75% of the respondents had been consulted by HIV-infected clients for treatment. Of these, 14% had prescribed antiretroviral drugs, sometimes without adequate knowledge of the guidelines for their use. Other supportive and symptomatic treatments were also frequently prescribed. Private practitioners commonly referred HIV-infected clients for management to other private doctors, or to public hospitals. There were variations in respondents' practices by sex and system of medicine. CONCLUSION: Private practitioners are actively involved in diagnosing and managing patients with HIV/AIDS. Some of their management practices are inappropriate and need to be remedied. There are also concerns about gaps in the continuity of care of HIV-infected persons, for which networks between providers need to be strengthened. Public-private partnerships must be created to improve the flow of information to private practitioners, and Include them in the national health framework.

Anti-HIV Agents↗
PubMed2005

[Consultations with specialists in private practice in a Norwegian district].

BACKGROUND: After the Norwegian hospital reform of 2002, there has been increased acceptance of private-sector health-care providers. Still, the use of specialist services in private practice is less well documented. This article explores the use of private specialist health care in the south-east of Norway. MATERIAL AND METHODS: The article is based on several sources of data, including data from the Norwegian Patient Register and from the National Insurance Administration on reimbursements. Also a survey was sent out to a sample of general practitioner; in-depth interviews were carried out with a sample of hospital physicians and private specialists. RESULTS: The article shows that private specialists with contract with Helse Øst provided 151 consultations per 1000 inhabitants over the period September to November 2003, while the public outpatient clinics provided 186 consultations. The service provision varies geographically and between specialties. In one county the use of private specialists is 174 consultations per 1000 inhabitants; in another it is 80 per 1000 inhabitants. Private-sector specialists within the fields of eye, ear-nose-throat and skin provided two thirds of all outpatient services in their respective fields. INTERPRETATION: The results indicate that the services of specialists in private practice should be more focused on and discussed in relation to integrated healthcare and the relationship between specialised hospital services and primary healthcare.

Ambulatory Care↗
PubMed1998

[The unequal clinical profile, quality of life and hospital mortality in patients undergoing aortocoronary bypass in the public and private centers of Catalonia. The CIRCORCA Study].

INTRODUCTION AND AIMS: The influence of the type of health care funding and management of hospital centres on hospital mortality in coronary artery bypass surgery (CABG) has not been analyzed in detail. We therefore assessed clinical and quality of life preoperative profiles and in-hospital mortality in public and private patients undergoing coronary bypass surgery in Catalonia. METHODS: Clinical questionnaires, Duke Activity Status Index (DASI) and SF-36 were preoperatively administered to all patients undergoing first coronary bypass surgery without associated procedures in Catalonia between November 1996-June 1997. In-hospital morbidity and mortality were recorded. RESULTS: Predictors of in-hospital death, including DASI, SF-36 and comorbidity scores, were significantly worse in public than in private patients. In-hospital mortality rate was more than ten times greater in public than in private patients (8.2% vs 0.7%; p < 0.001). Multivariate analysis identified private funding of health care, among others, as an independent predictor of in-hospital survival. Non evidence-based indications for surgery were significantly more common in private than in public patients (6% vs 0.7%, p < 0.001). CONCLUSIONS: a) In catalonia, the risk profile of public patients undergoing coronary bypass surgery was significantly higher than that of private patients, accounting, at least in part, for a remarkable mortality difference; b) non evidence-based indications for surgery were more common in private than in public patients; c) these unequal patterns raise questions about the adequacy of care and referral patterns in both private and public sectors.

Aged↗
PubMed1996

Regulating the private health care sector: the case of the Indian Consumer Protection Act.

Private medical provision is an important constituent of health care delivery services in India. The quality of care provided by this sector is a critical issue. Professional organizations such as the Medical Council of India and local medical associations have remained ineffective in influencing the behaviour of private providers. The recent decision to bring private medical practice under the Consumer Protection Act (COPRA) 1986 is considered an important step towards regulating the private medical sector. This study surveyed the views of private providers on this legislation. They believe the COPRA will be effective in minimizing malpractice and negligent behaviour, but it does have adverse consequences such as an increase in fees charged by doctors, an increase in the prescription of medicines and diagnostics, an adverse impact on emergency care, etc. The medical associations have also argued that the introduction of COPRA is a step towards expensive, daunting and needless litigation. A number of other concerns have been raised by consumer forums which focus on the lack of standards for private practice, the uncertainty and risks of medicines, the effectiveness of the judiciary system, and the responsibility of proving negligence. How relevant are these concerns? Is the enactment of COPRA really appropriate to the medical sector? The paper argues that while this development is a welcome step, we need to comprehensively look into the various quality concerns. The effective implementation of COPRA presumes certain conditions, the most important being the availability of standards. Besides this, greater involvement of professional organizations is needed to ensure appropriate quality in private practice, since health and medical cases are very different from other goods and services. The paper discusses the results of a mailed survey and interview responses of 130 providers from the city of Ahmedabad, India. The questionnaire study was designed to assess the opinion of providers on various implications of the COPRA. We also analyze the data on cases filed with the Consumer Disputes and Redressal Commission in Gujarat since 1991. Four selected cases filed with the National Commission on Consumers Redressal are discussed in detail to illustrate various issues affecting the implementation of this Act.

Consumer Advocacy↗
PubMed2003

Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health.

The purpose of this study was to examine the association of public and private domains of religiosity and adolescent health-related outcomes using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of American adolescents in grades 7-12. The public religiosity variable combines two items measuring frequency of attendance at religious services and frequency of participation in religious youth group activities. The private religiosity variable combines two items measuring frequency of prayer and importance of religion. Our results support previous evidence that religiosity is protective for a number of adolescent health-related outcomes. In general, both public and private religiosity was protective against cigarettes, alcohol, and marijuana use. On closer examination it appeared that private religiosity was more protective against experimental substance use, while public religiosity had a larger association with regular use, and in particular with regular cigarette use. Both public and private religiosity was associated with a lower probability of having ever had sexual intercourse. Only public religiosity had a significant effect on effective birth control at first sexual intercourse and, for females, for having ever been pregnant. However, neither dimension of religiosity was associated with birth control use at first or most recent sex. Public religiosity was associated with lower emotional distress while private religiosity was not. Only private religiosity was significantly associated with a lower probability of having had suicidal thoughts or having attempted suicide. Both public and private religiosity was associated with a lower probability of having engaged in violence in the last year. Our results suggest that further work is warranted to explore the causal mechanisms by which religiosity is protective for adolescents. Needed is both theoretical work that identifies mechanisms that could explain the different patterns of empirical results and surveys that collect data specific to the hypothesized mechanisms.

Adolescent↗
PubMed2001

Effects of gasoline formulation on methyl tert-butyl ether (MTBE) contamination in private wells near gasoline stations.

UNLABELLED: The extent of methyl tert-butyl ether (MTBE) contamination in private wells near gasoline stations, which lack the relative protection afforded many public waters supplies through zoning and routine testing, was examined. Samples were collected from 74 private wells near 21 randomly selected gasoline stations and from 21 control wells, one per facility. Two hypotheses are tested: (1) private wells downgradient and close (<0.5 mi) to gasoline stations (case wells) are more likely to have MTBE contamination than private wells upgradient and distant (>1.5 mi) (control wells); and (2) private wells near gasoline stations selling oxygenated gasoline are more likely to have MTBE contamination than private wells near gasoline stations selling conventional gasoline. Data on the concurrence of MTBE and other gasoline constituents are presented. RESULTS: MTBE concentrations ranged from <1.0 micro/L (microg/L) to 61 microg/L, with a mean of 12.0 microg/L. MTBE contamination of > or =1 microg/L was detected more frequently in case wells (28%) than control wells (5%) (p = 0.015). MTBE contamination of > or =1 microg/L occurred more frequently in private wells near facilities selling oxygenated gasoline (38%) than private wells near facilities selling conventional gasoline (20%) (p = 0.11). Statistical significance may have been achieved with a larger sample size. Benzene (0.5 microg/L) was found concurrently with MTBE in only one well, which also had the highest concentration of MTBE.

Benzene↗
PubMed2003

Private speech in preschool children: developmental stability and change, across-task consistency, and relations with classroom behaviour.

This study examined (a) developmental stability and change in children's private speech during the preschool years, (b) across-task consistency in children's self-speech, and (c) across-setting relations between children's private speech in the laboratory and their behaviour at home and in the preschool classroom. A group of 32 normally developing three- and four-year-old children was observed twice (six month interobservation interval) while engaging in the same individual problem-solving tasks. Measures of private speech were collected from transcribed videotapes. Naturalistic observations of children's behaviour in the preschool classroom were conducted, and teachers and parents reported on children's behaviour at home and school. Individual differences in preschool children's private speech use were generally stable across tasks and time and related to children's observed and reported behaviour at school and home. Children whose private speech was more partially internalized had fewer externalizing behaviour problems and better social skills as reported by parents and teachers. Children whose private speech was largely task-irrelevant engaged in less goal-directed behaviour in the classroom, expressed more negative affect in the classroom, and rated as having poorer social skills and more behaviour problems. Developmental change occurred during the preschool years in children's use and internalization of private speech during problem-solving in the form of a reduction over time in the total number of social speech utterances, a decrease in the average number of words per utterance, and an increase in the proportion of private speech that was partially internalized.

Age Factors↗
PubMed2006

Taxis but not private cars are mite allergen reservoirs in Brazil.

Indoor allergens are major causative agents in allergic disease development. Besides homes, public transport vehicles have been considered important mite and pet allergen reservoirs. Our recent studies on allergen exposure in automobiles showed that different allergen levels are found in private cars versus taxis. We quantified group 1 Dermatophagoides spp. (Der 1), Felis domesticus (Fel d 1), and Canis familiaris (Can f 1) allergen levels by ELISA in dust samples from 60 taxi and 60 private car upholstered seats. Mean levels of Der 1 and Fel d 1 were significantly higher in taxis than private cars. A significantly higher percentage of taxis (42%) harboring sensitizing levels of Der 1 compared to private cars (5%) was also found. In spite of the low mean Fel d 1 levels, comparison of the percentage of vehicles with moderate Fel d 1 levels showed a significant difference between taxis and private cars (43% vs. 20%). On the other hand, mean Can f 1 levels were significantly higher in private cars compared to taxis concomitant with a significantly higher percentage of private cars containing moderate Can f 1 levels than taxis (53% vs. 28%). We conclude that upholstered seats from Brazilian taxis but not private cars constitute an important mite allergen reservoir. Thus, additional effective measures for the reduction of allergen exposure in vehicles within the global allergen avoidance strategy should also be routinely accomplished to minimize the induction of sensitization and symptoms in allergic patients.

Allergens↗
PubMedDate not supplied

Outcomes of enhanced prenatal services for Medicaid-eligible women in public and private settings.

OBJECTIVE: With changes in Medicaid, more low-income women are receiving prenatal care in private practice settings. The authors sought to determine whether private settings can provide the enhanced prenatal support services for low-income women that have been offered for decades in public settings. METHODS: The authors analyzed birth outcomes of Medicaid-eligible women receiving care from public and private providers certified to deliver enhanced prenatal care services, which included assessments of nutritional, psychosocial, and health educational risks and individualized counseling along with clinical care. Birth outcomes were compared by type of provider setting using multivariate logistic regression models to adjust for differences in risks and use of care. RESULTS: Among settings certified to deliver enhanced perinatal support services, private physicians' offices had the best risk-adjusted birth outcomes and public health department clinics the worst, while public hospital clinics had outcomes no different from private physicians' offices. Adjusted for prenatal care use, outcomes were still better for women seen in private physicians' offices than for women seen in public health department clinics, community clinics, or private hospital clinics. CONCLUSIONS: The findings suggest that given a certification process, private providers can provide enhanced support services as effectively as providers in public practice settings.

Ambulatory Care Facilities↗
PubMedDate not supplied

The political process and the private health sector's role in Vietnam.

Vietnam has experienced a period of economic and political transition from a command economy to one of market socialism. This transition has precipitated a shift in the policies concerning the private sector, as well as increased demand for services from the private health sector. The private sector has evolved, though more rapidly in the Ho Chi Minh City area, with the passing of laws and regulations concerning private practice. The policy maker's concern is to maintain the equity gains realized under the public health system while using the private sector growth to make improvements in the system's efficiency. The political process enabling expansion of the private health sector has been slow, and will continue to be measured as it seeks to create a national health system with a rational integration of the public and private sectors.

Developing Countries↗