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PubMedDate not supplied

Increasing participation by private physicians in the EPSDT Program in rural North Carolina.

This study evaluated a method to increase physicians' participation in Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a preventive health care program for Medicaid eligible children. Use of EPSDT can improve children's health status and reduce health care costs. Although the potential benefits of EPSDT are clear, the program is underused; low rates of participation by private physicians contribute to underuse. This study targeted a population of 73 primary care physicians in six rural counties in North Carolina where the physician supply, their participation in EPSDT, and use of EPSDT were low. A mailed intervention packet attempted to address barriers to participation perceived by private providers. The packet consisted of a carefully constructed letter, an informative journal article, and an educational pamphlet. Participation in EPSDT screening increased from 15 to 25 private physicians (67 percent), at a cost, on average, of less than $30 per recruited provider. Suggestions are presented for adapting the intervention packet to other settings.

Adolescent↗
PubMed2002

Longitudinal periodontal treatment outcomes in private practice.

The majority of studies evaluating the efficacy of periodontal therapy have been conducted in university-based clinical trials under ideal and well-controlled conditions, where time (and cost) effectiveness was not an overriding factor. In Australia, where the larger proportion of dental treatment is provided by the private sector, there are no clinical studies which provide information on the efficacy of periodontal treatment in general or specialist private practice. The overall purpose of this study was to evaluate the efficacy of periodontal therapy in a specialist private practice over an initial period of 5.3 years in a group of 100 patients, and subsequently on the remaining 70 patients followed over a period 13.5 years. Hence the total observation period extended over nearly two decades. Using frequency distributions of site data, and statistical inferences based on the patient as the experimental unit, the results indicated an overall improvement and subsequent stability in clinical attachment in all categories of Initial Probing Depths, for both single- and multi-rooted teeth, for teeth treated with root planing alone and those that required adjunctive surgical intervention, and for younger and older patients. It was also noted that very few teeth were lost over the extended observation period. These positive results were achieved in a most favourable time in the initial phase of treatment (1.5-2.0 hours) as compared with the protracted time frame (5-8 hours) recorded in university-based clinical trials. Similarly, professional maintenance therapy took an average of around two appointments per year (1 hour) compared with an average of 3-4 hours per year in the university-based studies. The results therefore proved not only satisfactory from the standpoint of clinical parameters measured but also on the basis of time efficiency.

Adult↗
PubMed2002

[Evaluation of patients' satisfaction in relation to private or public health care providers].

The aim of the study was to evaluate of patients satisfaction in relation to private or public health care provider in the Warsaw's (capital of Poland) region. The authors have used original (partially psychometric test) tool named "Skala AB". 590 adult patients were randomly chosen from 20 private and public owned clinics and hospitals. Main outcome of the study was that patients of private owned clinics (but working on contract with general health insurance system) are much more satisfied from the services provided by these clinics than patients treated by local government-owned clinics. In general patients treated in hospitals were more satisfied than patients treated in clinics. Comparison of more detailed determinants of satisfaction, has shown that all health service facilities in study region, in their practices do not consider the "concentration on real needs of patients" as a serious matter and this is the reason of patients dissatisfaction. Level of satisfaction from the services provided by health care facilities did not correlate with gender or age of the respondents. In opposite, the (higher) level of education and place of living (in a big city) have negatively correlated with patients satisfaction. The tool ("Skala AB") used in this survey was found very convenient for evaluation of the patients satisfaction of services provided by health care facilities.

Adult↗
PubMed2003

Application of amendments to the Privacy Act (Cth) 1988 as they affect private clinical practice.

INTRODUCTION: The amendments to the Privacy Act (Cth) 1988 came into force on 21st December 2001. These changes expand the impact of the Act to include the private sector and will have considerable consequences upon healthcare delivery in Australia. This paper reports the findings of a survey, which examined the implications of the Act for doctors in private practice. METHOD: Both Government and private agencies were canvassed to seek clarification of various aspects of the Act. Responses were analysed to determine what needed to be done to ensure compliance with the Act and were reviewed in the light of published material provided by commentators. RESULTS: Of twenty-one contacts, only ten responded of which five were Government agencies. Government agencies chose to deflect commentary and did not respond to specific questions. The Medical Defence Organisations (MDOs) provided the most useful commentary, highlighting various 'grey areas' of concern. DISCUSSION: Government agencies tasked with the enforcement of the Act were unhelpful in providing useful guidelines to specific questions. MDOs offered by guidelines to risk management obviate litigation. This survey emphasised the concept that legislation developed for general purposes required redefinition to be applicable to the medical profession and had the capacity to negatively impact upon patient well-being.

Access to Information↗
PubMedDate not supplied

Scope of medical colleges in private sector.

Medical profession is still the most sought after profession, there are thousands of bright students who pass their F.Sc examination in First Division and desire to join medical colleges but are unable to get admission in government medical colleges. There is a great shortage of doctors in the country. Hundreds of young students go abroad for medical education, costing huge sum of foreign exchange to the families and to the government spending 5 to 7 years and obtaining degrees which are not recognized in Pakistan. Therefore to fulfill the demand of the public, and to overcome the shortage of doctors in the country and to save the valuable foreign exchange, private sector medical colleges are much needed in Pakistan. However, establishment of medical colleges is very expensive and difficult. PMDC is very firm in implementing its rules and regulations. Those colleges which fulfill the laid down requirement of PMDC, help in overcoming the shortage of doctors in the country and provide much needed health care to the population. Such medical colleges are much appreciated by the public and by the govt. Such private sector medical colleges have great future and some of them may become famous and outstanding like the private sector medical colleges in the USA.

Humans↗
PubMedDate not supplied

ITI implant use in private practice: clinical results with 5,526 implants followed up to 72+ months in function.

PURPOSE: To evaluate the success and failure rates over time of ITI implants placed in 3 private practices and used in a variety of clinical situations. MATERIALS AND METHODS: ITI solid-screw implants (n = 5,526) were placed in 3 private practices and restored by a variety of clinicians. Numerous clinical scenarios were treated with the implants, which were in function for between 0 and 72+ months. RESULTS: After 72+ months the cumulative success rates were 94.8% for maxillary implants and 97.5% for mandibular implants. The overall cumulative implant success rate was 96.1%. Implants that failed to osseointegrate were included in the data as failures in the 0- to 12-month interval. The criteria of Albrektsson and associates were used to assess implant success or failure. DISCUSSION: The results, which were achieved in conjunction with numerous restorative clinicians, were comparable to those reported by other authors. The clinical viability of ITI implant use was thus reinforced. CONCLUSION: ITI solid-screw implants were a predictable treatment modality in 3 private practices for a variety of clinical applications.

Dental Implantation, Endosseous↗
PubMed1992

Patterns of illicit drug use at the time of labor in a private and public hospital.

The majority of prevalence data on perinatal substance abuse describe low socioeconomic patient populations. This study of illicit drug use at the time of labor was done to identify patterns of drug use in both private and nonprivate patients. Anonymous urine samples were collected from 1000 patients, 500 admitted in labor to a private hospital and 500 admitted to a public hospital. All samples were screened for cocaine, opiates, cannabinoids, and amphetamines. A positive result of screening for any drug was detected in 8.2% of patients. More positive results of screening for any drug were found in nonprivate patients (11.4%) than private patients (5%), with nonprivate patients significantly more likely to test positive for cocaine or cannabinoids or both. Black patients contributed 64.5% of the positive tests for cocaine, significantly more than white (17.6%) or Hispanic patients (17.6%), whereas white patients contributed significantly more positive tests for cannabinoids (85%) than black (5.4%) or Hispanic patients (7.1%). Assessment of patterns of perinatal drug use in communities will support appropriate allocation of resources and targeting of patient and provider education.

Amphetamines↗
PubMedDate not supplied

Children's fear and behavior in private pediatric dentistry practices.

PURPOSE: This study assessed the proportion of children with dental fear, the proportion of children with negative behavior and the relationship of children's dental fear and children's negative behavior in private pediatric dentistry practices in western Washington state. METHODS: A total of 421 children seen in 21 private pediatric dentistry practices in western Washington State participated. The average age of the children was 6.8+/-2.8 years (range=0.8-12.8 years). An average of 21 children were studied per practice (range=7-25 children). Dental fear was measured using the parents' version of the Dental Subscale of the Child Fear Survey Schedule (CFS). Behavior of the child during treatment was rated using the Frankl scale. Additional data were collected regarding the child's previous experiences and parental fear. RESULTS: The children's average item score on the 15-item CFS was 2+/-0.7, corresponding to a total score of 29.6 out of 75, where 75 indicates maximum fear. The proportion of children with dental fear, defined as an average item score of > or = 2.5 (corresponding to a total score of > or = 38), was 20% (85/421, 95% CI=16.3, 24%). The proportion of children who displayed negative behavior during treatment was 21% (95% CI=17.5, 24%). A prevalence ratio of 2.4 was calculated to describe the relationship between children's behavior during treatment and children's dental fear prior to dental treatment. Multivariate logistical regression analysis showed children with dental fear, younger children, and children exposed to treatment involving local anesthesia have higher odds of displaying negative behavior. CONCLUSIONS: The proportion of children with dental fear in private pediatric dentistry practices was 20%, and the proportion of children with negative behavior during treatment was 21%. Children with negative behavior had greater odds of having dental fear and children with dental fear had greater odds of having negative behavior. Screening for dental fear may allow pediatric dentists to prepare children more adequately for positive treatment experiences.

Age Factors↗
PubMed2004

[Assessment of annual exposure to noise and risk of occupational hearing loss among private farmers specializing in plant production].

BACKGROUND: In agriculture noise is the most frequent hazard, but until now very poorly recognized. It affects the hearing organ in private farmers. Because of a great variety of machines used on farms and a changing magnitude of exposure to noise, this agent has to be studied over the whole annual cycle. The aim of the study was to recognize and evaluate annual exposure to noise among private farmers engaged in plant production. MATERIALS AND METHODS: The study covered 17 family farms with arable land, ranging from 10 to 50 ha (mean, 22.3 ha). They were equipped with agricultural tractors and a set of agricultural accessories, wood-cutting saws, self-propelled and workshop machines. Based on detailed time-schedule records of agricultural activities and dosimetric measurements conducted during the whole year, two acoustic parameters were determined, total monthly exposure and equivalent daily exposure. RESULTS: The study showed that the highest values of the total monthly exposure to noise (E(A,T)) occurred in the summer-autumn (July, September, October) and winter (December, January) seasons. During the former, the degree of noise load among farmers was directly associated with intensity of field works and transport activities, whereas during the latter with the frequency of using wood-cutting machines and repair activities. The calculated mean equivalent daily exposure to noise revealed the highest values in two months, December (6.01 Pa2 h) and September (5.51 Pa2 h), and the lowest values were observed in the other months (3.67-4.28 Pa2 h). The mean value for the whole year was 4.35 Pa2 h (the standard was exceeded by 4.4 times). CONCLUSIONS: The study showed that the mean annual noise load among farmers engaged in plant production was characterized by the level equal to 91.3 dB-A with the highest hearing risk in December and September. In those two months, maximum allowable exposure to noise was exceeded by six times (E(A,8h)). Owing to the precision of the obtained values and their strong uniformity, they may be used in practice by relevant services to evaluate the degree of noise risk among private farmers engaged in plant production.

Agricultural Workers' Diseases↗
PubMedDate not supplied

Bacterial contamination rate of eyedrops: comparison of a hospital and a private outpatient center in Kermanshah, Iran.

Bacterial contamination rate of eyedrops: comparison of a hospital and private outpatient ophthalmology centers of Kermanshah, Iran. Eye drops are sterile solutions with different clinical effects. Like any therapeutic medication, they should be administered using aseptic technique and stored in a way that prevents bacterial contamination. In our hospital and local private clinical settings, some cases of bacterial keratitis are thought to be due to eyedrops, which are used on multiple patients and at some point become contaminated. This study was done to compare the bacterial contamination rate in an educational hospital with private ophthalmic centers and attempt to identify the route of contamination and consequently, a method to resolve or reduce the problem.

Cross Infection↗
PubMed2004

The effect of public or private structures in wastewater treatment on the conditions for the design, construction and operation of wastewater treatment plants.

Organised in public or private structures, wastewater services have to cope with different framework conditions as regards planning, construction, financing and operation. This leads quite often to different modes of management. In recent years there has been a push for privatisation on the water sector in general, the reasons for which are manifold, ranging from access to external know-how and capital to synergistic effects through integration of wastewater treatment into other tasks of similar or equal nature. Discussed are various models of public/private partnership (PPP) in wastewater treatment, encompassing for example the delegation of partial tasks or even the proportional or entire transfer of ownership of treatment facilities to private third parties. Decisive for high performance and efficiency is not the legal or organisational form, but rather the clear and unmistakable definition of tasks which are to be assigned to the different parties, customers and all other partners involved, as well as of clear-cut interfaces. On account of the (of course legitimate) profit-oriented perspective of the private sector, some decision-making processes in relation to project implementation (design and construction) and to operational aspects will differ from those typically found on the public sector. This does apply to decisions on investments, financing and on technical solutions too. On the other hand, core competencies in wastewater treatment should not be outsourced, but remain the public bodies' responsibility, even with 'far-reaching' privatisation models. Such core competencies are all efforts geared to sustainable wastewater treatment as life-supporting provision for the future or as contribution to the protection of health and the environment and to the development of infrastructure. Major areas of wastewater treatment and other related tasks are reviewed. The paper concludes with a list of questions on the issue of outsourcing.

Facility Design and Construction↗
PubMedDate not supplied

Geographic distribution of pediatric dentists in private practice in the United States.

PURPOSE: The objectives of this study were to: (1) determine the geographic distribution of pediatric dentists in private practice across the United States; and (2) compare state-based pediatric dental practitioner-to-children ratios. METHODS: Enumeration of pediatric dental practitioners was derived from the American Academy of Pediatric Dentistry's 2000-01 Membership Directory by including all active and fellow members who were in private practice in the United States. Population information for the 50 states and District of Columbia was obtained from Census 2000 data available on the US Census Bureau's Web site. RESULTS: A total of 2,913 pediatric dentists were in private practice in the United States, with the largest number located in California (333), Texas (238), and New York (202), and the smallest number located in Maine (3) and North Dakota (4). There were 4.03 pediatric dental practitioners for every 100,000 US children younger than 18 years of age. Connecticut and Massachusetts had almost twice (7.7) as many pediatric dental practitioners per 100,000 children as the national average. On the other hand, Maine had only one fourth (1) the number of pediatric dental practitioners per 100,000 children as the national average. CONCLUSIONS: Marked differences exist between the various states in their pediatric dental practitioner-to-children ratio.

Adolescent↗
PubMed2003

Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan.

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis (TB). The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration forTB control in urban areas are urgently required.

Anorexia↗
PubMedDate not supplied

[Discrepancy in attitudes toward diabetes between physicians and diabetic patients attending the private, social security or state medical services].

OBJECTIVE: One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services. MATERIAL AND METHODS: They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test. RESULTS: Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector. CONCLUSIONS: All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.

Adult↗
PubMed2005

Policy principles and implementation guidelines for private sector participation in the water sector--a step towards better results.

To achieve the Millennium Development Goals, all partners (public, private, NGOs) must be engaged for improving and expanding the water supply and sanitation services. Yet, high transaction costs, unclear role allocation and lack of trust and commitment put Private Sector Participation (PSP) at risk. The initiative "Policy Principles and Implementation Guidelines for Private Sector Participation in Sustainable Water Supply and Sanitation" contributes to equitable, effective, ecological and efficient PSP projects. Based on a multi stakeholder process, the Policy Principles are offering an open and transparent framework for the negotiation of valid, widely accepted and action-oriented solutions, while the Implementation Guidelines focus on success factors for building partnerships on the operational level.

Ecology↗
PubMed1992

Budget cutting and privatization: the threat to health.

The worldwide drive for budget cutting and privatization, led by the WorldBank and the International Monetary Fund, has led to serious deterioration of health services as well as education, housing, nutrition and other social services in many countries. The model for this policy is the United States, which represents the pinnacle of private enterprise in the health field. The U.S. experience with this model--its effects on preventive and treatment services and health status--is reviewed. The example of the current drive toward privatization in Spain is discussed, and alternative recommendations are made to protect and improve the health of the Spanish public.

Budgets↗
PubMed2005

Expanding access to the management of HIV/AIDS through physicians in private practice: an exploratory survey of knowledge and practices in two Nigerian states.

Over the past few years, the cost of antiretroviral drugs has continued to decline. A significant proportion of people in Nigeria seek medical care primarily in the "for profit" private sector. The complexity of managing HIV and AIDS has led to debates on whether care should only be restricted to trained and accredited experts in HIV care. This research studied the knowledge and practices of physicians in private practice in two Nigerian states on the management of patients with HIV/AIDS using an anonymous self-administered questionnaire eliciting knowledge and attitudinal information. This is to ascertain their preparedness to manage HIV positive patients. The doctors were found to be poorly informed on practical issues in the management of HIV patients. These included the need to confirm their patient's HIV status, where to do the confirmation and where to refer such patients for counselling. Most of them referred to the mass media as their primary source of information. There is an urgent need for pro-active planning to prepare physicians in private practice for increasing demands in the management of HIV/AIDS in Nigeria. Organising a nation-wide training programme that would lead to ongoing accreditation programme is a way of achieving this. The formulation of guidelines for managing both clinical and non-clinical aspects of HIV/AIDS should be prioritised.

Clinical Competence↗
PubMed2006

Involvement of private practitioners in tuberculosis control in Ballabgarh, Northern India.

SETTING: The Revised National Tuberculosis Control Programme (RNTCP) in India covered 70% of the population in 2003. However, the private sector, where a large proportion of tuberculosis (TB) patients are seen, does not have sufficient involvement in the programme. OBJECTIVE: To test the feasibility of involving private practitioners (PPs) in the RNTCP for identification and management of TB cases. DESIGN: PPs in Ballabgarh Block, Haryana, were identified and invited for training in RNTCP guidelines. They referred TB suspects for confirmation of diagnosis to a nearby public facility. Patients could subsequently choose to return to their referring doctor or to the government facility. Patients and doctors were interviewed at the end of the project to assess their perceptions. RESULTS: Of 146 PPs, 72% were trained in RNTCP guidelines and 14 agreed to provide directly observed treatment (DOT). During the study period (May 2001-December 2003) 113 patients initiated treatment, leading to an incremental gain of 11.5% in case finding. The cure rate among the 113 sputum positive patients was 73%, and the default rate was 11.5%. CONCLUSION: Involvement of private practitioners in TB control is possible and results in benefits for all stakeholders.

Communicable Disease Control↗