[Private practice as an occupation].
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Denmark↗
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[Different kind of private practice].
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Dentistry↗
[Working in private practice for a living].
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Costs and Cost Analysis↗
[Young physicians and their private practice].
A postal survey was carried out in Spring 1999 on a random sample of 3623 physicians having settled up their private practice during the first half of the 90's. The number of replies amounted to more than 1800. The proportion who "bought the right to be introduced to the clientele" have raised during the recent years. Those who bought the "right" succeeded to obtain more rapidly a "sufficient" number of patients. In general, the financial situation of French young practitioners was good during the 90's. The proportion of failures was not higher than 3%. France has been characterized by large gaps between its geographical areas as concerns medical staffing, a feature potentially harmful to equity in access to health services. In view of designing sound policies in the matter, medical practitioners were asked if they accepted to change their installation site in case an allowance of 50,000 Francs (about 76,000 Euros) was granted. Less than 4% replied "yes" and 18% "perhaps" to the question. These figures concerned changes of site within the same region. The prospects of migrating to an other region gathered even less enthusiasm. It is evident that policies aimed at reshaping geographic medical staffing should be multi-faceted and not grounded on simple financial allowances.
Age Factors↗
Naltrexone treatment for addicted health-care professionals: a collaborative private practice experience.
Sixty physicians and other health-care professionals with narcotic dependency were treated with naltrexone, 300 to 350 mg/week, in private physicians' offices. Patients remained on naltrexone treatment for an average of 8 months. On a global scale rating the degree of improvement in drug abuse, professional activities, and psychosocial adjustment, 29 patients were rated much improved and 31 either moderately or slightly improved. When these two groups were compared, it was found that more patients in the much improved group did not drink (p less than .01) and remained in naltrexone treatment longer than 6 months (p less than .01). Patients in the much improved group were also older (p less than .01). Naltrexone, used in the private practice setting, appears to be a useful treatment adjunct for addicted health-care professionals.
Adult↗
A prospective study of 2,092 "curbside" questions asked of two infectious disease consultants in private practice in the midwest.
We prospectively studied 2,092 consecutive informal (or "curbside") consultations (CCs) posed of two infectious disease (ID) consultants in private practice in different cities. The frequency of CCs was similar for the two physicians: 31 and 30 per month. The majority of CCs (69%) were initiated by staff physicians, of whom 47% were engaged in primary care. The average duration of CCs was 5.1 minutes overall and increased significantly from 3 minutes in 1990 to 7 minutes in 1994 for one consultant (P < .0001). Overall, 52% of questions asked by staff physicians were considered inappropriate (on the basis of their complexity); this rate increased from 40% in 1990 to 53% in 1994 for one physician (P = .005). Although a variety of subject matters were represented, questions concerning treatment of specific infections were the most common. We conclude that the demand for community-based ID physicians' informal advice remains significant. Any need-assessment for the practice of these specialists in the community should take into account their often unrecognized direct and indirect contribution to the care of many patients they never formally see.
Communicable Diseases↗
The medical management of gestational diabetes in Australia within a solo private practice.
This study reports the obstetric and fetal outcomes of 266 consecutive patients with gestational diabetes managed by a solo practitioner in private practice. Labour was spontaneous in 75.6% and 93.2% had a gestational age of delivery between 37 and 41 weeks. The elective Caesarean section rate of 14.7% was slightly higher than the rate for the overall obstetric population. Insulin therapy was required in 12.8% of the patients with a mean daily dose of 35.3 units. The rate of insulin use increased to 23.8% during 1993 when the criteria for its use was revised. This was associated with a significantly lower macrosomic rate of 3.6%. Overall there was a significant reduction in the number of babies weighing < or = 2500 g and no increase in the number of babies weighing > or = 4000 g. One patient only was admitted to hospital during this 30-month period and there was 1 neonatal death. These results indicate that successful medical management of gestational diabetes, with obstetric and fetal results similar to the overall obstetric population, is possible outside of tertiary institutions and specialized clinics.
Adult↗
[Studies on respiratory infections in primary care clinic (II). Distribution and antibiotic sensitivity to 45 agents of bacteria isolated from patients with respiratory infections visiting a doctor in private practice].
The bacteriology of the isolates from the sputum or the throat swab of patients with respiratory infections visiting a doctor in private practice in Sendai city during the period from March in 1988 to February in 1989 was documented, and their sensitivity to 45 antimicrobial agents was determined. Of the 568 patients, 514 cases had acute pharyngitis, 8 cases each had acute tonsillitis and acute bronchitis, 7 cases were acute pneumonia, 6 cases had herpangina, 18 cases had hand-foot-mouth disease with the signs of respiratory infections, 5 cases had varicella with the signs of respiratory infections and 2 cases were mumps with the signs of respiratory infections. Three hundred strains of potential (greater than or equal to 10(7) CFU/ml) pathogens were recovered from 293 of the 568 cases, which consisted of 124 strains of Haemophilus influenzae, 58 strains of Streptococcus pneumoniae, 45 strains of Staphylococcus aureus, 26 strains of Branhamella catarrhalis, 25 strains of Streptococcus pyogenes, 9 strains of Klebsiella pneumoniae and 13 strains of other species, not including non-fermentile gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus. Staphylococcus aureus and other strains were documented simultaneously in 6 out of 7 cases in which multi-organisms were recovered. Many strains of Staphylococcus aureus were isolated from young patients throughout the year. On the other hand many strains of Branhamella catarrhalis were isolated from elderly patients in winter. The sensitivity of 45 antimicrobial agents of 231 of 300 strains was determined by sensitivity disks (EIKEN, Japan). No strain of the Haemophilus influenzae in this study was resistant to ampicillin. None of the Streptococcus pneumoniae and Streptococcus pyogenes was resistant to ampicillin or cefazolin. None of the Staphylococcus aureus was resistant to cloxacillin, cefazolin, gentamicin or ofloxacin. We conclude from the above results that antibiotic-resistant strains are found presumably only in a very few cases in primary care clinic.
Anti-Bacterial Agents↗
[Sciatica and other low-back disorders in private practice: extent of the problem and therapeutic approaches].
Using data collected by INSERM in a 1975 survey among French general practitioners and specialists in private practice, the reporting of sciatica and low back pain (LBP) was studied, as well as doctors' diagnoses and therapeutic approaches. Only 0.7% of patients were reported as having sciatica, while 2.8% were reported with LBP. These percentages suggest, respectively, 1.5 and 6.5 million consultations with private practitioners. The prevalence of sciatica was estimated at 8%. There was no urban-rural difference in the consultation rate; three-quarters of the patients were seen by GPs. The frequency of LBP was higher among the employed, particularly among manual workers. Referrals for additional examinations were nearly twice as high for sciatica as for LBP. GPs prescribed more medicines, and more sick leave, than specialists, but made fewer referrals for additional examination, probably because the patients seen were different, or were at a different stage of disease. It is concluded that the formulation of standards of care specific to each level of care might be useful.
Adolescent↗
A comparison of clinical pediatric patient encounters in university medical center and community private practice settings.
BACKGROUND: Growing numbers of medical students complete clerkships in community private practice (CPP) settings instead of the more traditional university-based clinics, yet few empirical studies have evaluated how setting type impacts clinical experiences, skill development, and student satisfaction. OBJECTIVE: This study compared the pediatric patient encounters seen by third-year medical students in university medical center (UMC) and CPP settings. METHODS: Third-year medical students were required to keep a log of all patients seen during their 8-week pediatric clerkship. Logbook entries were coded and then analyzed for differences in the number and distribution of the primary diagnostic categories between settings. RESULTS: CPP students reported, on the average, seeing over 3 times more patients than UMC students. The case mix distribution also differed significantly by setting. In general, CPP students reported seeing proportionately more routine illnesses, whereas UMC students reported seeing proportionately more uncommon disorders. Because CPP students saw more patients overall, they averaged more cases in almost all diagnostic categories. CONCLUSION: CPP students received more clinical patient exposure than UMC students, except for patients in a few diagnostic categories.
Academic Medical Centers↗
Medical superintendents with right of private practice in Queensland: practice, training and support.
This article presents the findings of a 1993 study into the work patterns, training and support needs of Medical Superintendents with Right of Private Practice (MSRPP), in Queensland funded by the Southern Queensland Rural Division of General Practice. These doctors form a small but significant subset of the medical workforce with a diverse range of duties, and until now there has been no formal study of their professional and family circumstances. Survey and interview data indicate that MSRPPs are a group subject to considerable professional and social pressure, usually in isolated practice and therefore vulnerable to attrition. This study aimed to provide a clearer identification of what MSRPPs do, what they need and how these needs can be met; and thus to contribute to more favourable retention rates for this sub-set of the rural medical workforce.
Adult↗
Limited private practice--to be or not to be?
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Health Knowledge, Attitudes, Practice↗
Patients who attend a private practice vs a university outpatient clinic: how do they differ?
BACKGROUND: Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured. OBJECTIVES: The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care. METHODS: We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP). Eligible patients were >30 years, Swiss nationals or long term residents, with one or more chronic conditions and attending the same practice for >3 years. They were asked to complete a questionnaire on sociodemographic data, use of medical resources and reasons for choosing and remaining at the same practice. Semi-structured interviews were conducted with a randomly selected subset of 26 patients to further explore their preferences. RESULTS: 329 patient questionnaires were completed, 219 by PP and 110 by OC patients. OC patients tended to be of lower socioeconomic status than PP patients. The main reason for choosing a PP were personal recommendation, while a higher percentage of patients chose the OC because they could obtain a first appointment quickly. A higher percentage of PP patients accorded importance to physician communication skills and trust, whereas a higher percentage of OC patients favoured investigation facilities. Qualitative data suggested that although OC and PP patients reported different reasons for consulting, their expectations on the medical and relationship level were similar. CONCLUSION: Our study suggests that the two groups of patients belong to different social backgrounds, have different patterns of care-seeking and attach importance to different aspects of care continuity. However, patients' expectations and perceptions of the physician-patient relationship are similar.
Adult↗
Immunization barriers in Minnesota private practices: the influence of economics and training on vaccine timing.
OBJECTIVE: Identify barriers to immunization and evaluate the timing of immunization in private practice settings. METHODS: Design was a comparison of childhood immunization data with a survey of physicians who administered the vaccines. Setting was primary care offices in rural and urban/suburban Minnesota. Subjects were children under 7 years old who were receiving either Diphtheria, Tetanus, and Pertussis vaccine, Diphtheria and Tetanus vaccine, or the first Measles, Mumps and Rubella vaccine and their primary care physicians. Main outcome measures were time from birth to the third Diphtheria, Tetanus, and Pertussis vaccine (DTP) and from birth to the first Measles, Mumps, and Rubella vaccine (MMR) and their determinants. RESULTS: The third Diphtheria, Tetanus, and Pertussis vaccine and first Measles, Mumps, and Rubella vaccine were late in 32% and 41% of children, respectively. We observed a significant difference, based upon insurance status, in Diphtheria, Tetanus, and Pertussis vaccine timing (p = 0.0001) but not in Measles, Mumps, and Rubella vaccine timing. Significant correlates of earlier Diphtheria, Tetanus, and Pertussis immunization include physician residency training, suburban/urban practice locale, and the likelihood that the physician would refer children based upon insurance coverage to health departments for immunization. CONCLUSIONS: Important determinants of immunization in the private sector include reimbursement and physician training about prevention.
Child↗
[Attitude of a group of South Africans toward advertising by dentists in private practice].
The advertising of dental services in South Africa is controlled by rules and regulations of the South African Medical and Dental Council. According to these, advertising is not permissible with the exception of specified professional information which may be made known only by means of a nameplate and an entry in a telephone directory. Questionnaires were sent to a randomised sample of 2,100 persons in order to determine the attitude of South Africans towards advertising by private practitioners. According to information obtained from this study there is a strong indication that consumers of dental services prefer a freer form of advertising by dentists in the private practice.
Adult↗
Asthma guideline use by pediatricians in private practices and asthma morbidity.
OBJECTIVE: We sought to examine whether pediatric clinicians in private, non-health maintenance organization practices could implement the national asthma guidelines and whether, when implemented, these guidelines would decrease medical services utilization and improve asthma care for children. METHODS: A trial of a disease management program (Easy Breathing II) involving 20 private pediatric practices in the greater Hartford, Connecticut area was conducted between January 1, 2001, and December 31, 2003. Demographic data on participating practitioners and patients were obtained from questionnaires. Medical services utilization data from claims were obtained from ConnectiCare, a regional managed care organization. RESULTS: Of the 16750 children enrolled in Easy Breathing II, 2458 were enrolled in ConnectiCare and 490 had asthma. Inhaled corticosteroid use increased in the community overall during the study period. After enrollment in Easy Breathing II, with adjustment for age, gender, ethnicity, asthma severity, season, and calendar year, children with persistent asthma experienced an additional 47% increase in inhaled corticosteroid use, a 56% reduction in outpatient visits, and a 91% decrease in emergency department visits for treatment of asthma. Adherence to national asthma guidelines for prescribing inhaled corticosteroids was 95%. Seventeen of the 20 practices are still using Easy Breathing, 5 years after program implementation. CONCLUSIONS: Pediatric primary care clinicians in private practice settings can implement an asthma management program patterned after the national asthma guidelines. When implemented, this program is successful in reducing medical services utilization for children with asthma. Just as differences in patterns of medical services utilization exist in private practices, compared with urban clinics, the impact of disease management on medical services utilization differs in private practices, compared with urban clinics.
Adolescent↗
Distribution of private practice offices of physicians with specified characteristics among urban neighborhoods.
The office location of New York County physicians in private practice is determined for a verified subpopulation of the "Medical Directory of New York State" listing for the year 1970-71. Physicians are categorized by specialty status, medical schools attended, dates of graduation, and hospital affiliations. Multiple regression analysis is performed to relate numbers of physicians per Health Area (average population: 20,000) to demographic, economic, and medical care characteristics of the areas. There is considerable unevenness in the number of private physician offices among Health Areas (mean, 66; standard deviation, 173; range, 1 to 1,043). Multiple regression analysis shows a strong, positive association between practice location and median area income. The influence of population size on practice location is also found to be significant for many categories of physicians but less strong than that of income. Other independent variables are found to have a weaker to nonsignificant impact on practice location. Disaggregation of physicians into specified categories reveals differences in elasticity of location estimates that would have gone undetected had only the aggregated physician population been investigated. Itis concluded that policy decisions concerning physician distribution should be made on the basis of data on smaller areas than has been done in the past, and on specified categories of physicians rather than on aggregates.
Age Factors↗
Private psychiatry and accountability: a response to the APA task force report on private practice.
The authors note that the imminence of national health insurance makes it very important to determine the roles, efficiency, and effectiveness of both the private and the public sectors of mental health care. The difficulties in distinguishing public from private care are examined. The authors present estimated distributions of care by type of provider that differ from those of an APA task force report on private practice. They point out the need for objective research on the quality of care in both sectors and on the effectiveness of alternative mental health systems, suggesting that public choices should be made on the basis of correct interpretations of reliable data and accountability to those being served.
Cost-Benefit Analysis↗