[Practice of the dental art in private practice: study of the practicioner-patient relations and the responsibilities of the dentist].
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Dentist-Patient Relations↗
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Comparison of continuity in a resident versus private practice.
BACKGROUND: There is widespread agreement among pediatric educators that continuity (following a panel of patients on a first contact basis for all their health care) is an important part of the education of pediatricians. OBJECTIVE: To measure continuity in a pediatric residency practice and to compare this continuity with 2 nearby private general pediatric group practices. We also examined measures of continuity suggested in the literature. DESIGN: Visit data were obtained from the practice billing system for a resident continuity practice and 2 nearby private practices for the 3-year period from July 1, 1992, to June 30, 1995. Visit data used were restricted to patients seen in the office of the practices during regular office hours. Continuity was measured using 5 different indices: 1) the usual provider of care index, visits by the usual clinician/total visits, 2) continuity for patient, the average proportion of visits that an individual patient was seen by his or her own physician, 3) continuity for physician (PHY), the average proportion of visits that an individual physician saw his or her own patients, 4) Continuity of Care Index (COC), and 5) the Modified, Modified Continuity Index. During the period examined, pediatric residents were present in the continuity practice for 1 half-day each week. The resident continuity practice (RCP) had 57 residents and saw 3386 patients for 18 955 visits. Private practice 1 (PP1) had 4 pediatricians who saw 4968 patients for 33 537 visits. Private practice 2 (PP2) had 5 pediatricians who saw 11 953 patients for 75 778 visits. RESULTS: For all visit types, continuity in the RCP was not as high as in the private practices, PHY-RCP versus PP1, PP2; 53% versus 70%, 77%. However, continuity in RCP was greater than 50% for all measures except the COC index, which precipitously decreases as the number of clinicians seen increases. Examining continuity for health maintenance visits (PHY-RCP, PP2 vs PP1; 96%, 96% vs 82%) RCP was equal to the best of the private practices. The percentage of patients not seen for a health maintenance visit during the study period was lowest in the resident practice (RCP/PP1/PP2, 15/22/30). CONCLUSIONS: Although continuity for all visits in this RCP was less than in private practice, it was surprisingly high, considering the limited time residents spend in clinic. In a particularly important area for continuity, health maintenance visits, continuity was identical to one and superior to the other private practice.
Continuity of Patient Care↗
The emerging role of the oncology nurse practitioner: a collaborative model within the private practice setting.
PURPOSE/OBJECTIVES: To describe the development of the role of an oncology nurse practitioner (ONP) in a private practice. DATA SOURCES: Articles, book chapters, and personal experience. DATA SYNTHESIS: Successful role implementation will be facilitated by using a collaborative model supported by a shared philosophy of practice, written agreements delineating shared responsibilities and accountability, incorporation of the role into day-to-day practice, and regular evaluation and readjustment of goals. CONCLUSIONS: As oncology care has transitioned to outpatient settings, the role of the ONP can effectively meet both the medical and nursing needs of patients. A collaborative practice model can provide the framework for the physician-nurse professional relationship to ensure a higher level of patient care within the private practice selting. IMPLICATIONS FOR NURSING PRACTICE: The shift of health care to outpatient and private practice settings and the increased availability and use of ONPs mandates a systematic understanding of the process of ONP role development.
Career Mobility↗
The receptivity to and the feasibility of patient education for patients of private practice, primary care physicians.
This article describes a study of the receptivity to and the feasibility of a patient education service for patients of private practice, primary care physicians. A stratified (by medical specialty), random sample of 400 private practice, primary care physicians in the State of Maryland was selected from the State medical society roster. In addition, a random sample of 800 health care consumers was selected from a listing of residents in a five county area of Maryland. Questionnaires were developed, pilot tested, revised, and eventually mailed to the physician and consumer samples. Completed questionnaires were obtained from 140 physicians and from 314 consumers. Results indicated that both physicians and consumers were receptive to patient education in the private practice medical setting. Based upon the findings, recommendations are offered regarding the manner in which patient education in a private practice medical setting should be organized.
Attitude of Health Personnel↗
Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in pediatric private practice.
BACKGROUND: Universal screening of sexually active adolescents for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) has been recommended in settings in which prevalence is 2% or greater. Although believed to be above 2%, the prevalence of CT and GC infection in private practice settings has not been clearly established and may affect screening practices. OBJECTIVES: To determine CT and GC infection prevalence in 2 pediatric private practices. DESIGN: Cross-sectional study. SETTING: Two pediatric private practices in suburban North Carolina. PATIENTS: Convenience sample of patients aged 15 to 24 years who were seen from August 1998 through June 1999. MAIN OUTCOME MEASURES: Prevalence of CT and GC infection. RESULTS: Of 1114 eligible patients, 803 (72%) completed questionnaires and provided urine specimens tested for CT and GC infection using ligase chain reaction assays. Mean age was 17.1 years (standard deviation: 1.8). Most participants were female (63%), white (87%), and from highly educated families (64% of their mothers graduated from college). Sexual activity was reported by 41%. Prevalence of CT infection in all participants was 0.9% (confidence interval [CI]: 0.4%-1.8%); in sexually active participants, 2.1% (CI: 0.9%-4.3%); in sexually active females, 2.7% (CI: 1.0%-5.7%); and in sexually active males, 0.9% (CI: 0.0%-5.1%). One case of GC infection was found. CONCLUSIONS: The prevalence of CT and GC infection in this private practice population was much lower than reported in other settings. Screening recommendations may need to be reassessed if other low prevalence populations are found.
Adolescent↗
Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia.
OBJECTIVES: There is much debate as to whether the treatment effects achieved in well-controlled studies such as randomized controlled trials (RCTs) are generalizable to more "naturalistic" clinical populations, such as that seen in private practice. The current study sought to examine this issue in relation to social phobia. DESIGN: A benchmarking strategy was used to compare the effectiveness of a cognitive-behaviour therapy group programme for social phobia that was developed and evaluated in a research unit, to that of a private practice population. METHODS: Fifty-eight participants from a university research unit and 54 participants from an independent private practice who met the principal diagnostic criteria for social phobia completed the 10-session group programme. Symptom severity was measured at pre-treatment, post-treatment, and 3 months after treatment. RESULTS: No significant treatment differences were found between the research unit and private practice groups. Both groups showed significant treatment effects that were maintained at 3-month follow-up. CONCLUSION: These findings suggest that treatments developed for RCTs are potentially transportable to private practice settings.
Adult↗
[A comparison of paying patients in private practice and in public dental service--found from the Harstad-study 1974].
Since 1950, the Public Dental Service (PDS) has gradually been developed in Norway. In addition to rendering free and systematic treatment to children aged 6--17 years, which has priority, the PDS also offers treatment to other categories of patients at fixed fees, generally lower than those in private practice. The purpose of the present study was to elucidate the impact made by PDS on the dental treatment pattern within one particular area (the district of Harstad with a population of approximately 29,000). Furthermore, the study included a description of the clientele in the PDS, excluding the "free clientele" aged 6--17, in relation to that treated in private practice. During a limited period in February--March 1974, all the 9 dentists in the PDS treating "paying clientele" and all the 9 private practitioners in the district, filled in a questionnaire by each patient visit (course of treatment) (Fig. 1). In addition to the information on social and demographic characteristics, data were also collected on dental treatment pattern, the treatment presently rendered, and the presence of teeth and possible dentures (Fig. 1). Four--fifths of the visits made by "paying clientele" were made in private practice, only one--fifth in the PDS. In private practice, rural people, women and people of young age were underrepresented. Children under 6 years of age comprised 3% of the clientele in private practice and 9% in the PDS. No significant difference was found between the two types of practice regarding the social class composition of the clientele. Dental status as measured by the occurrence of teeth and dentures was generally poorer among the PDS patients, seemingly due to the overweight of rural people and of those with an irregular or occasional treatment pattern. Totally 40% of all visits were made by regular treatment attenders. 20% of the services delivered were prophylaxes and/or periodontics, 56% were conservative and/or endodontic treatments. The introduction of the FDS in the district some 10--15 years ago has conceivably contributed to an overall increase in the demand for dental services, and to an improvement of denial treatment patterns. During this period, the number of public dentists has increased from 2--3 to a total of 12. Correspondingly, the number of private practitioners has increased from 5 to 9, of whom 2 work part time. The treatment attendance of some population subgroups is, however, still lagging behind: rural people, small children and persons over 50 years of age, and particularly people belonging to lower socio-economic brackets.
Adolescent↗
Cytologic grading of fine needle aspirates of breast carcinoma by private practice pathologists.
OBJECTIVE: To determine the reproducibility of two clinically proven grading systems for breast carcinoma assessed by private practice pathologists. STUDY DESIGN: Twenty fine needle aspiration (FNA) slides of histologically proven breast carcinoma were submitted to 15 private practice pathologists practicing in 11 separate groups who interpret cytology as part of their daily practice. The pathologists received the same set of slides. They graded the FNAs using the modified Black (MB) (grades 1-3) and simplified Black (SB) (low grade, high grade) grading systems. Specified criteria and guidelines as well as case samples were provided. RESULTS: There was complete agreement among the 15 pathologists on only one case using the MB grading system as compared to five using the SB grading system. In MB, > or = 10 pathologists were in agreement on 14 cases as compared to 19 cases using SB. There were three cases in MB where the grades ranged from 1 to 3. Also noted in MB was the high number of cases graded 2 (intermediate grade). The predominant comment made by the pathologists was the easier, more objective and practical application of the SB. CONCLUSION: High reproducibility in the cytologic grading of FNA of breast carcinoma can be more readily attained among private practice pathologists using the two-tier SB grading system.
Biopsy, Needle↗
Editorial: Private practice.
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Dentistry↗
Perspectives on private practice. Handling the finances: HMO versus private pay.
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Financial Management↗
Letter: Is the Academy demolishing private practice?
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Pediatrics↗
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↗
Patients receiving immunotherapy report it is effective as assessed by the rhinitis outcomes questionnaire (ROQ) in a private practice setting.
BACKGROUND: Outcomes measurement is a proficient method in determining the effectiveness of medical therapy. Currently, there are no easy-to-use and inexpensive questionnaires available to evaluate the effectiveness of immunotherapy by allergists in private practice. OBJECTIVE: To evaluate the effectiveness of immunotherapy in the treatment of patients with allergic rhinitis in a private practice setting using the rhinitis outcomes questionnaire (ROQ). METHODS: One hundred seventy-five patients were randomly chosen from three private practices nationwide. They were surveyed regarding global systemic problems and nasal, eye, and chest symptoms, as well as their medical treatment history. This questionnaire was administered twice in one sitting, with the first a recall of symptoms before immunotherapy treatment, and the second an evaluation of current symptoms. RESULTS: The data revealed that 81% of the patients believed immunotherapy worked, with 19% unsure. Patients experienced a 67% decrease in antibiotic use, a 68% decrease in emergency room visits, a 75% decrease in days lost from work or school, and a 79% decrease in hospital admissions. The average symptom score reduction with immunotherapy was 52%. CONCLUSIONS: This study demonstrates that the user-friendly ROQ can be effectively and inexpensively used in a private practice setting and that immunotherapy is effective in the treatment of allergic rhinitis.
Female↗
[Adolescent medicine in private practice ].
Out of 13,455 private practice examinations performed over 6 months by 3 pediatricians and 2 general practitioners 4.2% concerned adolescents, aged 10 to 19, while they represent 16% of the population of the area. Pediatricians see less adolescents than general practitioners, and only adolescents under 14. Adolescents from workers' families seem to seek less medical advice than one would expect from their number in the population. Among the causes, respiratory infections come first, followed by requests for various medical certificates. For general practitioners, gynecologic and obstetrical problems represent one third of the reasons for consultations in girls and two thirds after 15 years.
Adolescent↗
Physical therapists in private practice: information sources and information needs.
Increasing numbers of physical therapists are providing evaluation and therapy in their own private-practice clinics. Their move out of the hospital setting has reduced their access to the sources of information designed to support clinical and practice-management decision making. The author designed a survey to determine how often physical therapists in private practice in Vermont use seven sources of information for clinical and practice-management decision making. Survey respondents also were asked to rate the anticipated usefulness of a variety of health sciences library information and research services not currently available to them and to rank access paths to information according to their preferences. The therapists' responses show frequent reliance on personal and office collections of professional literature for clinical decision making but virtually no use of bibliographic databases. Respondents ranked document-delivery services and mediated searches as having the greatest anticipated usefulness for clinical decision making. The limitations of their current information-seeking behavior and their high level of interest in increased access to a wide range of information and research services make physical therapists in private practice of special interest to health sciences librarians who are planning outreach programs.
Information Services↗
Patient education through the Internet: academic and private practice sites.
Although Internet use among patients continues to increase, the quality of disseminated information in orthopaedic surgery often is substandard. We reviewed and compared the web sites of academic orthopaedic surgery departments and private practices and rated their informational content with respect to patient education. Only 11.5% of academic sites and 52% of private practice sites list information on common orthopaedic conditions. Of these, less than 1/3 have information on various topics, and few have links to other patient education sites. Private practice web sites make better use of the Internet to provide patients with practical information about their individual practices. Few sites post the date of last update and those that do often have not been updated for more than 6 months. Academic and private practices underutilize the Internet as an educational resource. Orthopaedic surgeons are missing an important opportunity to provide accurate and reliable information to their patients.
Academic Medical Centers↗
A comparison of hospital outpatient departments and private practice.
This article addresses cost differences between primary care physicians in private practice and hospital outpatient departments (OPD's). The analysis utilizes ambulatory visit groups (AVG's), the outpatient equivalent of diagnosis-related groups (DRG's), to adjust for case mix. Major findings are that OPD's have higher per visit costs than physicians' private offices; internists are more expensive than general practitioners regardless of site; and ancillary service costs are actually slightly higher in private practice. Any prospective payment system for ambulatory care must consider these costs differences.
Costs and Cost Analysis↗
Value of immunoglobulin E (IgE) in the private practice of allergy. Eight years experience: 1973-1981.
In private practice the majority of patients evaluated by allergists are truly atopic. To assess the clinical value of determining the serum level of immunoglobulin E (IgE) in such patients the records of an individual private allergist were reviewed and all new patients were evaluated. Over an eight year period 7,000 new patients were seen and 5,500 measurements of IgE were performed. An elevated serum IgE value was indicative of the atopic state with few false positives. Successful immunotherapy as determined by patient reports, the decreased use of medications and reduced clinical visits was correlated positively with a decrease in serum IgE levels. This was true regardless of the initial value of the IgE. Unsatisfactory results in immunotherapy were often accompanied by an increase in IgE levels. Serial determinations of serum IgE levels over several years of treatment are of value in the evaluation of allergic patients in private practice.
Adolescent↗