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At least 973 records · Page 54Linked to original sources
PubMed1993

Preoperative autologous blood donation. Linkage of the public and private hospital sectors.

OBJECTIVE: To evaluate the safety and efficacy of a preoperative autologous blood donation (PABD) program with liberal patient exclusion criteria. DESIGN: Prospective patient accrual from September 1990 to May 1992. SETTING: A PABD program in a public tertiary care hospital linked with a specialist orthopaedic practice in a private hospital. PATIENTS: One hundred and twenty patients consecutively scheduled for orthopaedic surgery were referred for PABD. There were 77 women (median age, 63 years) and 43 men (median age, 62 years). One-third of patients were 70 or more years old. Coexistent medical disease, mainly cardiovascular, was present in 46% of patients and 3% were excluded because of coexisting morbidity. Total hip or total knee replacement was performed in a private hospital with intraoperative or postoperative blood salvage in 37% of the patients. OUTCOME MEASURES: Adverse effects of PABD, autologous blood collected and used and homologous blood transfused. RESULTS: One hundred and sixteen patients donated 267 units of autologous blood. In 70 patients undergoing total hip replacement, 78% donated three and 20% donated two units, with 95% of autologous blood being used. In 38 patients undergoing total knee replacement, 42% donated two units and 55% donated one unit, with 87% of autologous blood being transfused. Seventy-eight per cent of all patients only received autologous blood. In the remaining patients, homologous blood use was confined to two units or less in 80%. Hypotensive episodes associated with phlebotomy occurred in 3% of patients, and 13% of patients had preoperative haemoglobin levels ranging from 85-100 g/L without adverse clinical effects. CONCLUSION: A hospital-based PABD program with less strict patient exclusion criteria does not prejudice the clinical status of the donors. Its linkage to private hospitals can significantly reduce the use of homologous blood in selected elective surgery.

Adult↗
PubMed1996

The delivery of immunizations and other preventive services in private practices.

OBJECTIVES: To measure the proportion of children cared for in private practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age. DESIGN: Cross-sectional chart review. SETTING: Fifteen private pediatric practices in central North Carolina (11 chosen randomly). PATIENTS: One thousand thirty-two randomly selected 2-year-old children. MAIN OUTCOME MEASURES: Proportion of children immunized and screened for anemia, TB and lead poisoning by 24 months of age and immunization and screening rates of the practices. RESULTS: Sixty-one percent of the children were fully immunized at 24 months of age; the rates among practices varied widely (38% to 82%). Sixty-eight percent of the children had been screened for anemia, 57% had been screened for TB, and 3% had been screened for lead poisoning. Physicians overestimated the proportions of fully immunized children in their practices by an average of 10% (range, -3% to 17%). The median number of well child visits by 2 years of age was 5 (range, 0 to 14), and only 19% of the entire sample made 8 or more well child visits, the number recommended by the American Academy of Pediatrics in the first 18 months of life. The numbers of well child and non-well child visits were the strongest predictors of complete immunization. Practice characteristics associated with being fully immunized included the use of preventive services prompting sheets (eg, flow sheets) in the medical records, not seeing the same physician for all well child care, and having nurses review patients' immunization status during their visits to the office. CONCLUSIONS: Underimmunization and inadequate screening are significant problems in private pediatric practices in North Carolina. Physicians are unaware of the rates of underimmunization in their offices.

Anemia↗
PubMed1996

Implications of the development of managed health care in the South African private health care sector.

The South African private health care sector has been looking to managed health care (MHC) to control the unsustainable cost escalations of the last decade. This paper draws on experience of MHC in other countries, particularly the USA, to assess its potential for solving the private sector's difficulties. In addition, it looks at problems which may be associated with MHC in a South African setting. The conclusion reached is that MHC alone cannot be seen as a panacea for the private sector's financial problems, although it may produce a degree of saving and be part of a solution. It is argued that MHC per se seems unlikely to compromise equity, quality of care or the public health care sector, and that it may potentially promote national health policy objectives. However, if MHC's benefits are to be maximised and potential negative effects controlled, ongoing monitoring of MHC, coupled with an appropriate regulatory and incentive environment, will be required.

Cost Control↗
PubMed1996

[From in vitro fertilization to embryo transfers: evaluation of ten years of reproductive medical assistance in the private sector in France].

The activity of the private-run French AMP centers was analyzed through a retrospective study. The results were given in Toulouse in December 1995. IVF: 50% of activity in France are done in private centers. From 1983 to 1995, 71,974 oocyte retrievals allowing 53,370 embryo transfers were realized and 11,721 pregnancies occurred with 11,088 healthy babies born. ICSI: from 1992 to 1995 3,399 embryo transfers were done. The segmentation rate is 48%. The evolution of the 886 pregnancies thus obtained and the results of the foetal karyotype are detailed in the study. The other assisted reproductive technics (embryo freezing, oocyte donation) are undertaken in the private sector. The results can be found herewith.

Adult↗
PubMedDate not supplied

Assessing family planning service-delivery practices: the case of private physicians in Jamaica.

This report presents the results of a study of the family planning service-delivery practices of private physicians in Jamaica. All 367 private physicians in Jamaica who offer family planning services, counseling, or referral were included in the survey. The study revealed that a client seeking services might be given a method by one provider and not by another, and that the methods clients use are likely to be influenced by the providers' preferences. Private physicians in Jamaica are in need of access to current international guidance on contraceptive methods and service practices.

Adult↗
PubMed1996

Patients' perception of public, voluntary and private dispensaries in rural areas of Tanzania.

Eighty percent of rural dispensaries are run by the government and 19% by voluntary organisations that charge for some services. After the re-legalisation of the private health sector in 1991, private dispensaries are also emerging in villages. Privatisation is among the health reform policies of the country. Moreover, cost-sharing will be introduced at public dispensaries soon. Perception of 320 patients in the Coast Region of Tanzania on services delivered by the three health sectors has been investigated. Results show that patients are generally satisfied with the services and they would go back to the same dispensaries for treatment. Polydrug prescription was common in all sectors, while lack of prescribed drugs was a main complaint among public dispensaries patients. Voluntary dispensaries patients were less satisfied with long waiting time and with staff that did not give them enough information about the treatment. Currently, health service in public dispensaries is free but cost-sharing will be introduced soon. Most of voluntary and private dispensaries patients stated that the fees for service were moderate. The paper discusses the need for monitoring the implementation of cost sharing in public dispensaries to ensure equity in access to services by rural patients.

Adult↗
PubMedDate not supplied

Private physicians' provision of contraceptive services.

Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.

Adolescent↗
PubMed1997

The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: a study from Pediatric Research in Office Settings.

OBJECTIVES: To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private pediatricians. STUDY DESIGN: Retrospective and cross-sectional surveys of immunization data. SETTING: The offices of 15 private pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs. PATIENTS: Children 2 to 3 years old followed by the participating physicians. METHODS: The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each pediatrician's practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one measles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized. RESULTS: For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual pediatrician and size of the metropolitan area in which the pediatrician's practice was located were significant predictors of a child's immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90). CONCLUSIONS: Individual provider behavior may be the most important determinant of the immunization status of children followed by private pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population.

Attitude of Health Personnel↗
PubMed1998

High immunization rates versus missed immunization opportunities in a private pediatric office.

OBJECTIVE: This prospective study examines coverage levels for immunization of two-year-old children in a large private pediatric practice, and delineates the frequency of missed opportunities for vaccination. SETTING: A private single-specialty group pediatric practice in a suburban locale. DESIGN: With the aid of our office billing computer, 218 children between the ages of 21 and 24 months who had ever received medical care in our practice were identified. A manual chart review was performed to identify those children no longer receiving care from us. Of the 189 patients remaining, the immunization records in the patients' charts were compared to the State of Delaware immunization registry to identify those who had not received the full panel of recommended vaccines. Those charts were examined to identify reasons for underimmunization. No patient recall was performed. The charts of underimmunized children were reexamined five months later to determine how many had become fully immunized. RESULTS: On initial review, 86 percent of 21-24 month old children in our practice had received all recommended vaccines. Only 15 percent of the underimmunized children had had a missed opportunity for vaccination in the initial chart review. About half of the underimmunized patients received their missing vaccines over the next five months, yielding an eventual immunization rate of 94 percent. Only two of the 11 children still underimmunized by the end of the study (aged 26 to 29 months) had appeared for an 18 month or a 24 month well child visit; only four of the 11 had had a missed opportunity to receive immunizations during the five month study period. A subsequent chart review showed that 90 percent of our patients were up-to-date at 24 months of age. CONCLUSIONS: Achievement of a 90 percent immunization rate for two year old children is possible in a large private practice. Most underimmunized children in our practice had failed to appear for recommended well visits; a minority experienced missed opportunities for immunization.

Child, Preschool↗
PubMed1998

Improving sexually transmitted disease management in the private sector: the Jamaica experience.

OBJECTIVES: To improve the quality of sexually transmitted disease (STD) case management in Jamaica by providing comprehensive continuing medical education to private practitioners who manage 60% of all STDs on the island. METHODS: Six half-day STD seminars were presented at 3-4-month intervals and repeated in three separate geographic locations. All Jamaican practitioners received invitations. The subjects were as follows: urethritis, genital ulcer disease, HIV infection, vaginal discharge syndrome, STDs in children and adolescents, and a review seminar. The program effectiveness was evaluated with a written, self-reported pre-test and a telephone post-test that measured changes in clinical management. RESULTS: Six hundred and twenty eight practitioners attended at least one seminar. Comparing pre- versus post-test scores, there were practitioner improvement trends in all four of the general STD management categories: counseling/education (69.8-73.3%; P > 0.05); diagnostics/screening (57.2-71.0%; P= 0.042); treatment (68.3-74.5%; P> 0.05); and knowledge (66.4-83.2%; P= 0.002). Obtaining syphilis serologies during pregnancy rose from 38.3 to 83.8% (P= 0.001), and providing effective treatment for gonorrhea rose from 57.8 to 81.1 % (P= 0.002), but correct responses on treatment for mucopurulent cervicitis at the post-test was a low 32.4%. CONCLUSION: The introduction of continuing medical education for improved STD care targeting private physicians in Jamaica was successful based on high attendance rates and self-reported STD management practices. However, efforts should continue to address the weaknesses found in STD management and counseling and to reach the providers who did not participate. In the global effort to reduce HIV transmission by improving STD care services, continuing education programs that target the private sector can be successful and should be included as a standard activity to improve care and provide a public/private link to STD/HIV control.

Adolescent↗
PubMed1998

[Medical responsibility of midwives in public and private maternity units. Results of a survey of 11 French regions].

OBJECTIVE: To describe medical responsibilities of midwives in maternity units and to compare these responsibilities between categories of maternity units. METHOD: A mail survey was carried out in 1996 on a random sample of midwives. The analysis was based on 884 midwives providing antepartum, perpartum or postpartum care in public or private maternity units. RESULTS: For many procedures and decisions, medical responsibilities of midwives were more important in the public sector than in the private sector. Responsibilities were more extended in university hospitals than in other public hospitals. These differences were observed in the postnatal ward, in the antenatal ward, and for some specific tasks in the labor ward. In the private sector, responsibilities varied according to the status of the maternity unit: midwives performed fewer procedures in profit-based maternity units than in non-profit ones. CONCLUSION: The roles of midwives vary from one type of maternity unit to another, but differences are also observed within the same categories of units. Consensus on what are the medical responsibilities of midwives does not exist in a variety of situations, even with regard to the management of normal pregnancies and deliveries.

France↗
PubMed1998

Detection and measurement of hypercholesterolaemia in South Africans attending general practitioners in private practice--the cholesterol monitor.

BACKGROUND: This paper reports data on the detection and management of hypercholesterolaemia in patients attending general practitioners in private practice in South Africa. METHODS: The frequency of cholesterol testing and the level at which active therapeutic intervention occurred at medical practices were monitored over a 2-year period. A sample of 200 medical practitioners was selected from private practices in major cities. Data on patients seen by the selected doctors during a 5-day monitoring period were recorded on a standardised form. RESULTS: 12,842 patients were seen by the 200 private practice GPs. More men (18.7%) than women (10.4%) had coronary heart disease (CHD), and their mean total cholesterol (TC) levels were 5.9 mmol/l and 6.0 mmol/l, respectively. Only 3.1% of the patients were reported to have familial hypercholesterolaemia (FH) and 12.8% were reported to have a family history of CHD. Reported smoking rates were exceptionally high (77.5% of women and 64.4% of men). The most commonly prescribed group of lipid-lowering agents was HMG-CoA reductase inhibitors. CONCLUSIONS: Inadequate management of hypercholesterolaemia leaves many patients with a high risk of CHD mortality in South Africa. Appropriately investigated patients with hypercholesterolaemia should receive treatment to reduce cardiovascular disease using more effective TC control programmes than are currently used in South Africa.

Adult↗
PubMed1995

Differences in the frequency of cholesterol screening in patients with Medicaid compared with private insurance.

OBJECTIVE: To assess compliance with preventive screening for Medicaid recipients compared with individuals with equal access to preventive services. SETTING: A community-based family practice residency program. METHODS: Survey of a consecutive sample of English-reading individuals, aged 18 to 50 years, with Medicaid (n = 98) or private insurance (n = 75), who had scheduled appointments in the clinic. MAIN RESULTS: Patients with Medicaid were as likely as those with private insurance to be screened for hypertension and cervical cancer in the last 5 years but were less likely to have received cholesterol screening (39% vs 65%, P < .001). Even after adjusting for differences in gender composition, age, race, marital status, and education level attained, patients with Medicaid were still less likely to have received cholesterol screening (odds ratio, 0.43; 95% confidence interval, 0.21 to 0.57). Although patients with Medicaid were no more likely to identify a barrier and, when identifying barriers, did not identify significantly more barriers than patients with private insurance, Medicaid recipients were less likely to state that cholesterol testing had been recommended by their physician (30% vs 44%, P = .05). CONCLUSIONS: Because access to screening tests by patients with Medicaid is equal to or better than that of those with insurance, differences in the frequency of cholesterol screening should not reflect financial barriers. Differences in the attention paid to screening by physicians and differences in cultural beliefs about the importance of screening may play a role in the underuse of screening services by individuals in lower socioeconomic groups.

Adult↗
PubMed1994

The Larimer County Children's Clinic. A public-private partnership to provide medical care to indigent children.

OBJECTIVE: To describe a unique collaboration between private and public entities to provide comprehensive health care to medically indigent children in rural Larimer County, Colo. SETTING: The Children's Clinic, Fort Collins, Colo. STUDY PARTICIPANTS: Uninsured children and those eligible for Medicaid, living in families with incomes below 150% of the federal poverty level. SELECTION PROCEDURES: Eligible patients have been enrolled in the Children's Clinic on a first-come, first-served basis. INTERVENTIONS: A community collaboration involving an interactive system with the Children's Clinic staff, the Larimer County Department of Health and Environment, private primary care and subspecialty physicians, ancillary health providers, and the family practice residency program at Poudre Valley Hospital, Fort Collins. Funding for this endeavor has been composed of city and county funds, public and private grants, community business support, and local fund-raising efforts, as well as Medicaid reimbursements. MEASUREMENTS/MAIN RESULTS: Since 1989, comprehensive pediatric care has been provided to a growing number of eligible children. At present, 3619 children, aged birth to 18 years, from 2230 families are being served. From this population, there were 8945 office visits to the Children's Clinic, 1392 patient contacts by the clinic social workers, 1287 visits to the Larimer County Department of Health and Environment for well-child care, 543 referrals to subspecialists and other community health care providers, and 615 after-hours visits to the Poudre Valley Hospital emergency department between July 1, 1992, and June 30, 1993. The clinic's professional staff consists of 2 1/4 full-time pediatric care providers, one nurse, one medical social worker, one receptionist, and one administrator, with an expenditure of $356,471. CONCLUSIONS: The Children's Clinic collaboration has provided comprehensive pediatric health care to a population that previously received only fragmented care. The next step is to assess the impact of this program on the frequency of emergency department visits for these patients.

Adolescent↗
PubMed2003

Occupational dermatoses among Polish private farmers, 1991-1999.

BACKGROUND: Little is known about work-related skin diseases among Polish self-employed farmers. In the National Register of Occupational Diseases, private farmers are placed in one category together with other agricultural workers, despite fundamental differences in compensation legislation and separate insurance institutions. The Agricultural Social Insurance Fund reports only on numbers of compensated cases. The aim of this study was to create reliable statistics on occupational dermatoses among private farmers. METHODS: All cases of work-related skin diseases diagnosed from 1991 to 1999 were included in the statistics. Compensation records of the Agricultural Social Insurance Fund were analyzed for diagnoses, causative factors, and health impairment of the skin. RESULTS: The first occupational dermatosis was registered in 1992. Until the end of 1999, there were 101 cases (63 women and 38 men). The incidence rose from 0.006/10000/year in 1992 to 0.189/10000/year in 1999. Allergic contact dermatitis was the most common diagnosis (86%), followed by infectious skin diseases (10%), irritant contact dermatitis (3%), and urticaria (2%). The most frequently identified causative factors were plant dusts (38%), animal allergens (36%), metals (29%), pesticides (18%), and rubber chemicals (15%). The median impairment due to skin disease was 20% (range 2-36%). CONCLUSIONS: Since the introduction of workers' compensation, the numbers of occupational dermatoses diagnosed in Polish private farmers have increased rapidly. However, compared to countries with a longer experience in this field, these figures remain low, probably due to low detection of these diseases.

Agricultural Workers' Diseases↗
PubMed1977

The private specificity H-2.4 and the public specificity H-2.28 of the D region are expressed on two independent polypeptide chains.

The antigenic specificities H-2.4 (private) and H-2.28 (public) in the H-2a haplotype are controlled by the D region of H-2 as defined by the available recombinants. In previous studies we have demonstrated by the antibody-induced redistribution method that the antisera against these specificities contain antibodies against at least two different polypeptide chains. We here report the results of the indirect immunoprecipitation of radiolabeled antigens after solubilization with Nonidet-P40. The antisera against the two specificities precipitated from such extracts two different and independent polypeptide chains, indicating that the products of the D region, as presently defined, comprise at least two different molecules. The molecular weight of both chains is approximately 45 000, which is similar to other molecules bearing private H-2 antigenic specificities. Consequently, the chromosomal segment presently defined by recombination studies as the D region, must contain another locus, controlling the second polypeptide chain which is detectable by anti-H-2.28 antisera, besides the H-2D locus which controls the polypeptide chain bearing the private specificity H-2.4 as well as most of the public specificities.

Animals↗
PubMed1990

A private idiotype can become recurrent through genetic recombination and gene(s) unlinked to the Igh locus governs its expression.

Any immune response is characterized by its idiotypic profile. Two different kinds of idiotype (Id) have been described. Private Id are restricted to a few individuals from a species while recurrent Id appear in a large majority of individuals from the same species immunized with the same antigen. We describe, in this report, an experimental model whereby a private Id can become recurrent through genetic recombination. The immune response of A mice against the hapten arsonate is characterized by a recurrent Id called cross-reactive idiotype A (CRIA). A strongly CRI, called CRIA-like, can be occasionally detected in some BALB/c mice (5% to 10%) immunized with arsonate. Molecular studies show that CRIA and CRIA-like antibodies have highly homologous D segments and identical light chains. By contrast, their VH segments are vastly dissimilar. We have examined the anti-arsonate response of inbred strains of mice whose Igh loci are recombinant between those of A/He and BALB/c. Interestingly, we have observed that the CRIA-like Id which is private in BALB/c becomes recurrent in the AXC-1 strain which harbors the VH genes from BALB/c, the DH and CH genes from A/He. Structural studies demonstrate that highly homologous, VH, VL and D segments are used in BALB/c and AXC-1 mice. The basis for this differential expression of highly similar genes could be linked to the DH locus. However, F1 mice stemming from the cross between AXC-1 and BALB/c do not express the Id. The backcross analysis shows that the non-expression of the Id in F1 mice depends on genes unlinked to the Igh locus.

Animals↗
PubMed1997

A comparison of the socio-demographic and clinical characteristics of private household and communal establishment residents in a multi-ethnic inner-city area.

This study compares the socio-demographic, physical and psychiatric profiles of representative samples of adults resident in communal establishments (n = 170) with those living in private households (n = 544) in a deprived multi-ethnic inner-city health district. Respondents were interviewed about their psychiatric and physical health as well as their early life experiences, close personal relationships, experiences of police contact and episodes of deliberate self-harm. Communal establishment residents were more likely to be single, white men and to be out of work than those in the private household sample. They typically left school at an earlier age, had a more disrupted upbringing, were less likely to have close personal relationships and reported more contact with the police. Both physical and psychiatric morbidity were substantially higher in the communal establishment residents than among those living in private households (especially for psychotic disorders). In contrast to these findings, comparisons between communal establishment residents with and without mental health problems revealed few differences. Our data highlight the extensive needs of those living in communal establishments and the need for a wide range of agencies to co-ordinate their efforts effectively if services to this population are to be effective.

Activities of Daily Living↗