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PubMed2000

Assessing immunization coverage in private practice.

To achieve national health objectives of eliminating most childhood vaccine-preventable diseases by the year 2010, all health care providers will have to improve the immunization rates of their patients. Currently, immunization rates of children 19 to 35 months of age are less than national objectives, suggesting a need for optimized immunization services. A key strategy for improving age-appropriate immunization coverage by health care providers is the assessment of immunization coverage. Because most (62%), immunization services in the United States are delivered in the private sector, a concerted effort in private practice is critical to improving immunization rates. Assessment of immunization coverage of patients enrolled in private practice serves 1) to measure the overall performance of the practice in providing the standard of care, 2) to identify strategies for improving coverage, and 3) to document the quality of health services delivered (report card). Assessment of immunization coverage has been demonstrated in several practice settings to be highly effective in improving immunization rates. All types of physicians should benefit from assessing immunization coverage of their patients. Simple assessment tools are available at no cost to the public and can be obtained by contacting the Centers for Disease Control and Prevention. These tools include a manual self-assessment or a computerized software package (CASA) to fit the needs of the practice.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

Public-private partnerships in health care for developing countries: a new paradigm for change.

The shift in traditional corporate philanthropy policy and practices from one of objective giving to strategic investing is discussed along with the positive impact of these changes as realized through a social awareness and the emerging new paradigm of public private partnerships. Examples of corporate support with focus on a case study concerning HIV/AIDS in Africa are presented within the context of lessons learned. These examples illustrate how public and private sectors working together, can maximize the potential philanthropic endeavor. Using strategically directed, yet humanitarian and culturally sensitive efforts, managed care organizations may find the concepts and negotiations inherent to philanthropic partnerships a familiar setting, and would therefore be suitable candidates to engage in public-private partnerships.

Africa South of the Sahara↗
PubMed2000

Prevalence of nasopharyngeal antibiotic-resistant pneumococcal carriage in children attending private paediatric practices in Johannesburg.

OBJECTIVES: To determine the nasopharyngeal carriage rate, serogroups/types, and antibiotic resistance of Streptococcus pneumoniae in children attending paediatric practices in the private sector in Johannesburg and to relate patterns of resistance to antimicrobial exposure and other demographic characteristics in individual children. DESIGN: A total of 303 children aged from 1 month to 5 years were recruited from eight private paediatric practices in northern Johannesburg. Nasopharyngeal samples were taken and parent interviews were conducted. RESULTS: Pneumococci were isolated from 121 children (40%). The most common serotypes were 6B, 19F, 6A, 23F, 14, and 19A. Carriage was significantly associated with prior hospital admission (odds ratio 1.89) and day care attendance (odds ratio 2.31) and was negatively associated with antibiotic use within the previous 30 days. Antibiotic resistance was found in 84 isolates (69.4%); 45 (37.2%) were multiply resistant. One-third of the pneumococci showed intermediate level resistance to penicillin and 12.4% were highly resistant. There was a high level erythromycin resistance in 38% of the isolates. A total of 94/214 children (42%) had recently used antibiotics and were four times more likely to carry antibiotic-resistant pneumococci (P < 0.05). CONCLUSION: Pneumococcal resistance was significant in this group of children with easy access to paediatric services and antibiotic use. The implication of such high resistance for the treatment of pneumococcal diseases is that high-dose amoxicillin is the preferred empirical oral therapy for treatment of otitis media. Ceftriaxone or cefotaxime should be used in combination with vancomycin for the treatment of meningitis until a cephalosporin-resistant pneumococcal cause is excluded. Intravenous penicillin or ampicillin will successfully treat pneumococcal pneumonia in this population. Antimicrobial resistance among pneumococci colonising children in the private sector has increased dramatically in recent years.

Amoxicillin↗
PubMedDate not supplied

Public or private providers? U.S. women's use of reproductive health services.

CONTEXT: U.S. women receive contraceptive and reproductive health services from a wide range of publicly funded and private providers. Information on trends in and on patterns of service use can help policymakers and program planners assess the adequacy of current services and plan for future improvements. METHODS: Women who reported in the 1995 National Survey of Family Growth that they had obtained any contraceptive or other reproductive health service in the past year were classified by their primary source of care, and the services they received, their characteristics and their primary source of care were analyzed. Logistic regression was used to test which factors predict women's use of publicly subsidized family planning clinics and of specific types of services. RESULTS: The percentage of women of reproductive age who obtained family planning services increased slightly between 1988 and 1995, primarily among women aged 30 and older. Nearly one in four women who received any contraceptive care visited a publicly funded family planning clinic, as did one in three who received contraceptive counseling or sexually transmitted disease (STD) testing and treatment. Women whose primary source of reproductive care was a publicly funded family planning clinic received a wider range of services than women who visited private providers; moreover, the former were significantly more likely to report obtaining contraceptive care or STD-related care, even after the effects of their background characteristics were controlled. Young, unmarried, minority, less-educated and poor women were more likely than others to depend on publicly subsidized family planning clinics. Source of health insurance was one of the most important predictors of the use of public family planning clinics: Medicaid recipients and uninsured women were 3-4 times as likely as women with private insurance to obtain clinic care. CONCLUSIONS: Publicly funded family planning clinics are an important source of contraceptive and other reproductive health care, providing millions of U.S. women with a wide range of services. Since women's need for reproductive care and for publicly subsidized care is not likely to diminish, clinics may be financially challenged in their efforts to continue delivering this broad package of services to growing numbers of uninsured or disenfranchised women.

Adolescent↗
PubMed2001

Public-private partnerships for health: their main targets, their diversity, and their future directions.

The global burden of disease, especially the part attributable to infectious diseases, disproportionately affects populations in developing countries. Inadequate access to pharmaceuticals plays a role in perpetuating this disparity. Drugs and vaccines may not be accessible because of weak distribution infrastructures or because development of the desired products has been neglected. This situation can be tackled with push interventions to lower the costs and risks of product development for industry, with pull interventions providing economic and market incentives, and with the creation of infrastructures allowing products to be put into use. If appropriately motivated, pharmaceutical companies can bring to partnerships expertise in product development, production process development, manufacturing, marketing, and distribution--all of which are lacking in the public sector. A large variety of public-private partnerships, combining the skills and resources of a wide range of collaborators, have arisen for product development, disease control through product donation and distribution, or the general strengthening or coordination of health services. Administratively, such partnerships may either involve affiliation with international organizations, i.e. they are essentially public-sector programmes with private-sector participation, or they may be legally independent not-for-profit bodies. These partnerships should be regarded as social experiments; they show promise but are not a panacea. New ventures should be built on need, appropriateness, and lessons on good practice learnt from experience. Suggestions are made for public, private, and joint activities that could help to improve the access of poor populations to the pharmaceuticals and health services they need.

Cooperative Behavior↗
PubMed2001

Private investment in AIDS vaccine development: obstacles and solutions.

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market.

AIDS Vaccines↗
PubMed2001

Communicated threats and violence toward public and private targets: discerning differences among those who stalk and attack.

A computation of false positive and false negative rates concerning the probability that directly communicated written or oral threats predict subsequent violent behavior yields a striking difference between "public" and "private" targets. Among private targets, communicated threats appear to increase risk, but are so common that they have little predictive value. On the other hand, public targets are unlikely to receive a direct threat from those who approach to attack. The author suggests that the most parsimonious explanation for this difference is the type, or mode of violence, that is apparent. Private targets appear to be most likely victimized by affective violence, wherein the emotionally reactive subject will immediately shove, push, punch, slap, choke, fondle, or hair pull the victim without the use of a weapon, usually in response to a perceived rejection or humiliation. Public targets are most likely to be victimized by predatory violence, which is planned, purposeful, cognitively motivated, opportunistic rather than impulsive, and often involves a firearm. Implications for risk assessment are discussed.

Adult↗
PubMed2001

Opinion survey of Hong Kong private primary care doctors about cervical screening.

The policy and practice of Hong Kong private primary care doctors regarding cervical screening were investigated by way of two different questionnaires sent to comparable random survey samples. The overall response rate was 60.8% (313/515). Both sexes of eligible doctors believed that cervical smears were effective and important, but only 40.2% (47/117) of male doctors performed the test compared with 65.5% (19/29) of female doctors. Those doctors who do not perform the test themselves usually refer their patients elsewhere. The small proportion of private doctors offering cervical smears may reduce opportunities for women who need them. Over 80% of private doctors recommended annual smears despite local recommendations for 3-yearly tests, while graduates from western countries were more likely to recommend longer intervals. Since the proportion of women in Hong Kong having Papanicolaou tests is still low, effort should focus on providing smears for more women, rather than repeated annual testing of those who already participate.

Attitude of Health Personnel↗
PubMed2001

[Evaluation of continuing medical training in private sector French cardiologists in 1999].

The authors present the results of a retrospective national enquiry which took place in 1999 and was mailed and faxed to the 3,800 cardiologists practising in the private sector in order to assess the different types of continuous, individual and collective postgraduate training which they had benefited from in the preceding 12 months. The data was analysed by comparison with that obtained from an individualized representative sample in a panel of private sector cardiologists. The results were then compared with the criteria of a yardstick proposed by the National Committee of Continuous Medical Education of 1997, according to the April 25th 1996 decree. The meeting of these criteria would require carrying out 114,000 to 76,000 hour-equivalents of continuous education whereas the present offer is about 100,000 hour-equivalents. The different forms of individual or collective training were compared in the 327 questionnaires which were exploitable following adhesion to the French Society of Cardiology, to the Cardiologists' Union, to local cardiological societies, by age, gender and type of practice. The average number of annual hours of collective education was 52.2 +/- 60.1 hours (25% quartile = 25 hours, 75% = 60 hours). The average value of hours of individual education was 89.7 +/- 89.3 hours (25% quartile = 25 hours; 75% = 120 hours). This evaluation indicates that about 15% of cardiologists practising in the private sector have inadequate continuous medical education and that 68% would satisfy the criteria laid down in 1997. Moreover, the present offer would seem to be adequate providing the criteria of accreditation have been met.

Adult↗
PubMed2001

Comparison of allergic contact dermatitis cases in the private and subsidized clinics in the National Skin Centre, Singapore.

INTRODUCTION: This is an epidemiologic study to compare allergic contact dermatitis patients in the private and subsidized clinics. PATIENTS AND METHODS: All patients diagnosed to have allergic contact dermatitis in the National Skin Centre from January 1999 to June 1999 were studied retrospectively. RESULTS: More private patients were evaluated for allergic contact dermatitis than subsidized patients in the study period (138 vs. 99). The female-to-male ratio in the paying clinics was greater than in the subsidized clinics (3:1 vs. 1:1). The mean age was the same for both groups i.e., 40 years. There was a greater proportion of unskilled workers attending the subsidized clinic (24.2% vs. 5.4%). The mean duration of rash before evaluation was longer for paying patients than for subsidized patients (31 vs. 22 months), but this was not statistically significant. A significant proportion of the patients had a history of atopic disease and endogenous dermatitis. The most frequent sites for allergic contact dermatitis were the face, hands and the exposed areas of the limbs. The most common allergens were nickel, cobalt and fragrance in the paying patients; and nickel, chromate and fragrance in the subsidized patients. CONCLUSION: More female patients with allergic contact dermatitis and more atopic patients were seen in the private clinics. The forearms, fingers, feet and ears were more commonly affected in the subsidized patients.

Adolescent↗
PubMed2001

The emerging role of the oncology nurse practitioner: a collaborative model within the private practice setting.

PURPOSE/OBJECTIVES: To describe the development of the role of an oncology nurse practitioner (ONP) in a private practice. DATA SOURCES: Articles, book chapters, and personal experience. DATA SYNTHESIS: Successful role implementation will be facilitated by using a collaborative model supported by a shared philosophy of practice, written agreements delineating shared responsibilities and accountability, incorporation of the role into day-to-day practice, and regular evaluation and readjustment of goals. CONCLUSIONS: As oncology care has transitioned to outpatient settings, the role of the ONP can effectively meet both the medical and nursing needs of patients. A collaborative practice model can provide the framework for the physician-nurse professional relationship to ensure a higher level of patient care within the private practice selting. IMPLICATIONS FOR NURSING PRACTICE: The shift of health care to outpatient and private practice settings and the increased availability and use of ONPs mandates a systematic understanding of the process of ONP role development.

Career Mobility↗
PubMed2001

Private benefit, joint ventures, and the death of healthcare as an exempt purpose.

The private benefit doctrine has become the IRS' main policing tool for tax exemption in healthcare. The IRS' modern interpretation of private benefit has clearly become the major limitation on exempt status. This Article begins by tracing the common law origins of this doctrine and how it became such an integral part of the IRS' analysis. Next, the author looks at policy issues regarding alternative analysis to the private benefit doctrine in cases of joint ventures between healthcare providers and for-profit investors. Finally, Professor Colombo questions the expanded use of this doctrine, arguing that in its current form it has no sound legal or policy under-pinnings.

Government Agencies↗
PubMed2002

Private pharmacies in tuberculosis control--a neglected link.

In most settings in India, private pharmacies dispense prescriptions for anti-tuberculosis drugs made out by private practitioners. In a cross-sectional study, we assessed the dispensing practices for tuberculosis and knowledge about the national tuberculosis programme of 300 pharmacies. In all, 2800 prescriptions were dispensed monthly by the pharmacies. Doctors' prescriptions were for durations of several months, but half of the patients bought drugs one dose at a time for self-administration. This practice might promote drug resistance. Although 95% of pharmacists were not aware of the existence of the tuberculosis programme, the majority (97%) were willing to learn and contribute towards tuberculosis control. The need and the potential of private pharmacies for participation in tuberculosis control are highlighted.

Antitubercular Agents↗
PubMed1975

Costs of providing dental services for children in public and private practices.

This study compares the costs of providing children's dental services in three practice settings: private practices, public mobile clinics, and public fixed clinics. Some 15,000 children were provided comprehensive dental care over a three-year period. Results indicate that costs per visit and per child were lowest in mobile clinics and highest in private practices. The differential was partially explained by differences in productivity but mostly by the fact that the price of services in public practices represented costs of production, whereas in private practices they represented market values.

Appalachian Region↗
PubMedDate not supplied

[Anxiety disorders in private practice psychiatric out-patients: prevalence, comorbidity and burden (DELTA study)].

Few data are currently available on the prevalence and associated characteristics of anxiety disorders in psychiatric out-patients in France, in particular in the private health-care. However, this represents one of the principal systems of care for patients suffering from anxiety disorders, with a possible direct access and several types of treatments available (pharmacotherapy but also different kinds of psychotherapy). The aim of our study was to describe the prevalence of anxiety disorders in a large sample of patients consulting in the private sector, and in addition to study the comorbidity, the severity of the disorders, their consequences on quality of life and health care consumption. The studied patients were included and assessed by 501 psychiatrists from all the country, at the time of a first visit. Inclusions were to be made in a consecutive way, but with the exclusion of psychotic disorders and dementia. A sample of 1 955 patients was obtained, and all subjects had a standardized diagnostic assessment with the Mini International Neuropsychiatric Interview (MINI) and with various dimensional scales of symptomatology severity, quality of life, and health care consumption. On the whole, at least one current anxiety disorder was found in 64.3% of the patients, while 55% had a depressive disorder. Individually, the prevalence rates are 29.4% for generalized anxiety disorder, 25.9% for agoraphobia, 19.2% for panic disorder, 15.3% for social phobia, 11.4% for obsessive-compulsive disorder, and 5.4% for post-traumatic stress disorder (PTSD). A history of suicide attempts was found in 12-20% of patients, and an elevated suicide risk was found for example in 25% of PTSD patients. The scores of the symptomatic scales, adaptation and quality of life measure show a very significant anxious symptomatology, with serious functional consequences. Approximately 75% of patients had another medical consultation during the three previous months, and 9% have been hospitalized. An interruption of work was found in 25% of the patients during the last three months, in average for 35 days. Concerning drug consumption before the visit by anxiety disorders patients, the preponderance of anxiolytic use is notable (85 to 98% according to categories of anxiety disorders) when compared to that of antidepressants (20 to 40%). Moreover, 38.4% of the whole sample took an anxiolytic once a day for at least three months and about 40% of them had dependence symptoms. In conclusion, this study showed the quantitative importance of anxiety disorders among psychiatric out-patients in the private practice sector in France, all the categories of anxiety being represented, and the high level of severity and burden of these disorders. Compared to some data published before, the prevalence rates of these anxiety disorders seem to be increasing.

Adolescent↗
PubMed2003

Working for herself: case study of a private duty nurse, 1965-1974.

Private duty nursing is not well researched in Australian history of nursing literature. While it would appear private duty nursing formed the main avenue of employment for trained nurses during the first part of the twentieth century, this type of nursing seems to have disappeared by the mid 1970s. This paper used a case study obtained from an oral history project to examine possible factors contributing to the phasing out of private duty nursing. It concluded there were two main influential issues: an increase in the use of medical technology and the impact this had on nursing practice; and an increase in the financial value placed on nursing which saw nursing wages increase dramatically from 1970.

History, 20th Century↗
PubMed1957

The clinical psychologist; his role in private medical practice.

The independent diagnosis and treatment of mental and nervous disorders according to California law constitutes practicing medicine. By this yardstick, an increasing number of clinical psychologists are entering the private practice of medicine. The medical profession has not provided through its leadership the opportunity for clinical psychologists to utilize their skills in a legitimate and supervised way in the treatment of private patients, nor has the medical profession taken sufficient interest in modern methods of treating patients with psychogenic disorders. If the psychiatric team is a feasible and practical approach to spreading the base of psychiatric treatment in hospitals and clinics, it should be applicable to private practice settings too. In the team setting, the psychologist can render great assistance to the physician in the diagnosis and treatment of patients with psychogenic disorders without compromising the principle that the primary responsibility for the patient is the physician's. By virtue of his training and experience, it is the psychiatrist who is best qualified to supervise the work of the psychologist; and until such time as the medical profession is better acquainted with psychotherapeutic techniques, the employment of psychologist assistants should be (according to good medical practice) left to the psychiatrist. The need for some regulation of the use of the title "psychologist" is increasing in order to protect the public from quacks who pose as psychologists. However, any law which is directed toward elimination of the quack should specifically define psychotherapy and contain provisions for its use under adequate medical supervision. The medical profession is obligated to take its traditional role in providing the best possible treatment for patients who are in need of it, and psychotherapy is an inherent part of treatment.

California↗
PubMed1992

[Chilean hospitals: availability and productivity of the public and private sectors].

Hospital bed availability, trends in number of beds, productivity and administrative aspects in the public and private hospital sectors are analyzed. At present, there are 3.3 beds per 1000 population in Chile. This represents a decrease from previous figures, in spite of increasing demands derived from population aging and greater birth assistance needs. Overall productivity of the hospital system is reflected in 31 annual admissions per bed, an average hospital stay of 8 days and a 75% occupancy rate. The National Health Service System is responsible for 76% of admissions. However, it takes care of more than 90% of bed needs for tuberculosis patients and more than 80% for hospital birth assistance, complications of pregnancy, perinatal disease, communicable diseases, respiratory illnesses, miscarriages and skin diseases. The private sector takes care of more than 40% of rheumatic and musculo skeletal diseases and more than one third of mental health problems. The National Health Service, compared to the private sector, exhibits a greater occupancy rate with an average stay only one day longer. Complexities of hospital administration, new world trends and the relation to external economic resources are discussed.

Bed Occupancy↗