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PubMedDate not supplied

Design and implementation of a nuclear cardiology testing facility in a private-practice cardiology office setting.

Nuclear cardiology services increasingly are being provided in private-practice cardiology office settings. Because training programs are hospital based, trainees in nuclear cardiology may find only limited guidance on how to set up a private-practice nuclear laboratory. Furthermore, there is no literature to date advancing "models" for such facilities that might be useful for practice managers. The purpose of this review is to address common issues related to setting up and administering a nuclear cardiology laboratory in a private-practice cardiology office.

Cardiology↗
PubMedDate not supplied

Nuclear cardiology in private practice.

The provision of nuclear cardiology services in private-practice settings is probably currently the fastest growing segment of nuclear medicine. One reason is that myocardial perfusion scintigraphy, by determining which patients require coronary angiography and revascularization, has the potential to help a cardiology practice complete more successfully in the managed-care environment. Private practices can establish their own patient databases to determine how scintigraphic findings correlate with patient outcomes and with findings if coronary angiography is performed. Based on these data, pressure can be exerted to modify clinical responses to optimize the relationship between scintigraphic findings, quality of clinical care, and cost-effective patient management. To succeed in a managed-care setting, nuclear cardiologists must demonstrate that, without their services, the quality of cardiac care would be lower and the cost of caring for patients with heart disease would be higher. As in other settings, nuclear cardiologists in private practice must be involved managerially so they will be active participants in the development of clinical-care guidelines and the negotiation of capitated and other types of managed-care contracts.

Algorithms↗
PubMed1994

Introduction of laparoscopically assisted vaginal hysterectomy in a private teaching community hospital.

STUDY OBJECTIVE: To compare laparoscopically assisted vaginal hysterectomy (LAVH) with traditional total abdominal hysterectomy (TAH) when the laparoscopic approach is introduced into a private hospital. DESIGN: During 1 year, 49 LAVHs were performed and compared with 51 consecutive TAHs using retrospective chart review and statistical analysis. SETTING: A private, university-affiliated, teaching hospital. PATIENTS: All patients undergoing LAVH, and the first 51 TAHs performed during the study year. MEASUREMENTS AND MAIN RESULTS: No major complications occurred in either group. Significant differences were observed in uterine weight (161 +/- 92 g vs 331 +/- 354 g), operating time (164 +/- 48 min vs 108 +/- 28 min), and hospital stay (2.93 +/- 1.21 days vs 4.00 +/- 1.54 days) for LAVH and TAH, respectively. Hospital charges for LAVH average $4074 more than for TAH, primarily due to the use of disposable laparoscopic equipment. CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy may be performed safely in a private community hospital with appropriate surgeon credentialing and training. Modifying techniques to minimize the use of disposable equipment would make the procedure more cost effective.

Adult↗
PubMed2002

Perineal outcomes in NSW public and private hospitals: analysing recent trends.

Women using private health insurance for pregnancy care may be unaware of the impact that this choice has in increasing their risk of experiencing a range of interventions during childbirth. This paper identifies recent trends in episiotomy rates and perineal outcomes for New South Wales (NSW) public and private hospitals between 1997 and 1999. Clear and consistent differences exist in birth outcomes in NSW private hospitals in respect to greater episiotomy use and poorer overall perineal outcomes, higher caesarean section rates and higher instrumental birth rates. Given the potential health impact for women who experience intervention during childbirth, identification of clinically unjustified practices is an important step towards ensuring that women's choices provide them with optimal childbirth outcomes regardless of their health insurance status.

Decision Making↗
PubMedDate not supplied

Sources of disagreement among public and private agency paramedics.

INTRODUCTION: The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system. METHODS. This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics. RESULTS: On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment. CONCLUSION: A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.

Adult↗
PubMedDate not supplied

Comparing a public and private sector NFP program: implications for NFP expansion.

This paper synthesizes a six year collaboration between a natural family planning (NFP) non-governmental organization (NGO) and the National Health Service of the Emilia Romagna region in Italy. It also compares the public program experience with NFP services provided in the private sector in the adjacent region of Veneto. Midwives provided NFP services in government family health clinics while in the private sector NFP was taught by non-health laypersons in a church-based facility. The populations served by these two programs were different. Women in the public sector were slightly older and two-thirds were married. Forty percent of the clients had chosen to use NFP to achieve a pregnancy. The private sector client, recruited in part through premarriage counseling programs, was equally divided between married and single women, though the majority came for advice on avoiding or spacing pregnancies. In both regions NFP users were more highly educated than the general population.

Contraception↗
PubMed2000

Public health care and private insurance demand: the waiting time as a link.

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

Adult↗
PubMed1999

Inpatient treatment of comorbid psychiatric and substance abuse disorders: comparison of public sector and privately insured populations.

Public health delivery systems are increasingly compared to private systems as policymakers continue to focus on reducing the costs of care. However, there are very few studies comparing trends in utilization and cost between public and private providers. This study examines discharge abstract records for VA patients and insurance claims data for a national sample of privately insured individuals to investigate trends in inpatient utilization and costs for dually diagnosed individuals in these two systems. Although the substantial differences in the populations treated could account for the differences in these measures across systems, this study is useful in illustrating the possibilities and limitations of system comparisons.

Adult↗
PubMed1998

Need for vision rehabilitation in India. Survey of a private eye hospital.

PURPOSE: To determine the visual success outcomes following treatment in an urban private eye hospital in India. METHODS: A retrospective survey was done of 4122 consecutive files of fee-paying patients admitted to a private eye hospital in Hyderabad during a 3-month period in 1996. Data obtained a minimum of 4 months after completion of treatment included age, sex, diagnosis and distance visual acuity in the best eye. RESULTS: After completion of treatment 86.5% of patients had normal vision, 10.9% had low vision and 2.5% were blind. Of the people with low vision or blindness after treatment, 81.7% had a best corrected visual acuity of between 6/18 and 6/60. The 4 most common causes of low vision after treatment were unoperated cataract (20.4%), glaucoma (13.3%), diabetic retinopathy (12.4%) and retinitis pigmentosa (10.2%). CONCLUSION: The visual success rates in an urban Indian private eye hospital appear high with nearly 90% of patients achieving normal vision after the completion of treatment.

Adolescent↗
PubMed2002

Privatizing medicaid-funded mental health services: trading old political challenges for new ones.

States have aggressively pursued privatizing the management of Medicaid-funded mental health services. Although privatized managed care addresses many concerns, it brings several challenges. This article evaluates the impact of privatization on Medicaid-funded mental health services and highlights several contracting issues that should be considered to ensure high-quality mental health care.

Health Policy↗
PubMed1999

Privatizing alcohol sales and alcohol consumption: evidence and implications.

AIM: To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. METHODS: Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. FINDINGS: Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer-term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. CONCLUSION: The existing evaluation literature on the subject of privatization has tended to focus on examining the net short-term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol-related harm. Finally, seven specific suggestions that may assist future studies are discussed.

Alcohol Drinking↗
PubMed2002

Public-private partnerships to reduce tobacco dependence.

Four-fifths of the estimated one billion deaths that will be caused by tobacco dependence over the next 100 years will occur in low-income countries. Along with other tobacco control policy measures, the treatment for tobacco dependence is a cost-effective policy measure in low-income countries. In public health, public-private partnerships for drugs and vaccines and incentives for commercial private sector engagement are proposed to tackle the communicable diseases of the poor. This paper will argue that public-private partnerships are also an appropriate and important vehicle to reduce the harm caused by tobacco. For the pharmaceutical sector to engage in the marketing of tobacco dependence treatment products in low-income countries the incentives must be aligned, and a self-sustaining market must be developed. A rational market would be large, characterized by high volumes and low margins. The framework convention on tobacco control of the WHO provides a global infrastructure for taking public sector action to reduce the harm caused by tobacco. The convention could call for a proportion of tobacco tax from high-income countries to be used to fund tax credits and other incentives for increasing the access to tobacco dependence treatment in low-income countries.

Global Health↗
PubMed2001

Measuring mental health outcomes in a private psychiatric clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36.

OBJECTIVE: This study reports on data collected from the routine use of the Health of the Nation Outcome Scales (HoNOS) and the Medical Outcomes Short Form (SF-36). Three main aims were addressed in using these measures: (i) to establish patient disability levels; (ii) to determine the level of treatment effectiveness; and (iii) to explore the ability of these instruments to predict length of stay and mood change. METHOD: The clinician-rate HoNOS and the patient-rated SF-36 were included in the assessment battery, at admission and discharge, of consecutive inpatients (n = 754) at one private psychiatric facility over a 2-year period. RESULTS: The sample, on admission, was comparable in illness severity to levels reported at other Australian private psychiatric facilities. Treatment was shown to be effective, and the degree of changes in HoNOS ratings compared favourably with other private psychiatric facilities. Certain factors underlying the structure of the HoNOS and the SF-36 only weakly predicted length of stay and changes in depression and anxiety levels. CONCLUSION: The HoNOS and the SF-36 provided valid and reliable data on patient function, with the HoNOS being most sensitive to treatment change. However, neither instrument proved useful in predicting length of stay or levels of depression and anxiety at discharge.

Adult↗
PubMed2001

Alcoholic liver disease: a clinical series in an Australian private practice.

BACKGROUND AND AIM: The published literature on alcoholic liver disease (ALD) in Australia lacks a large clinical series out of private practice as distinct from hospital-based hepatology referral units. This series describes the presentation and clinical features of ALD in a consecutive series out of metropolitan private practice in Australia. METHODS: A retrospective descriptive study by case-note review found 297 cases of ALD at a Brisbane practice over 20 years. The main outcome measures were: clinical features and stage at presentation, reasons for referral, and the predictive value of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio. RESULTS: Most patients (57.9%) had no symptoms of liver disease and 29 patients (9.8%) had neither symptoms nor signs. Cirrhosis was found in 41% of patients and hepatitis-fibrosis was found in 26% of patients. The male to female (M : F) ratio was 4.7:1. The AST/ALT ratio was not reliably predictive of ALD stage. The average reported daily alcohol intake was 131 g. Females drank less on average and presented a more vigorous clinical picture. CONCLUSIONS: This series presents the spectrum of ALD in a metropolitan Australian private practice. Many patients are asymptomatic on presentation. All heavy drinkers should be targeted for early investigation without waiting for volunteered symptoms or abnormal physical signs. The male to female ratio in ALD is higher than hitherto reported. The AST/ALT ratio is not generally applicable in the staging of ALD. The differences from hospital series data suggest the demography and epidemiology of ALD in Australia are incomplete, and further study is warranted.

Adult↗
PubMed2003

Paradigms of public-private partnerships in end-stage renal disease care: the National Kidney Foundation Singapore.

Novel forms of funding chronic renal replacement therapy and other chronic kidney disease programs are urgently required in order to address the increasing global burden of end-stage renal disease (ESRD). For areas of infectious disease control in less-developed countries, the formation of public-private partnerships has successfully yielded short-term improvement in clinical outcomes. This article reviews the concept of public-private partnerships and its various formats. We argue that similar partnerships play an important role in addressing the public health problem of chronic kidney disease. Through its establishment of numerous paradigms of partnerships with private for-profit corporations in building a nationwide chronic dialysis program and through partnerships with other non-governmental institutions and healthcare institutions in order to create a new entity characterized by a separate management structure, the NKFS has been able to provide chronic dialysis care to over 70% of the country's total ESRD population. This extensive network of partnerships is currently being applied as the NKFS continues to expand its programs to focus on the prevention of chronic kidney disease at a nationwide level.

Foundations↗
PubMed1984

The private practice study group as phase-IV research tool.

Research in the routine field of psychiatry must include psychiatrists in private practice. A majority of psychiatric patients is treated as outpatients and many of these are only seen by private psychiatrists. Setting or patient variables pose restrictions on the therapy which leads to the development of specific treatment strategies. Because these are empirically based, it can be expected that the knowledge of practitioners can make a major contribution to the development of optimal treatment recommendations. Research in private practice requires special organisational efforts. One way to get access to this field are collaborative study groups which bring together scientists and their research facilities with practitioners and their surgeries. Such an instrument may allow: access to patients, which may never show up in any other research institution; monitoring of patient characteristics and treatment modalities under routine conditions; elaboration of special skills, insights and treatment strategies developed by the practitioner. These study groups can vary with regard to type of practice, type of collaboration and type of research. Studies can rely on information from patient self-reports, observations by the practitioners themselves or their office assistants and on data gathered by scientific staff working occasionally or continuously in the practice.

Clinical Trials as Topic↗
PubMed2002

Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital.

OBJECTIVE: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. STUDY DESIGN: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. RESULTS: The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. CONCLUSION: Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.

Adult↗