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PubMed1979

A comparison of obstetric morbidity and management between clinic and private patients.

The patterns of morbidity and management among clinic and private patients in a teaching hospital were compared by an audit of computerized case records. The clinic patients were more likely to have a poor obstetric history and antenatal complications, and the private patients were managed more actively. Perinatal mortality in the clinic patients was higher and was related to the higher frequency of low birth weight babies.

Adolescent↗
PubMed1992

Improving pregnancy outcomes: public versus private care for urban, low-income women.

This study describes the characteristics of women who received maternity care from the Chicago Department of Health or from private practitioners in 1988 and the first half of 1989, and who delivered at the University of Illinois Hospital or Cook County Hospital. The risk of preterm low birthweight for the infants of these women was compared according to source of prenatal care. The likelihood of giving birth to a preterm, low-birthweight infant was significantly greater (odds ratio 3.1, 95% confidence interval 2.3-4.0) for women who received care only from private physicians (n = 530) compared with those who received care entirely from the Chicago Department of Health (n = 2465). This relationship remained after adjustment for race, age, parity, history of adverse pregnancy outcomes, smoking, and use of drugs during pregnancy. We examined alternative explanations for these findings, and concluded that although the role of urban public health departments in the direct delivery of maternity care services continues to be a source of controversy, these institutions remain an important provider of such care for low-income women.

Chicago↗
PubMed2000

Conduct of trials in private clinical practice.

PURPOSE: Trials of antiepileptic medications are usually based in tertiary referral centers with teaching hospital resources. Epilepsy Research & Services (ERS) is part of a private outpatient neurological clinic that is involved in research as part of multicenter clinical trials, adhering to Good Clinical Research Practice. ERS is subject to external monitoring and auditing, but does so outside of the teaching hospital environment. METHODS: The clinic is operated by a neurologist supported by a research assistant, administrative and nursing staff and has no formal university attachment. Patients are recruited for trials from routine referrals for clinical care. The center has formal ties with the ethics committee of the local teaching hospital, but none of the team is formally attached to that hospital. RESULTS: The center conducted trials of zonisamide, oxcarbazepine, gabapentin, remacemide, tiagabine, vigabatrin, felbamate, and lamotrigine both as add-on trials in refractory seizure disorders and as monotherapy trials in de novo epilepsy. More than 200 patients have been recruited for trials at ERS (with some patients being involved in more than one trial). External review endorsed ERS as a superior environment for such research and as a model for other centers. CONCLUSIONS: Private practice is a viable alternative for the conduct of clincial trials and should be considered when establishing such protocols. Simplicity of administration and clinical practice, which more closely mirrors standard patient care, may enhance recruitment and management.

Ambulatory Care Facilities↗
PubMed1996

The natural history of outpatient alcohol and drug abuse treatment in a private healthcare setting.

Managed healthcare has had a major impact on the delivery of alcohol and drug abuse treatment services in the private setting, primarily by shifting patient enrollment from inpatient to outpatient treatment programs. The purpose of this study was to investigate the natural history of outpatient alcohol and drug abuse treatment in a private, nonprofit healthcare setting. Patient profiles at pretreatment, their attendance record in a 6-week outpatient program, and their outcome in the year after treatment were evaluated in 120 patients with a DSM-III-R diagnosis of alcohol and/or cocaine dependence. There were 70 outpatients who successfully completed the program, and 50 who did not. Two subtypes of outpatient treatment failures were identified: S5 who prematurely left treatment against medical advice (n = 23), and S8 who attended treatment but continued heavy use of substances (Treatment Resistant, n = 27). A logistic regression revealed that younger age, multiple prior treatments, and employment problems were related to outpatient treatment failure. Outpatient failures did not immediately seek alternative treatment, and most of them continued heavy substance use in the year post-treatment: i.e., 82% vs. 43% successful completers (chi 2 = 13.8, df = 1, p < 0.01). Thus, there were a clinically relevant number of outpatient failures (42%), either because of lack of program attendance or continued substance use throughout treatment. These behaviors were related to continued heavy use of substances in the year after treatment.

Adult↗
PubMed2004

A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants. Results from a private practice.

This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were < or =11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or length of the rehabilitations was no specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2-4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead os surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bon grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners.

Adolescent↗
PubMed1996

Long-term periodontal maintenance in private practice.

Adult periodontitis is a chronic disease suffered by the mainstream of the world's population. To date, its treatment consists of providing support, control, and stabilization of the disease rather than a cure. Although treatment modalities rely upon a maintenance program to preserve a controlled environment that has been established, it is painstakingly evident that total patient compliance does not exceed 40% in private practice. In addition, there is little evidence that any society is populated by plaque-free patients. The important variables in private practice are the end point goals of treatment, manpower availability, patient behavior, the size of the treatment facility and the economic pressures of the geographic location. Each of these has to be considered in its entirety to appreciate the difficulties encountered in managing this significant issue in a periodontal practice.

Adult↗
PubMed1982

Oral health care delivery in Denmark: a system of private enterprise and public accountability.

The Danish oral health care delivery system is a publicly funded, predominantly school based system of care for children and adolescents and a private practice copayment national health insurance mode for adults. Study of this dualistic system can provide useful information to dental public health practitioners. Interviews with experts in the Danish oral health care system and a selected review of the literature demonstrate that improvement trends are occurring in the oral health status of both adults and children. These improvement trends can be directly related to a combination of treatment and preventive measures undertaken by the country as a whole, and to specific interventions for certain subpopulation groups, such as preschoolers. Four key variables can be defined which have contributed to the success of the Danish oral health care delivery system (DOHCDS). These include 1) the role of private sector input into the development of the DOHCDS, 2) demography, 3) the Danish value system, and 4) the structure of the DOHCDS.

Adolescent↗
PubMed1993

Dental status of 12-year-olds treated in private practice and a school dental service.

Different ways of service provision frequently lead to different services being provided. In the School Dental Service (SDS) in Western Australia, all 5-15-yr-olds are eligible for care free of charge and most avail themselves of the service. The parents of some children choose to use private dentists (typically copaying about 50% of the cost) and their children do not attend the SDS. This study aimed to compare the dental status of 12-yr-olds who attended private dentists with that of matched children enrolled in the SDS. Non-enrolled 12-yr-olds in Perth (F- 0.8 mg/l) were identified and asked to provide background information and participate in clinical examinations. Each non-enrolled participant was matched with a classmate of the same sex. Of 184 non-enrolled children, 100 actually participated. Data on caries experience (DMFT and DMFS), fissure sealants and gingival health (CPITN) were collected by clinical examination. Analyses used Wilcoxon's signed rank, categorical and t-tests and simple linear regression. Caries prevalence was lower in non-enrolled children (0.31) than in enrolled (0.47). Caries experience was also lower in non-enrolled children (mean DMFT 0.71 vs. 0.95, ns). Enrolled children had more FT than non-enrolled (Wilcoxon, P = 0.059) but the mean number of DT in each group was 0.14. Enrolled children had somewhat fewer fissure sealants than non-enrolled children but in enrolled children there was an apparent (P = 0.056) inverse relationship between number of fissure sealants and DMFT scores; this was not the case in the non-enrolled group, suggesting better targeting of fissure sealants in the SDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed1997

Insurance status and provision of dental services in Australian private general practice.

Annual expenditure on dental care in Australia amounts to AUD 1.9 billion. Approximately one-third of this expenditure involves private dental insurance, yet little is known about the impact of insurance on the provision of services. The aim of this analysis was to examine differences in dental service provision between insured and non-insured patients. Data collected from a random sample of dentists from a survey conducted in 1993-94 were used, providing 817 responses (response rate 74%). Logistic regression analysis controlling for patient age and sex and reason for visit indicated that in private general practice insured patients were more likely to receive preventive (OR = 1.37), crown and bridge (OR = 2.25), and endodontic services (OR = 1.27), but less likely to receive extraction services (OR = 0.52). However, no significant differences by insurance status were found for diagnostic, restorative, or prosthodontic services in the multivariate models. These differences in service provision by insurance status indicate a more favorable pattern of services for insured patients, and point to equity issues in the provision of services.

Adolescent↗
PubMed2002

Prenatal care services in the public and private arena.

PURPOSE: This exploratory study described the prenatal care experience in the public and private arena from the perceptions of childbearing women using interpretive interactionism. DATA SOURCES: A face-to-face interview comprised of eight open-ended questions was used to obtain pregnant women's perceptions of their prenatal care experience and prenatal care needs. The purposive sample consisted of six women who received private prenatal care and 14 women who received public prenatal care. CONCLUSIONS: Five essential elements of the prenatal care experience were identified. Prenatal care was viewed as a cooperative effort between informal self-care and formal care by health professionals. Issues related to individuality and normality were important considerations in the delivery of prenatal care. IMPLICATIONS FOR PRACTICE: Controversy exists over the effectiveness of prenatal care in preventing poor outcomes, as the definition of what constitutes adequate prenatal care remains unclear. Advanced practice nurses (APNs) continue to play a pivotal role in the provision of prenatal care services. The expanded knowledge and skills possessed by APNs place them in a pivotal position to develop and implement individualized, developmentally appropriate prenatal care that the women in this study so desperately wanted. In addition, they can assist women in continuing the health promoting behaviors initiated prenatally through out their lifespan.

Adult↗
PubMed1983

Measurement of effects of a state dental practice act on potential delegation and production in general dental private practice.

Detailed treatment information was obtained on every procedure performed for all patients seen during a two-year period in 14 private dental practices in Kentucky. This information permitted the investigation of the effect of Kentucky's State Dental Practice Act on the amount of production that could have been legally delegated in the 14 practices. The development of a new measure called the Standard Production Minute (SPM) allowed for the examination of the relations between delegation and production by measuring the two variables in the same time-based units. Results of the study indicated: In 14 private dental practices in Kentucky, 58.7 percent of all production was legally delegable under the State Dental Practice Act. The three areas of operative, hygiene/prevention, and exam/diagnostic data accounted for 74.8 percent of overall production and 67 percent of the production in these areas was legally delegable to auxiliaries in Kentucky. Within individual areas of dentistry, the greatest potential delegation rates were found in these three areas. Given the procedure-mix for the 14 practices, 31 percent of all potential delegation was restricted to hygienists and 18 percent of all production was delegable only to the hygienist under the Kentucky State Dental Practice Act. If the delegation of placing and finishing restorations was restricted by the Kentucky State Dental Practice Act, the percentage of production that could be delegated in the operative area would have decreased from 53.1 percent to 20 percent. However, the percent of production that could be delegated across all areas would have decreased from 58.7 percent to 46 percent.

Delivery of Health Care↗
PubMed1987

Training and calibrating evaluators for a national private dental office assessment program.

The work described was conducted to train and calibrate ten general dentists to participate as evaluators in a national program in which methods were developed and tested for the in-office evaluation of private general dental practice. The methods used in conducting six days of initial training are described, as well as the approach taken in establishing the posttraining levels of individual and group calibration achieved. Training and calibration that occurred halfway through a two-year field experience also are described. Techniques employed included the use of slides in lecture format; review of records, radiographs, and other materials from dental offices; examination of patients; use of a videotaped simulation of an office visit; and evaluation of private dental offices by paired evaluators. Calculation of percent of comparability of evaluator performance was used in determining calibration levels. We concluded that evaluators can be trained in six days to achieve a high level of calibration. Additional benefits were derived from the additional training session at the midpoint of field activities. Evaluators perceived themselves to be well prepared as a result of the training described.

Dental Care↗
PubMed1989

The effect of public or private management on patients with temporomandibular joint pain dysfunction.

Australians may receive free dental treatment via the public sector if they have a health care card but otherwise must seek treatment via the private sector. These two modes of dental delivery have different objectives, facilities, and patient populations. Two groups of patients, one public and one private, who presented to the same clinicians with temporomandibular joint dysfunction were studied. There were differences in age, numbers of natural teeth and some psychological features. However, the outcome to simple non-surgical management resulted in similar levels of successful treatment.

Adult↗
PubMed2003

Service provision trends among Australian private general dental practitioners: 1983/84 to 1998/99.

AIM: To investigate time trends in service provision. DESIGN: Four cross-sectional surveys across a 15-year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Services per visit, annual services per dentist, annual services per patient. RESULTS: Total services per visit increased over the study period from 1.78 to 2.14 (Poisson regression; p < 0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased over the period from 3.47 to 5.22 (OLS regression; p < 0.05), reflecting both the increased service rate per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more endodontic and crown and bridge services. The pattern of annual care received per patient also included more endodontic and crown and bridge services but differed from the dentist pattern through increased service rates over the study period in areas such as restorative, diagnostic and preventive. CONCLUSIONS: While dentists are providing a similar number of services annually, the content of their workload has changed to include less emphasis on removal and replacement of teeth and more effort on maintenance and retention of natural dentitions.

Adult↗
PubMed2000

Genomics. Public-private project to deliver mouse genome in 6 months.

Research on the mouse genome lurched into the fast lane last week, as private donors joined the U.S. government to step on the gas. A public-private consortium announced on 6 October that it's kicking $58 million into a new fund that will pay to sequence the DNA of the "black six" (C57BL/6J) strain of laboratory mouse. The consortium aims to produce a draft version of the genome by the end of February.

Animals↗
PubMed1988

Boom in private rest homes in Southampton: impact on the elderly in residential care.

A survey in 1986 of 450 elderly people in 51 private rest homes and 206 residents of seven local authority (part III) homes in the Southampton area showed no significant difference in overall dependency between the two populations. Although age and sex distributions of the residents of part III homes had remained the same between 1982 and 1986, the average level of dependency had fallen significantly. Since the provision of places increased because of expansion in the private sector residential care institutions are generally catering for a more independent population.

Activities of Daily Living↗
PubMed2005

Improving the quality of STI care by private general practitioners: a South African case study.

OBJECTIVES: Evaluation of an intervention to improve quality of sexually transmitted infections (STI) care among 64 private general practitioners (GPs) working in two urban districts in Gauteng Province, South Africa. METHODS: We implemented a multifaceted intervention, the core of which were four interactive continuing medical education seminars. Changes in STI treatment practices were evaluated through record reviews before and after the continuing medical education intervention in 17 randomly selected practices in the intervention districts and in nine randomly selected practices from a reference GP group (n = 34). RESULTS: There were statistically significant improvements in the quality of drug treatment for urethral discharge but not pelvic inflammatory disease among both intervention and reference GPs. CONCLUSIONS: Improvements in STI quality were possibly the result of a background secular trend rather than the intervention itself. Further research is needed on financial and other incentives to improved quality of STI care in the private sector environment.

Family Practice↗
PubMed2004

Emergency department image interpretation services at private community hospitals.

PURPOSE: To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services. MATERIALS AND METHODS: The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses. RESULTS: Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage. CONCLUSION: There is great variation in the current provision of emergency radiology services in private community hospitals.

Academic Medical Centers↗