THE ROLE AND CONTRIBUTIONS OF THE PSYCHIATRIST IN PRIVATE PRACTICE.
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Humans↗
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Private practice in hospitals.
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Hospitals↗
Private practice and the NHS.
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Private Practice↗
Private practice use of real-time B scan ultrasound in obstetrics and gynecology.
An informal survey of 25 obstetrics and gynecology practices that use real time B scan ultrasound equipment was carried out to assess the economic and patient-care impact of such equipment. From this informal survey, it can be seen that the incorporation of real time B scan ultrasound scanning into private practice has become economically feasible and useful for the daily clinical management of obstetric patients. The implications and economics of such changes for obstetric health care costs remain to be assessed.
Gynecology↗
Profile of orthodontic services provided in private practice by general practitioners and specialist orthodontists for an insured population.
In Australia, the proportion, volume and type of orthodontic care provided by general practitioners and orthodontists are largely unknown. The overall objective of this study was to create a profile of orthodontic services provided by general practitioners and orthodontists for a cohort of insured patients using private practices in New South Wales, Australia, from 1st January 1992 to 31st December 1995. Data were derived from claims records submitted by members of a health insurance fund for rebates for fees paid to private practitioners for orthodontic services they received during the study period. Distribution of the volume and type of service provided by general practitioners and orthodontists was compared using the Chi-squared test. Statistical significance was taken at the 5 per cent level. Orthodontic services were provided predominantly by orthodontists (80%). Fixed orthodontic treatment was provided almost exclusively (91%) by orthodontists. The majority of removable appliance services was provided by general practitioners. Orthodontists provided more orthodontic services in the capital city and other metropolitan areas, whereas general practitioners provided more orthodontic services in rural areas. Orthodontists provided more services to members in the highest socio-economic group, whereas general practitioners provided more services to members in the lowest socio-economic group.
Age Factors↗
One-on-one tutorials in private practices and clinics: four years of experience in Basel, Switzerland.
The one-on-one tutorial is a new form of learning that is practice oriented. It is based on a teacher-student relationship continuing over two years. Since 1997, third- and fourth-year students have worked for one half day per week under the supervision of their tutor, be it in a private practice or in a hospital. This programme facilitates direct patient contact at an early stage of medical school. In addition, it allows students to apply their knowledge in everyday life. The interactive form of learning is of paramount importance in this module. The ARIVA learning model was developed specially for third-year students and the logbook for fourth-year students. After each tutorial third-year students completed the ARI VA worksheet and fourth-year students completed the logbook. They were handed in together with the structured learning report. Between 85 and 109 students per year participated in these tutorials, totalling 733 students. Each student was taught an average of 3.1 patients in the presence of the tutor. In addition students examined an average of 2.4 patients independently and fulfilled an average of 1.2 practical tasks. For the fourth-year students the number of contacts with patients and the spectrum of diseases examined are impressive. All learning goals were fulfilled The one-on-one tutorial is a practice-oriented, interactive learning method. It uses a variety of didactic methods based on the principals of problem-oriented learning. In a relatively early stage of their medical education one-on-one tutorials give students the opportunity to learn independently how to interview and examine patients. They also give students the possibility to acquaint themselves with a multitude of diseases with the aid of instructions and demonstrations. They are conducive to work with patients above all because students learn how to perform certain techniques.
Attitude of Health Personnel↗
Application of regulations to cosmetic lasers in private practice.
Recent years have seen a growth in the number of non-NHS premises, for example beauty salons, offering cosmetic laser treatments such as laser hair removal. By law, such practices are subject to registration and monitoring by Health Authorities. However, a national consensus on appropriate standards is urgently required, particularly on interpretation of the legal requirements for medical direction and operator training, in order to ensure consistency of standards in private practice with lasers across the country. This paper outlines the difficulties experienced in the inspection and registration process, and makes recommendations on appropriate interim standards, pending formal guidance from professional bodies and the promulgation of revised regulations. Until such guidance is in place, it may be wise for Health Authorities to include within their inspection protocols a requirement that applicants for laser registrations produce a statement as to the exact form which medical direction of laser treatment will take, to enable the Health Authority to consider and take advice on its suitability. Similarly a requirement that laser operators are state-registered health professionals will ensure that these potentially hazardous devices are only used by properly qualified operators, whilst professional bodies work towards a consensus on minimum training standards.
Cosmetic Techniques↗
Disease control in asthmatic children seen in private practice in Switzerland.
BACKGROUND: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice. METHODS: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2. RESULTS: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2. CONCLUSIONS: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.
Asthma↗
[Pelvic inflammatory disease in private practice. An indirect estimation of the importance of the phenomenon in the French population].
A significant increase in the incidence of pelvic inflammatory disease in women aged 15-45 over two decades has been notified by many authors. We have therefore used the data of a survey in private practice in order to evaluate the size of the problem in France taking into consideration that the majority of cases of PID are managed primary primary care systems (G.P. and private specialists). Compared with other pathological problems PID rarely appears in practice (0.6% of contacts with physicians) but the total number of contacts during a year can be estimated at 745 000 in 1975 throughout the country. The highest frequency is observed in the 25-29 age group. There is no difference between professional women and women who have no profession, nor between rural and urban areas. Half of all cases had been notified by general practitioners and the others by gynaecologist/obstetricians. About two-thirds of cases present as acute problems. With this information it is possible to discuss extrapolation to the whole area so as to estimate the prevalence and incidence of PID in France. If a woman has 3 contacts a year with her doctor when she has PID it can be calculated that in 1975 the prevalence was about 2.1% of women aged between 15 and 44 (+/- 0.5). If all acute problems are considered as new cases, the incidence can be estimated at about 1.3% (+/- 0.4) of women aged between 15 and 44.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Private practice--an advanced practice option.
Currently there is considerable debate on the role and function of nurses in Australia and internationally. This debate stems from developments within the nursing profession itself from political and economic issues in health platforms, due to restructuring of the health care system, consumer expectations of health care and nurses' expectations of a career. This paper provides the opportunity to reflect on the development of the role of the private practice (independent nurse) and where that role is situated in the nursing profession. This forms the basis for discussion of the development of specialty practice at an advanced level in Australia and to demonstrate its relationship with the nurse practitioner movement in Australia.
Attitude of Health Personnel↗
Clinical application of the satisfaction with amplification in daily life scale in private practice I: statistical, content, and factorial validity.
Statistical, content, and factorial validity of the Satisfaction with Amplification in Daily Life (SADL) scale was assessed. SADL subscales closely correspond to four satisfaction domains. Subjective benefit is a key component of satisfaction, but other nonauditory factors contribute to wearer satisfaction, notably telephone use and appearance. Results confirm the SADLs psychometric properties and verify its use to validate hearing aid fitting satisfaction in private practice settings for a general patient population at 1-year postfitting. Interim SADL norms may be refined as more SADL data are obtained for different patient populations, hearing aid types, and fitting environments.
Aged↗
The primary care network--a new type of HMO for private practice physicians.
A new type of health maintenance organization has been developed to encourage primary care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all hospital admissions and care by specialists. The primary care physician authorizes all payments from his own account for care provided to his patients. He shares any deficit or surplus remaining at the end of the year. Hospital admission rates and length of stay are lower than those of Blue Cross, with only one of three dollars paid to hospitals. The plan is providing care to 38,000 persons with 750 participating physicians in Northern California, Washington and Utah. This plan represents an attempt by physicians to control costs without government regulation.
Cost Control↗
Evaluation of a new triphasic oral contraceptive in private practice.
We evaluated the clinical and metabolic effects of a new triphasic regimen developed in the continuing attempt to reduce the dose of estrogen and progestogen in oral contraceptives. A combination of ethinyl estradiol (EE) and levonorgestrel (LNg) was used (six tablets with 30 micrograms EE + 50 micrograms LNg, five tablets with 40 micrograms EE + 75 micrograms LNg, and 10 tablets with 30 micrograms EE + 125 micrograms LNg), also known as Triphasil (Wyeth). In a private practice, 409 subjects participated in 7,286 treatment cycles. Three pregnancies occurred, all due to subject failure. Menstrual regulation was excellent and the incidence of side effects extremely low. Withdrawals from the study for possibly drug-related medical reasons totaled 9.0% through 56 cycles of treatment. Metabolic changes also were evaluated in 14 of these women over a 6-month period. The only statistically significant increase in carbohydrate values occurred at 6 months. The mean glucose level at 30 minutes of the oral glucose tolerance test was above the baseline mean value, but serum insulin levels showed no statistically significant deviation. Lipid values presented are total lipids, total cholesterol, triglycerides, alpha-, beta-, and pre-beta-lipoproteins, and high density and low density lipoprotein cholesterol. There was no statistically significant difference between the mean values at baseline and those during treatment for any lipid variable. These results indicate that this triphasic oral contraceptive has a high degree of efficacy, a low incidence of side effects, excellent cycle control, and high subject compliance, and would seem to indicate a minimal influence on the metabolism of lipids and carbohydrates in the small number of subjects studied.
Blood Glucose↗
Clinical experience with intrauterine devices in a private practice.
Clinical experience with intrauterine devices was evaluated, based on 627 insertions over a 14-year period in a private practice. Overall, there were few differences in the event rates leading to IUD discontinuation for the IUDs evaluated, principally Cu-7, Dalkon Shield and Lippes Loop. Pelvic infections were infrequent (0.7-2.2 cases per 100 woman-years of IUD use). The rate of PID in the study population appeared to be similar to that noted in the general population. IUD use did not appear to compromise future fertility, based on evaluations of patients after removal of their IUDs or from their return to fertility following IUD removal. IUD event rates (pregnancy, expulsion, displacement, removal for bleeding and/or pain) were related to the difference between endometrial cavity length and IUD length. A significant increase in the event rates was noted, regardless of the IUD type, when the endometrial cavity length exceeded IUD length by 2.0 cm or more, or when the difference between the endometrial cavity and IUD length was less than 0.5 cm.
Adult↗
[4th report of German Association of Cardiologists in private practice (BNK) on quality assurance in cardiac catheterization and coronary intervention 1999-2002].
The Society of German Cardiologists in private practice (BNK) reports about its project on quality assurance in invasive cardiology (QuIK). Results of a computerized data collection and analysis of cardiac catheterizations and interventions in the years 1999-2002 are presented. These results are compared with other registries. The QuIK-project is done voluntarily by 70% of the society's cardiologists who perform invasive methods. A total of 225,562 diagnostic and 64,895 interventional procedures are documented over the 4 years. Patient characteristics and procedural data kept unchanged. Complication rates were low (< 2%), MACE < 0.5%. There was a rising number of patients referred with acute myocardial infarction. Less time was used to complete procedures from 1 year to another. Two out of three of the centers underwent a monitoring/auditing process in 2002. The desirable post-interventional follow-up after discharge in all cases appears to be impossible to fulfill under the given economical circumstances.
Adult↗
Antidepressant-associated hypomania in outpatient depression: a 203-case study in private practice.
The incidence of hypomania/mania was studied in 203 consecutive mood disorder outpatients, presenting for treatment of depression in private practice, during a follow-up of 3 to 6 months. Of these 50.7% were unipolar, 45.3% were bipolar II, and 3.9% were bipolar I patients. Compared to unipolar patients, bipolar II patients had a threefold greater risk of switching (17.3% vs. 5.8%, a significant difference), but a lower rate than expected from previous work. In a previous analysis of the whole sample, bipolar II patients had a lower age at onset and more frequent atypical features than unipolar patients. Both unipolar and bipolar switchers had instead early age at onset and frequent atypical features, suggesting that these factors might increase the risk of switching in unipolar depression.
Adult↗
On a policy of transferring public patients to private practice.
We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.
Benchmarking↗
Compliance with primary prevention in private practice: creating a tobacco-free environment.
A sample of private orthodontic practices (n = 40) from a controlled trial for clinician-initiated tobacco-use prevention was used to test the effectiveness of preventive medicine representative (PMR) visits in creating and maintaining an anti-tobacco office environment. Clinical staff of 20 offices, randomly assigned to the experimental group, were trained by a PMR on the use of anti-tobacco materials (no-smoking signs, posters, and print materials). Twenty control-group offices did not receive any training or special treatment. Subsequently, experimental-group offices were visited by a PMR once every three months and were telephoned six weeks after each visit over a 12-month period. During visits and phone calls, PMRs prompted offices to order anti-tobacco materials. Visits served to introduce offices to new materials and to encourage their continued use. Data from direct observations and self-report measures showed significant differences between experimental and control offices for display of anti-tobacco materials at 1.5 months and 12 months (P < .001). Results suggest that PMR visits may serve as an effective method of introducing and maintaining preventive medicine procedures in clinical environments.
Community Participation↗