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PubMed2002

Using patient-focused research in evaluating treatment outcome in private practice.

The increasing emphasis on therapist accountability and empirical demonstration of psychotherapeutic treatment effectiveness points to the need for practicing therapists to integrate treatment evaluation methods into routine clinical practice. Unfortunately, most private practitioners have little involvement in carrying out evaluation procedures. In this study we demonstrate how patient-focused research was used to track the progress and outcome of patients seen by a clinical psychologist in private practice. Twenty-nine adults and 40 children/adolescents were evaluated on a weekly basis to assess the number of sessions required to reach improvement (reliable change) and recovery (clinically significant change). Dose-response survival analysis results indicated that 50% of adults reached clinically significant change in 54 sessions, and 50% of youth met the same standard in 14 sessions. These results were compared with outcome in large-scale studies. Implications of this study for integrating treatment evaluation methods into clinical practice are discussed.

Adolescent↗
PubMed1994

Gender wage differentials in private and public sector jobs.

"In this study gender wage differentials in private and public sector jobs in Austria are calculated. Occupational attainment is considered as endogenous by the use of an ordered response model. Results show that wage discrimination is also present in the public sector, though on a lower level. Both in private firms and for public servants a substantial part of this unwarranted differential is due to unequal professional advancement."

Austria↗
PubMed1977

Methodology and results of a survey of adverse reactons to a drug in private practice.

A survey of tolerance of a drug, determined in private practice under "naturalistic" conditions by 591 physicians, and involving 22277 patients is presented. The procedure used in private practice to gather systematic information about reactions to the drug involved a system of data sheets with detachable cards for optical reading and computer analysis. The survey was conducted under the responsiblity at regional level of a team of scientific coordinators-hospital pharmacologists and poison control centres. Possible side effects were noticed in 13,82% of patients, a figure similar to known nocebo reactions. Tolerance was significantly related to sex, age, weight, geographical area, duration of treatment, association with other durgs and therapeutic result. When related to individual physicians, the overall number of side effects and the frequency of three of them in particular did not follow a binomial distribution; the rate of adverse reactions was significantly related to the number of years of practice of the physicians.

Adult↗
PubMed1997

The role of private-for-profit managed behavioral health in the public sector.

Managed behavioral health, once largely confined to private sector employees, has been growing rapidly in the public sector. Throughout the country, behavioral health services, particularly for Medicaid enrollees, are coming under the management of private-for-profit firms. The authors discuss these developments, and the controversies that have come about as a result. Several public/private models of managed behavioral health services are identified.

California↗
PubMed1996

Trauma-related disorders in psychiatrists' and general practitioners' private practice in Switzerland.

A questionnaire addressing traumatic stress related issues was mailed to every third psychiatrist in private practice and to every fifth general practitioner in Switzerland (N = 1406, number of returns 517 (37%). Trauma-related disorders seem to be underdiagnosed. Patients suffering from rape, accidents and war related trauma were most often mentioned. Psychiatrists knew more about specific treatment possibilities than general practitioners. Only 14% of the responding clinicians were satisfied with the existing therapeutic services for trauma victims; more psychiatrists voiced a need for their improvement. A majority suggested interdisciplinarity and the cooperation of institutions and therapists in private practice for the treatment of trauma-related disorders. It is proposed that further education should be tailored according to the target professional group.

Adult↗
PubMed1998

Privatized Medicaid managed care in Massachusetts: disposition in child and adolescent mental health emergencies.

Data from child and adolescent emergency mental health screening episodes prior and subsequent to privatized Medicaid managed care in Massachusetts are used to investigate the relationship between payer source and disposition and to compare the match between clinical need and disposition level of care. Having Medicaid as the payer in the post-Medicaid managed care period decreased the odds of hospitalization by nearly 60%. None of the clinical need variables that contributed to hospitalization for Medicaid episodes in the pre-Medicaid managed care period were significant in the post-Medicaid managed care period. Multiple forces shaping professional standards, decision making, and quality of care are described. Public sector agencies must lay the groundwork for comprehensive evaluation prior to the implementation of privatized Medicaid managed care initiatives.

Adolescent↗
PubMed1999

Private practitioners' documentation of outpatient psychiatric treatment: questioning managed care.

This study investigates how social workers, psychologists, and psychiatrists document the treatment they provide clients to managed behavioral health care organizations. The rosters of the Register of Clinical Social Workers, the American Psychological Association, and the American Psychiatric Association yielded a sample of 168 private practicing social workers, 158 psychologists, and 258 psychiatrists from across the nation. Results indicated that practitioners differed based on age, amount of time spent in private practice, racial self-identification, percentage of time with clients diminished due to communicating with managed behavioral health care organizations, and documentation of clients' prognoses. Some practitioners believe it is necessary to report treatment needs in ways to assure certification rather than in ways that accurately depict clients' clinical profiles. The ramifications for clinicians' evaluation of their own practices, reimbursement for their services, and meeting clients' needs while working under managed behavioral health care guidelines are discussed.

Adult↗
PubMed1983

Experience with routine office sigmoidoscopy using the 60-cm flexible colonoscope in private practice.

Based on reported success and safety, 1121 sigmoidoscopies were performed in 964 patients seen privately by one surgeon, as a routine office screening procedure, using the flexible 60-cm sigmoidoscope instead of the rigid 25-cm instrument. The doubling of the distance that was examined doubled the diagnostic yield for neoplasia and inflammatory bowel disease, specific or nonspecific. As compared with barium-enema examinations, the yield was even greater: 5:1 for neoplasia, 7:1 for inflammation, 3:1 for polyps greater than 1 cm, and 5:1 for false-negative, false-positive, or equivocal x-ray findings. No serious complications were encountered in any of the examinations including 72 polypectomies performed in the office. The study supports flexible fiberoptic sigmoidoscopy as a major screening tool for individuals in private practice in truly evaluating the interior of the lower 60-cm of the colorectum for neoplasia and for the diagnosis and monitoring of bowel disease or neoplasia confined to that area.

Adolescent↗
PubMedDate not supplied

A target-based model for increasing influenza immunizations in private practice. Genesee Hospital Medical Staff.

OBJECTIVE: To measure the impact of a population-based tracking system on influenza immunization rates. DESIGN: Thirteen practices with 45 physicians were randomized to a control and two intervention groups. SETTING: Private practices. PATIENTS: All patients aged 65 years and over who were seen in participating physicians' practices within the preceding two years. INTERVENTION: In both intervention groups influenza immunization rates for physicians were recorded weekly as cumulative percentages of their target populations, using a specially prepared poster. In addition, postcard reminders were sent to all the patients in one of the intervention groups. MEASUREMENTS AND MAIN RESULTS: Immunization rates in the two intervention groups were 30% higher than in the control group; the control group immunized 50% (2,405/4,772) of its target population, while the poster and poster/postcard groups immunized 66% (1,420/2,149) and 67% (2,427/3,604), respectively. CONCLUSION: A population-based strategy that monitors performance can significantly improve rates of influenza immunization in private practices.

Aged↗
PubMedDate not supplied

Training physicians about smoking cessation: a controlled trial in private practice.

STUDY OBJECTIVE: To test the hypotheses that physicians in private practice who receive a continuing education program (entitled "Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients. DESIGN: Randomized trial with blinded assessment of principal outcomes. SETTING: Private practices of internal medicine and family practice. SUBJECTS: Forty-four physicians randomly assigned to receive training (24) or serve as controls (20) and consecutive samples of smokers visiting each physician (19.6 patients per experimental and 22.3 per control physician). INTERVENTIONS: Physicians received three hours of training about how to help smokers quit. Physicians and their office staffs were also given self-help booklets to distribute to smokers and were urged to use a system of stickers on charts as reminders to counsel smokers about quitting. MEASUREMENTS AND MAIN RESULTS: Based on telephone interviews with patients, physicians in the experimental group were more likely to discuss smoking with patients who smoked (64% vs. 44%), spent more time counseling smokers about quitting (7.5 vs. 5.2 minutes), helped more smokers set dates to quit smoking (29% vs. 5% of smokers), gave out more self-help booklets (37% vs. 9%), and were more likely to make a follow-up appointment about quitting smoking (19% vs. 11% of those counseled) than physicians in the control group. One year later, the rates of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking were similar among patients in the experimental (3.2%) and control (2.5%) groups (95% confidence interval for the 0.7% difference: -1.7 to +3.1%). CONCLUSIONS: The authors conclude that this continuing education program substantially changed the way physicians counseled smokers, but had little or no impact on rates of long-term smoking cessation among their patients. There is a need for more effective strategies to help physicians help their patients to quit smoking.

Clinical Competence↗
PubMed2001

Picture archiving and communications systems (PACS) in private practice: St. Paul Radiology PACS project.

While much of diagnostic radiology is practiced in a private setting, many of the papers and presentations describing picture archiving and communications systems (PACS) implementation to date have been sponsored by university and government health facilities. We will present a 4-year retrospective review of a private practice PACS project. The challenges, benefits, and cost analysis of the PACS project will be presented.

Cost-Benefit Analysis↗
PubMed2005

[Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4].

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.

Endoscopy↗
PubMed2003

[Experience with a quality control system for mammography in a private practice setting].

Design and performance of a private audit of mammography utilizing the BI-RADS classification in a private practice setting are presented. By using a combination of physical examination,mammography and, whenever necessary, additional views and sonography, the goals of the BI-RADS audit were met. Practical issues of this audit are addressed.

Breast Neoplasms↗
PubMed1999

"Doi moi" and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam.

Vietnam, a developing country, has had comparatively good health and human survival at low cost. The economic reform changed the health care system, and private pharmacies during the last 5 years have taken over a majority of the drug distribution. Problems include weaknesses in drug regulation and reported increases in antibiotic resistance. This case study, a purposive sample of two private pharmacies in Hanoi, explored management, including dispensing, inventory and financing, using the concept of triangulation. Observations and interviews of customers were complemented by stock inventory and interviews of the pharmacy staff. Drugs were classified according to the ATC code and the essential drug list of Vietnam. Pretested protocols were used. In all 1833 encounters were studied during the 2 weeks, out of which 286 were children. Less than 1% of customers came with prescriptions and 94.9% decided by themselves which drugs to buy. Antibiotics represented 17%, of which 90% were broad spectrum. Ampicillin dominated, both in children and adults. Some 50% of the antibiotics were given for 2.5 days or less. Less than 50% of the drugs were essential drugs (ED) on dispensing and even less on inventory. Antibiotics and vitamins were the most commonly sold drugs and, overall, brand names dominated. Little if any drug information was observed. Antibiotics were said to represent the most profitable drugs, according to the pharmacy staff. More than 20% of all products were combination drugs, including irrational and popular products with antibiotics and corticosteroids and combinations of aspirin, phenacetin and caffeine. This study shows an unexpectedly high proportion of customers, being "Tu Lam Bac Sy" (their own doctors), deciding themselves which drugs to buy. Although the "Doi moi" renovation has led to much improved drug availability, at least in urban setting, our case study highlights major problems in need of urgent actions. In particular the prevailing practices regarding antibiotics and combination drugs need to be seriously scrutinized and drug regulatory mechanisms should be enforced.

Adolescent↗
PubMed2002

Amenity values of public and private forests: examining the value-attitude relationship.

Public values toward forests have changed since the late 1980s, from a commodity-oriented perspective toward a more inclusive (commodity and non-commodity) orientation. This study examines the influence of four indicators of population diversity (age, ethnic background, place of residence, and gender) on amenity values of forests, environmental attitudes, and forest value-attitude correspondence. Four values of public and private forests were assessed, wood production (utilitarian value), clean air (a life support value), scenic beauty (an aesthetic value), and heritage (a spiritual value). Environmental attitudes were measured using a modified version of the New Environmental Paradigm scale. Five hundred and forty-eight randomly selected residents of households in 13 states of the Southern United States participated in a telephone interview. Age and ethnic background were found to moderate the value-attitude relationship, with the strength of the association being dependent upon the type of forest (i.e., public or private) and the forest value (i.e., utilitarian, life support, spiritual, and aesthetic). Females, younger persons (less than 43 years old), and whites reported lower utilitarian values of forests than their respective counterparts. Results are interpreted within the context of an emerging post-material society, in which a biocentric orientation to forests and the natural environment may be favored more by a younger (versus older) generation and increasingly racially diverse U.S. population. Implications for managing forests using a multiple-values (versus multiple-uses) approach are discussed.

Adolescent↗
PubMed2003

Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study.

Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five-night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.

Adult↗
PubMed2006

The demand for private health care under national health insurance: the case of the self-employed.

This study explores the demand for private health care and supplemental health insurance in Israel, where universal national health insurance provides all inhabitants with a standard package of medical care. Our theoretical model and empirical study follow research previously conducted in four other countries. It was found that the self-employed in Israel demand more private health services and supplemental health insurance than wage-earners. Income, age, education, health status, marital status, origin, and profession were found to play a part in explaining these demands.

Employment↗
PubMed2005

Hospital cost flexibility in the presence of many outputs: a public-private comparison.

This paper develops flexibility measures in the context of a multi-firm output based on a generalized average cost function. We then apply this methodology to assess and compare the relative flexibility of hospital services in Québec and California based on two very complete data sets. Results indicate that there is no clear distinction between private and public institutions and that there is no clear distinction between Québec and California hospitals. However, there are clear differences in flexibility among different outputs. This last result suggests that there are bottlenecks in the health care system and calls for a targeted approach on the part of hospital administrators, whether public or private, in Québec or California.

California↗