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At least 1,225 records · Page 68Linked to original sources
PubMed2002

Survey of dental radiographic services in private dental clinics in Damascus, Syria.

OBJECTIVES: To perform a radiographic survey of private dental clinics in Damascus, Syria using a postal questionnaire to produce recommendations for improving the quality of dental radiographic services and education in Syria. METHODS: Three hundred private dental clinics in Damascus were surveyed using a postal questionnaire (in English and Arabic) containing 27 questions on demographic information, equipment, techniques, selection criteria, frequency of examinations, and undergraduate/ postgraduate education. RESULTS: Two hundred and two (67%) dentists responded of which 95% graduated in Syria. The results showed a general lack of knowledge and understanding of dental radiography. Sixty four per cent did not know the kVp setting of their equipment, 73% used D-speed film, 57% did not use film holders and beam aiming devices, 25% did not use a viewing box. In addition, 45% of known equipment operated at 50 kVp or less and 16% was over 20 years old. No meaningful selection criteria existed with a wide variation in type and frequency of radiographs used for different clinical conditions. Syrian undergraduate training in dental radiology was minimal and there was no postgraduate education in the speciality. CONCLUSIONS: Several areas of the radiographic service in Damascus fall short of current recommendations on good practice. Recommendations are made to improve the service, the quality of undergraduate education and to establish postgraduate education.

Adult↗
PubMed2003

Nurses who left the British NHS for private complementary medical practice: why did they leave? Would they return?

BACKGROUND: Although the successful retention of National Health Service (NHS) nursing staff is a policy concern, evidence suggests that substantial numbers of registered nurses continue to leave the profession, and some to own and run small caring-related business. At the same time, private complementary medicine has undergone a rapid expansion in recent years, and initial impressionistic evidence suggests that many therapists are former nurses. AIMS: The paper investigates the motivations and experiences of nurses who have either left nursing altogether, or substantially reduced their involvement, and who now practise complementary medicine in the private sector. It also investigates the issue of whether they would consider returning to practise complementary medicine within the NHS. METHODS: A combined questionnaire (n = 63) and semi-structured interview (n = 11) survey was used to collect detailed attitudinal data from respondents. The analytical approach to the interview data used a form of constant comparative analysis which was derived from the principles of grounded theory. In particular, the interviews were developed and refined from each other as they progressed. RESULTS: The majority of therapists operate independently, either from their own homes or from small rented premises. They were originally motivated by a disillusionment with the health service and particular aspects of their former jobs. However, equally they were attracted by the therapies themselves, the conceptual paradigms which underpin them and the different experiences of practice. Despite stating a disillusionment with the NHS, most respondents expressed a cautious willingness to potentially re-enter the NHS to practise complementary medicine. CONCLUSIONS: Many practising complementary therapists are registered nurses who may be willing to re-enter the formal health service. It is therefore argued that a greater synergy between orthodox and complementary medicine may be one way of addressing shortages of nursing labour, and in particular this form of drop-out, whilst meeting evolving consumer health care demands.

Adult↗
PubMed2002

Improving private practitioner sick-child case management in two urban communities in Pakistan.

OBJECTIVE: To evaluate if INFECTOM, a multicomponent behaviour change strategy, would alter the care received by children visiting private healthcare providers so that it was more consistent with the IMCI algorithm. METHODS: Community surveys in two low income communities in Pakistan identified children who had visited healthcare providers in the preceding 2 weeks complaining of diarrhoea, cough or rapid breathing, or fever. Interviewers asked the mothers of these children whether providers performed specific behaviours recommended by the Integrated Management of Childhood Illness (IMCI) algorithm. These data were analysed to generate provider-specific IMCI-related behaviour profiles. A team including community representatives met with the providers, discussed the correct IMCI algorithm behaviour, reviewed the percentage of time each of their practices was consistent with IMCI recommendations, and negotiated a contract with a numerical target for improved practices. This cycle of survey, discussion of results and contracting was repeated three times over 10 months. RESULTS: Twenty-two providers, 13 of whom (59%) had a medical degree, regularly treated children in the two communities. Sixteen of the 21 targeted behaviours (76%) occurred with significantly increased frequency during the course of the intervention. Of the 10 practices that ill children with any of the syndromes should have received, at baseline children averaged receiving 4.3. In the final model, each subsequent round of evaluation was associated with a 0.57 increase in the number of appropriate practices performed at visits to non-Bachelor's Degree in Medicine (MBBS) qualified providers (P < 0.001) and a 0.75 increase among visits to MBBS qualified providers (P=0.004). The percentage of children who received an injection decreased from 70 to 56% (P=0.03). CONCLUSIONS: INFECTOM altered the practices of private providers so that they were more consistent with the IMCI algorithm. Efforts to further develop this approach could improve the quality of clinical healthcare in other settings.

Case Management↗
PubMed2002

Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit.

OBJECTIVE: To characterize psychological distress of women admitted with their infants to a private hospital mother-baby unit. METHODS: A cross-sectional self-report survey including standardized psychometric questionnaires of consecutive admissions to Masada Private Hospital Mother-Baby Unit, Melbourne between 1 June and 30 November 1997. Scores on the Profile of Mood States, Edinburgh Postnatal Depression Scale, Intimate Bonds Measure, Parental Bonding Instrument, Social Support Questionnaire, Vulnerable Personality Scale self-report instruments and responses to a structured self-report questionnaire. Of the women admitted, 109 out of 146 participated in the survey. RESULTS: Clinically significant fatigue was almost universal in this cohort. Psychological distress clustered into three distinct groups: (i) probable depression; (ii) fatigue and distress; and (iii) fatigue only. It may be more accurate to conceptualise postpartum psychological distress either as a continuum, or as a wide range of distinct states, rather than as a dichotomous condition in which individuals are categorized as being or not being cases. In this cohort, the severity of distress was associated most consistently with the quality of a woman's relationship with her partner and with infants who were difficult to settle. CONCLUSIONS: It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention.

Adult↗
PubMed2002

Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans.

OBJECTIVE: We compare preventive services utilization among privately insured African Americans and Hispanics in managed care organizations (MCOs) versus fee-for-service (FFS) plans. We also examine racial/ethnic disparities in the receipt of preventive services among enrollees in FFS or MCO plans. DESIGN: Analysis of the nationally representative 1996 Medical Expenditure Panel Survey. PARTICIPANTS: Participants included 1,120 Hispanic, 929 African-American, and 6,383 non-Hispanic white (NHW) adults age 18 to 64 years with private health insurance. MEASUREMENTS AND MAIN RESULTS: We examined self-reported receipt of physical examination, blood pressure measurement, cholesterol assessment, Papanicolau testing, screening mammography, and breast and prostate examinations. Multivariate modeling was used to adjust for age, gender, education, household income, and health status. Hispanics in MCOs were more likely than their FFS counterparts to report having preventive services, with adjusted differences ranging from 5 to 19 percentage points (P <.05 for physical examination, blood pressure measurement, breast examination and Pap smear). Among African Americans, such patterns were of a smaller magnitude. In both MCOs and FFS plans the proportion of African Americans reporting preventive services was equal to or greater than NHWs. In contrast, among Hispanic women in FFS, a non-statistically significant trend of fewer cancer screening tests than NHW's was observed (Pap smears 75% vs 80%; mammograms 66% vs 74%, respectively). In both MCO and FFS plans, Hispanics were less likely than NHWs to report having blood pressure and cholesterol measurement (P <.05). CONCLUSIONS: With the demise of traditional MCOs, reform efforts should incorporate those aspects of MCOs that were associated with greater preventive service utilization, particularly among Hispanics. Existing ethnic disparities warrant further attention.

Adolescent↗
PubMed2006

[Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by private practice gastroenterologists].

The standard treatment for patients with chronic hepatitis C consists of pegylated interferon (PegIFN) alpha in combination with ribavirin. Information on treatment effectiveness outside clinical trials is sparse. To study community-based health care, a regional network supported by the German network of competence for hepatitis (Hep-Net) was created between gastroenterologists in private practice and a tertiary referral centre. A treatment register containing evidence-based guidelines was established and 212 consecutive patients who were treated with either PegIF Nalpha 2a/ribavirin (n = 126) or PegIFNalpha2b/ribavirin (n = 86) for 24 weeks (HCV genotype 2, 3) and 48 weeks (HCV genotype 1, 4, 5), respectively, were included and followed prospectively. Twenty-four weeks after cessation of antiviral treatment a sustained virological response was achieved in 54 % of the patients. By univariate analyses, infection with HCV genotypes 2 or 3 (p < 0.0001), younger age (p < 0.0001), normal gamma-glutamyltransferase levels before initiation of treatment (p = 0.003), and absence of language communication problems (p = 0.023) were associated with a sustained virological response. The presence of liver cirrhosis in patients with HCV genotype 1, 4, 5 infection was associated with lower sustained response rates (p = 0.025). Patients infected with HCV genotype 1 in whom the PegIFNalpha dose was reduced had higher virological relapse rates (p = 0.049). With regard to the treating physician, sustained virological response rates ranged from 26 - 67 % in patients infected with HCV genotype 1. Our study shows that virological response rates similar to those in international randomised clinical trials can be achieved by private practice gastroenterologists. The presented network allows characterization of the treatment outcome in chronic hepatitis C not only with regard to virus- and host-related factors but also on an individual physician basis.

Adult↗
PubMed2006

[Persons insured with the German statutory sickness funds or privately insured: differences in health and health behaviour].

This paper deals with differences in health and health behaviour between those who are insured in the German Statutory Sickness Funds (GKV) and those who are privately insured (PKV). This topic has been largely ignored in German Public Health research. The analyses are based on data from a large survey in Germany conducted in 1998 and including 6822 adults. The multivariate analyses have been performed with OLS and logistic regression, separately for men and women and controlling for age, educational level, income and region. The most important result is that PKV-insured men have fewer diseases and feel more healthy than GKV-insured men. For women, though, no significant association could be found between health and type of health insurance. The interpretation of these results is mainly based on the "selection hypothesis", stating that healthier persons are more likely to be insured in the PKV than in the GKV. This would imply that the "causation hypothesis" (stating that being privately insured has a positive effect on health) is less important. Taking into account the current discussion on the balance between GKV and PKV, it is believed that future research should focus more on these topics.

Adult↗
PubMed2002

Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain.

OBJECTIVE: The purpose of this study was to examine body mass index and pregnancy weight gain as risk factors for primary cesarean delivery in nulliparous women in a middle-class private practice. STUDY DESIGN: Primiparous women who delivered in a private practice setting between February 1993 and July 13, 2001, were included. CIs along with Z statistics for paired count data were used to assess the statistical significance and relative importance of the relationships of body mass index and maternal weight gain to cesarean delivery. The effect of body mass index was examined as related to known confounders such as gestational age, birth weight, maternal age, and maternal height. RESULTS: The overall cesarean delivery rate for primiparous women was 21.76%. Risk of cesarean delivery increased consistently and significantly (P <.0001) with increasing body mass index. This effect was primarily mediated through an increase in cesarean delivery carried out for cephalopelvic disproportion/failure to progress. In our practice, the primiparous woman whose body mass index is >30 kg/m(2) is six times more likely to have a cesarean delivery for the diagnosis of cephalopelvic disproportion/failure to progress than the primiparous woman whose body mass index is <20 kg/m(2). This differential in cesarean delivery rate persisted when controlled for birth weight and gestational age and continues to persist when maternal age and height are also controlled. Excessive pregnancy weight gain exerted a statistically significant effect on cesarean delivery rate. This increase was primarily related to cephalopelvic disproportion/failure to progress among the nonobese women. CONCLUSION: Maternal body mass index is related strongly to the ability of primiparous women to be delivered vaginally without great difficulty. In fact, lean patients are excellent labor performers, particularly in contrast with obese patients. The relationship of increased body mass index to increased cesarean delivery is due to an increased rate of cephalopelvic disproportion/failure to progress. Excessive pregnancy weight gain is associated with a doubling of cephalopelvic disproportion/failure to progress rate in nonobese patients.

Adult↗
PubMed2001

Increasing the efficiency and flexibility of capital funding for public and private hospitals.

This paper outlines the recent history of capital funding in the health sector in Australia. It focuses on the trends in capital expenditures and the roles of the public and private sectors. The demand for future capital funding will depend upon a number of factors, including the state of the current capital stock and uncertain future impacts of technology and changes in patient demands. Because of these uncertainties, capital funding for the future must be flexible to meet any changes in operations and demand. The paper highlights the possible use of joint ventures between various public and private organisations, based on the principles of competition and cooperation.

Australia↗
PubMed2002

The price of choice: private health insurance in Australia.

Private Health Insurance (PHI) is an integral part of the financing of the Australian health care system. PHI is popular and has strong political support because it is perceived to give choice of access and responsiveness. However, in the past increasing premiums have led to a progressive decline in membership. A package of reforms by the Commonwealth Government in support of the private health insurance has reinvigorated the industry over the last three years. Some strategies for achieving a sustainable PHI industry are described. The key challenge is to control claims cost to maintain affordable premiums. Many techniques to do this compromise choice and challenge the very rationale for purchasing the product. Funds and providers will have to establish a new level of relationship to meet this challenge.

Australia↗
PubMed2002

Health insurance: managing risk in the private sector.

How does Australia, in both its private and public sectors, provide the health care that Australians want and need at prices they can afford to pay? If this is to be sustainable in the private sector health funds need to be given a capacity to manage their risk exposure. Provided insurers continue to insure sick people, costs will be driven not so much by the age profile of the insured population (though it will have some effect) as by technology and its capacity to supply and create the demands of the aged (not ageing per se). Handling these costs is the real challenge for the future.

Australia↗
PubMed2002

Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

It was anticipated that increase uptake of Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.

Elective Surgical Procedures↗
PubMed1997

Searching for the hospital yardstick: a case study of private hospital productivity bargaining.

The decentralisation of Australia's centralised wage fixation system has been seen as providing opportunities for employers and trade unions to tailor working arrangements to suit the needs of the workplace and to provide better paid long-term jobs. This paper details the productivity bargaining between the Private Hospitals' Association of Queensland and The Australian Workers' Union in 1995-97 in Queensland that led to the introduction of a number of productivity-based enterprise agreements. The case study shows that productivity bargaining in the private hospitals studied remains focused on 'bottom line' issues where cashable savings can readily be generated. The paper concludes with an examination of the lessons drawn from the productivity bargaining process.

Collective Bargaining↗
PubMed1999

The effect of the 30% private health insurance rebate on the purchasing behaviour and intentions of the Australian population.

This article examines the likely effect of the 30% private health insurance rebate on private health insurance coverage. It is based on a survey of the Australia population conducted in April-May 1999 which collected information on health insurance purchasing behaviour and intentions. These data are used to predict the subsidy's likely effect on hospital insurance coverage, with estimates ranging from 30.5% to 34.3% by May 2000. Ancillary insurance membership is forecast to increase to between 32.7% and 37.2% of the population over the same period. The 30% insurance rebate will probably produce, at best, a small increase in hospital insurance membership. The cost of the rebate is estimated at $1.4 billion in 1999-2000. Given the small increases in projected membership, the cost of the initiative is very high.

Age Factors↗
PubMed2000

Ten-year follow-up survey of clinical neuropsychologists: part II. Private practice and economics.

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.

Female↗
PubMed2002

Effects of dental attendance frequency in heavy and low private care-using young adults.

In Finland, adults born in 1961 or later were progressively entitled to subsidies for dental care from private practitioners during 1986-90, while at the same time having access to care in the Public Dental Service. The aim of this study was to compare the effects of attendance frequency of private dental care on treatment costs and treatment spectrum for the heaviest and lowest users over a period. Three separate cohorts of recipients of reimbursements were formed, using the Social Insurance Register. The highest and lowest cost groups in 1986, 1990, and 1994 were followed up to 1997. Initially, the mean numbers of visits were 1.2-1.3 and 5.2-5.6 and cost Euro 48 53 and Euro 358-379 among low users and heavy users, respectively, in all cohorts. Among the heavy users (the high-cost category) infrequent attendance was related to higher and frequent attendance to lower mean annual costs of care. Among the low users (the low-cost category the opposite was true. Those who initially belonged to the high-cost category received in 1997 significantly more (P < 0.01) restorative treatment and, to a lesser extent, more (P < 0.01) preventive and periodontal treatment than those belonging to the low-cost category. Frequent dental care seemed to benefit those who received a lot of care. Frequency of attendance was not associated with being a low or a heavy user, indicating rigid check-up routines. The inclusion of simple oral health data would greatly improve the usefulness of the register as an evaluation tool for health-political decisions.

Adult↗
PubMed1997

Utilisation rates and expenditure for public and private, curative-care services in semi-urban Guatemala.

In November 1994, a retrospective survey was conducted for two purposes; to investigate patterns of health-care uptake for childhood and maternal illness in semi-urban Guatemala; and to gain an insight into the expenditure incurred by the subjects when they consulted the various health-care providers. The subjects, who all belonged to a semi-urban ladina community, had easy geographical access to the health-care providers, of all types, operating in Sacatepequez, in the central highlands of Guatemala. The community was divided into clusters of roughly equal population size and 20 of these were selected. Within each selected cluster, eight households that had at least one young child (< 5 years of age) were investigated. Mothers belonging to each household were asked whether, how frequently, and where they had sought outside help for any health problem that had possibly affected them or their children during the past year. Subsequently, they were also invited to recall the expenditure incurred on the last visit, if any, to each type of health-care provider established in the area. The crude utilisation rates, for all providers combined, were 1.0/women.year and 0.8/child.year. Overall, 61% of women had no uptake of curative care for themselves and 12% of families no such uptake for their children. Lay curers and clinics run by non-governmental organizations were hardly utilised. Drug vendors accounted for 38% of contacts by women and 26% by children, private physicians for 34% and 38%, and public services for 22% and 33%, respectively. The utilisation rate of the official sector attained roughly 0.3/person.year in both women and children. Dissatisfaction with the treatment received and the lack of drugs were often given as reasons for not attending public services. The median total expenditure incurred per curative, health-care contact ranged from 0 quetzales in the official health centres to 63 quetzales with private physicians (a U.S.$ being equivalent to 5.5 quetzales at the time of the study). Although for each type of provider (except the health centres), expenditure was nearly equal for a woman or for a child contact, it consisted of a different mix of cost elements (consultation fee, drugs and transport) for each of the various categories of provider. The willingness for a more prominent role of the public sector. It would seem that there is, in the socio-economic environment of semi-urban Sacatepequez, room for experimenting with alternative modes of health-care financing to increase the quality and attractiveness of public services and their utilisation.

Adult↗
PubMed2005

A survey of private sector respirator use in the United States: an overview of findings.

Limitations of previous surveys of respirator use led the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Labor Statistics to undertake a survey of respirator use and practices among U.S. private sector employers. The survey was mailed to 40,002 private sector establishments in August 2001; the responses were used to develop national estimates. Respirator use was required in 4.5% of establishments and for 3.1% of employees. Of the establishments requiring respirator use, 95% used air-purifying respirators and 17% used air-supplied respirators. Manufacturing; mining (including oil and gas extraction); construction; and agriculture, forestry, and fishing had the highest rates of establishment respirator use. Respirators were used most frequently to protect against dust/mist, paint vapors, and solvents. Large percentages of establishments requiring respirator use had indicators of potentially inadequate respirator programs. Of establishments requiring respirator use, 91% had at least one indicator of a potentially inadequate respiratory protection program, while 54% had at least five indicators. The survey findings suggest that large numbers of employers may not follow NIOSH recommendations and Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration (MSHA) requirements for the selection and use of respirators, potentially putting workers at risk. The findings will aid efforts to increase the appropriate use of respirators in the workplace.

Air Pollution, Indoor↗