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At least 325 records · Page 18Linked to original sources
PubMed1978

Causes for the premature interruption of psychotherapy by private practice patients.

Thirty patients who discontinued private psychotherapy prematurely were evaluated. Factors stemming from the dynamic interaction between the patient and the treatment process were the most common reasons for dropping out, followed by chronic character traits such as impulsivity and masochism. It is hoped that this assessment of variables in the premature termination of therapy will serve to alert the therapist to the probability that treatment will be aborted, suggest which mechanisms will cause interruption, and enable the therapist to use preventive measures sooner.

Adult↗
PubMed1977

Early detection and treatment: social worker and pediatricians in private practice.

A social worker in the private group practice of pediatricians provides multiple and varied services to children and families. Findings from the first six months of a demonstration project suggest that service is rapidly provided and is utilized by referred patients. Professional issues of practice and education are identified and discussed.

Adult↗
PubMed1985

Insomnia: nonpharmacologic management by private practice physicians.

We report a survey investigation on the perceived value of behavioral assessment and the use of nonpharmacologic treatment of insomnia by 159 physicians in private practice in Davidson County, Tennessee. They generally attributed limited value to behavioral assessment, and reported infrequent use of nonpharmacologic treatment. However, the more patients the physicians saw with insomnia as the chief symptom, the more they tended to value behavioral assessment and other diagnostic procedures. Endorsement of behavioral assessment and all other diagnostic practices was in turn related to the use of behavioral treatment techniques. We suggest that a lack of awareness of the value of alternative assessment and treatment strategies may account for physicians' limited use of nonpharmacologic approaches to this common yet frequently serious medical problem.

Alcohol Drinking↗
PubMed1975

A clinical trial of clonidine (Catapres) in private practice.

Fifty moderately severe hypertensive patients seen in private consulting practice were treated with clonidine alone or in conjunction with diuretics and other hypertensive drugs. After six months, 38 (76 percent) were still satisfactorily controlled. Small initial dosage and cautious incrementation is needed to avoid patient resistance from side-effects, principally fatigue, dry mouth and constipation, but once satisfactory control is achieved maintenance therapy is relatively trouble free.

Adult↗
PubMedDate not supplied

Patients and community together. A family medicine community-oriented primary care project in an urban private practice.

BACKGROUND: There has been considerable discussion in the literature regarding the value and feasibility of community-oriented primary care (COPC), but relatively few published real-world examples. OBJECTIVE: To examine the effect of a practice-based COPC project on rates of preventive health interventions within an inner-city family medicine practice. METHODS: A newly created community advisory board called Patients and Community Together (PACT) and the medical director of the practice in Rochester, NY, collaborated on all phases of the COPC project. Papanicolaou smear and mammography screening, childhood immunizations, diabetes control, and smoking cessation were targeted for intervention. A practice/community awareness campaign was instituted and individual and group incentives were developed. Progress was monitored through a computerized medical record that included all active patients in the practice. RESULTS: Rates of annual Papanicolaou smears increased from 46% to 71%; annual mammography for women older than age 50 years, from 56% to 86%; completed childhood immunizations when younger than 6 years, from 78% to 97%; and performance of semiannual glycosylated hemoglobin, from 85% to 92%. Rates of patients with glycosylated hemoglobin values under 10% improved from 56% to 77%. There were 5 smokers who successfully quit. CONCLUSION: This project illustrates how practice-based COPC can be successfully implemented within a private practice setting. It also shows how COPC principles can be used to achieve the goals for Healthy People 2000 within inner-city practices.

Adult↗
PubMed1998

Resident continuity clinics: a learning design for group private practice.

Continuity clinics are required for residents in obstetrics and gynecology in the U.S., but are costly and difficult to administer. Organizing them into group resident continuity clinic programs which emulate the group private practice most residents will join, creates a design that is parsimonious of clinic resources, while providing a type of continuity with which patients, nurses, and physicians are familiar and comfortable.

Continuity of Patient Care↗
PubMedDate not supplied

Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: an effectiveness study.

A controversy exists over whether or not the results of randomized controlled trials (RCTs) are generalizable to routine clinical practice. The present study examines the effectiveness of cognitive-behavior therapy (CBT) for obsessive-compulsive disorder (OCD) in a private practice setting. Twenty-six consecutive clients referred to a private anxiety disorders specialty clinic began treatment for OCD. Of the 19 (73%) clients who completed treatment, 84% were treatment responders. Clients, treatment, and outcome of the present study are compared with those of representative RCTs, and it is concluded that there are more similarities than differences. It is concluded that CBT can be effectively delivered in routine clinical practice.

Adult↗
PubMed1996

Stress and coping amongst South African dentists in private practice.

Stress and coping were investigated in a randomly selected sample of 311 South African dentists of whom 268 were in private practice and 43 were non-private practitioners. Some of the most important findings are the following: Indications were that about 40 per cent of the respondents reported extremely high stress levels, irrespective of type of employment. No significant relationships were found between stress levels and biographical variables. Stressors most often experienced by private practitioners were financial issues and time and scheduling pressures. Other important stressors included patients' unfavourable perceptions of dentists, being perceived as an inflictor of pain, working with children, treating nervous patients, concerns about the future and worrying about the oversupply of dentists. The most stressful stressors were financial issues. Although it was found that time and scheduling pressures were the next most prevalent category of stressors, dentists reported, next to financial issues, problems in dealing with patients as the second most stressful group of stressors. Making decisions about future career directions and limited future options were intense stressors for 47.54 per cent of respondents. Dentists identified rising costs and problems with medical aid schemes as the most prevalent and intense stressors, ones they experienced most difficulty in handling. Stressors which posed few coping problems were staff-related problems, difficulties in keeping to appointment schedules, working under constant time pressures, repetitive nature of the work, feeling isolated and the possibility of a viral contraction. The results indicated that, in general, drug use amongst South African dentists was low. However, fairly high numbers of dentists used analgesics on a regular basis. Substantial numbers of dentists reported marital problems. The prevalence of severe interpersonal problems with the dentists' own children was low. In addition to marital problems, substantial percentages of the sample reported severe problems in other personal relationships and experienced a severe lack of social involvement or outside interests. In the present study 27 (10.23 per cent) of the private practitioners and 2 (4.76 per cent) of the non-private practitioners reported severe suicide ideation.

Adaptation, Psychological↗
PubMed2003

A pilot study of risk-based prevention in private practice.

BACKGROUND: Risk-based prevention is a means of ensuring that patients receive preventive treatment appropriate for their risk of disease. While straightforward, its application in private practice has not been examined. METHODS: Volunteer clinicians in 15 offices participated in a six-month pilot study to test methods for a larger, risk-based prevention demonstration study operated by a dental insurer. Concomitant with oral examinations for patients of this insurer, clinicians identified patients at elevated risk of developing dental caries and periodontitis. For these patients, the reasons for elevated risk (risk indicators), as well as planned preventive treatment in response to that risk, were recorded and transmitted to the insurer via the claim form. RESULTS: The clinicians identified relatively small percentages of patients as being at high risk of developing caries (4 percent) and periodontitis (7 percent), with little variation across the 15 offices. Larger proportions of patients were identified as being at moderate risk of developing caries (29 percent) and periodontitis (30 percent), with more extensive variation across offices. In general, patients classified as being at elevated risk had received more disease-related treatment than patients at low risk before the classification, which provided some validation for the accuracy of risk assessment. CONCLUSIONS: The results of this pilot study suggest that formal, risk-based prevention can be accomplished in dental offices. Clinicians' reported risk assignments and indicators, together with their planned preventive treatments, demonstrate a good understanding of risk-based prevention. CLINICAL IMPLICATIONS: Researchers may need to clarify the criteria used to assess moderate risk of developing dental caries, and clinicians may need to emphasize greater use of fluorides and more frequent recall visits for adults at elevated risk of developing dental caries.

Adult↗
PubMedDate not supplied

[Medical doctors in private practice in the Greater Paris area. General presentation and overview of results].

The French physician workforce, after decades of growth, will be soon entering a decreasing era. The demographic revolution will affect all parts of the country, including the region Ile de France which has the highest physician/population ratio. An opinion survey conducted among a sample of 1700 physicians gathered 770 replies in March 2003. The difficulties most frequently mentioned by the surveyed doctors are heavy taxes and social contributions (mentioned by 77%), problems for finding locum tenens (52%), traffic jams (48%), irrelevant requests from patients (45%), problems for finding nurses to care patients (28%), conflicts with the sickness fund (24%), lack of security (23%). It is noteworthy that the problems related to locum tenens and nurses are directly associated to the demographic situation of French health workforce. When asked about the risks associated to medical practice, 62% of the surveyed physicians quote the difficulty to combine harmoniously professional practice and family life whereas 60% mention low occupational income. But the highest risk after the surveyed doctors is their legal responsibility (68%). Certain modifications of French regulation concerning medical practice to cope with the forthcoming decrease in the numbers of doctors are approved. In particular, the possibility for a doctor in private practice to hire the services of an other doctor (approved by 41%) and that of having several medical offices (31%).

Paris↗
PubMed1993

Advantages and disadvantages of the alternatives of private practice, public health office and clinic out-patient department as dispensaries for methadone substitution of drug users.

In Germany, methadone substitution will be expanded considerably. Pilot projects and single private practitioners collected first experiences. Other programmes and practitioners follow, since important obstacles have been removed. Instead of individual solutions for limited numbers, broader concepts must be developed. Private practice, public health office and clinic out-patient departments each offer advantages and disadvantages. In several surveyed cities, there are a variety of substitution facilities and no general solution. Local facilities have to be examined for their advantages and disadvantages and should be connected cooperatively--e.g. containing a central out-patient department and a number of private practitioners--to serve the needs of the patients and the efficacy of the system.

Ambulatory Care Facilities↗
PubMed1998

Good clinical practice and audits for dual X-ray absorptiometry and X-ray imaging laboratories and quality assurance centers involved in clinical drug trials, private practice, and research.

Good Clinical Practice (GCP) guidelines, with an emphasis on quality and validation of processes and data, must be applied to the use of imaging in clinical drug development. All participants, including the sponsor, principal investigator, site staff, quality assurance centers, and contract research organizations, must be cognizant of the need for application of these principles to their activities related to the imaging programs. This article discusses the various aspects of GCP as they need to be applied to the use of dual X-ray absorptiometry (DXA) for bone densitometry and X-rays for vertebral fracture assessment in clinical trials for osteoporosis, as well as research and private practice settings. The theory of proper audit conduct to verify clinical trial data is presented.

Journal Article↗
PubMed1985

Cost-effectiveness of sealants in private practice and standards for use in prepaid dental care. Council on Dental Research.

Whether sealants are more cost-effective than restorative dentistry in reaching dental health goals for patients of private practitioners will depend on the relative excellence of materials and techniques, and on the values of prevention per se held by practitioner and patient. Given this heavy dose of subjectivity in the equation, it is doubtful if experimental cost-effectiveness studies of sealants in private practice will be fruitful. A more likely approach to answering questions on cost-effectiveness would be empirical testing of sealant reimbursement in prepayment programs under the standards suggested.

Cost-Benefit Analysis↗
PubMed1992

Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: II. Second line drugs and prednisone.

The probability of continuation of 1,077 courses of 2nd line drugs taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices was examined. This probability was that 50% of courses were continued over 10 months for oral gold, 20 months for hydroxychloroquine, 21 months for penicillamine, 25 months for parenteral gold, 27 months for azathioprine, and more than 60 months for methotrexate (MTX). MTX and prednisone were the only drugs continued by more than 50% of patients after 60 months, while about 20% of courses of other 2nd line drugs other than oral gold were estimated to be continued at 60 months. Estimated drug continuation did not differ significantly according to age, duration of disease, or whether the drug was the first, second, or 3rd 2nd line drug used. Some patients took each 2nd line drug for more than 5 years, suggesting a favorable experience, but most courses were not continued beyond 2 years.

Age Factors↗
PubMed1995

Misuse of pressurized metered dose inhalers by asthmatic patients treated in French private practice.

Although metered dose inhalers (MDIs) are widely used to treat asthma, clinical studies suggest that misuse is frequent. We studied the frequency of, and factors related to, misuse of MDIs in asthmatic patients of French private practice. 264 chest specialists or general practitioners completed questionnaires including characteristics of patients and asthma, technique in using inhalers and previous instruction, for three consecutive asthmatics aged > 6 years and currently using MDIs: 668 adults (mean age 47.8 years +/- 18.5, 51.8% males) and 100 children (mean age 11.5 years +/- 2.1, 72.0% males) were included. Adequate technique (deep inspiration synchronized with inhaler activation, followed by holding breath for 5 seconds) was used by 33.2% of adults and 26.0% of children; optimal technique (same, plus shaking the inhaler before use and activating it only once) was used by 22.1% of adults and 20.0% of children. The main factor related to misuse of MDIs was absence of previous instruction. However only 26.5% of instructed adults and 22.1% of instructed children used the optimal technique. Misuse of MDIs is a public health problem and instruction is unlikely to solve it. The use of different types of devices, like dry powder breath-actuated inhalers should be encouraged.

Adolescent↗
PubMedDate not supplied

Use of Broncho-Vaxom in private practice: phase IV trial in 587 children.

We conducted a Phase IV, open-label clinical trial to test the efficacy and safety of the immunomodulating agent Broncho-Vaxom in private practice. The trial comprised 587 children younger than 12 years of age who had an acute respiratory tract infection at entry and a history of recurrent respiratory tract infections. The patients were given one capsule daily, 10 days per month, for 3 consecutive months. During the acute phase of the disease the patients also received antibiotic therapy. Comparing the infection present at entry with previous infections, the time to improvement (mean +/- SD) decreased from 6.77 +/- 4.42 days to 3.76 +/- 2.18 days, while the time to cure decreased from 11.86 +/- 8.41 days to 7.36 +/- 4.93 days. During the 3 months of therapy, the number of infections decreased from 1.79 +/- 0.96 1 month before treatment to 0.24 +/- 0.46 in the third month of treatment; absenteeism decreased from 3.17 +/- 3.07 days to 0.16 +/- 0.63 days; and the number of antibiotic treatments decreased from 1.71 +/- 1.06 to 0.16 +/- 0.51. In the patients who experienced a recurrent respiratory tract infection during the study, the time to improvement decreased from 5.46 +/- 3.28 days before treatment to 2.79 +/- 1.36 days after treatment, and the time to cure decreased from 8.71 +/- 3.96 days to 4.54 +/- 2.26 days. Adverse events included asthenia and adynamia in 3 patients, diarrhea in 3, rash in 2, fever in 2, exacerbation of symptoms in 2, adenitis in 1, and flulike syndrome in 1. We conclude that Broncho-Vaxom is effective and safe for the treatment of acute episodes of respiratory tract infections and for preventing recurrences.

Acute Disease↗
PubMed1975

High fever. Experience in private practice.

Experience with confirmed high fever, 40 C (104 F) or more, in a private practice during 14 years is presented. The records of 1,500 patients covering 8,000 patient years disclosed only 108 confirmed episodes of high fever. Eleven diagnostic categories included 149 diagnoses. Fourteen of 43 roentgenographic examinations yielded positive findings, including two cases of pneumonia not detected on physical examination. Two of six stool cultures yielded specific enteric pathogens. Convulsions occurred in 12 of the 108 episodes of high fever, and recurred only once in one child. There were no deaths in this series of children with high fevers. Only one diagnosis, pneumonia, was significantly more frequent in confirmed high fever than in unconfirmed high fever. Lastly, the ability of a group of mothers to read thermometers set at three different temperatures proved to be surprisingly good.

Age Factors↗