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PubMed2003

Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: an assessment of its impact on case detection.

SETTING: Ho Chi Minh City (HCMC), Vietnam. OBJECTIVE: To assess the impact on case detection of a public-private mix (PPM) project linking private providers (PPs) to the National Tuberculosis Programme (NTP). METHOD: Nine-month monitoring of referral and diagnostic data recorded in new referral forms and treatment cards for PPs and upgraded NTP registers. RESULTS: A total of 1549 TB suspects were referred, of whom 1090 (70%) actually went to the NTP for sputum examination. A total of 569 cases were detected through referrals or notification, of whom 45% were new sputum smear-positive cases. The case detection of new sputum smear-positive cases in PPM districts increased by 18% (21/100,000, 95%CI 0-42) compared to the previous year, while a slight decrease occurred in control districts. In HCMC as a whole, case detection increased by 7% (7/100,000, 95%CI 2-11/100,000). Among sputum smear-positive cases detected in NTP through referrals from PPs, 58% defaulted before initiating treatment. CONCLUSIONS: The tendency towards increased case detection associated with this PPM indicates a potential for utilising PPs to improve case detection. However, the NTP and PPs should jointly address the problem of initial default before considering expansion of this PPM model.

Disease Notification↗
PubMed2003

Towards health impact assessment of drinking-water privatization--the example of waterborne carcinogens in North Rhine-Westphalia (Germany).

Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management. However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water. On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water. Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented. The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially. On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk. The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality. Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements. If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality.

Carcinogens, Environmental↗
PubMed1992

The evolution of private geriatric care management. Guidelines for responsible practice.

Fueled by a series of demographic, occupational, and programmatic trends, private firms providing care management services to the elderly and their families have experienced rapid growth. A range of leadership challenges faces social workers entering this specialty. Exemplary ethical and professional behavior will ultimately determine the extent to which private geriatric care managers become a central component of the gerontological services network.

Aged↗
PubMed1992

Private geriatric care management: how families are served.

This article provides a synopsis of a 1987 study of private care management and looks at the reasons why individuals and families seek out and use the services of private care managers. Among the most common reasons are: to negotiate the long-term-care system, to get help in filling out forms, to get objective assistance in assessing options, to mediate family conflict over what to do, and to plan and monitor the care of family members.

Aged↗
PubMed1953

Cytologic detection of cervical cancer; four years' experience with routine smear examination in private practice.

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician's office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients. In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases-in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a "negative" smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate. In a few cases, early cancer was detected when smears were reported as "atypical" or "suspicious." Such reports demand as careful follow-up as do "positive" reports. There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.

Cervix Uteri↗
PubMed2003

Treatment for substance abuse in Australia: a comparison of public and private programs.

Alcohol and drug abuse is a major problem in Australia and caused over 4000 deaths in 1998 alone. The national policy for reducing the harmful consequences of drug and alcohol use focuses on decreasing the production and supply of drugs, reducing the demand for drugs including a focus on abstinence in treatment, and minimizing the harm to individuals and communities. This research examines substance abuse treatment in Australia, and identifies similarities and differences in funding, philosophy, purpose, and strategies between public and private treatment programs. Interviews of 21 treatment program directors in Sydney and Melbourne were done, using a valid and reliable semi-structured interview guide. Nine public, not-for-profit programs primarily focused on consultation to medical providers, detoxification, outpatient counseling, and harm minimization including methadone treatment and needle exchange. Rehabilitation, prevention, and/or research were objectives of a limited number. Twelve private, non-governmental programs primarily provided abstinence-based treatment in a variety of settings. Some for-profit programs, funded by insurance, provided three to four weeks inpatient care, usually with outpatient follow-up. Not-for-profit programs provided residential treatment in a therapeutic community over a period of 6 months to 2 years. Still others (both profit and not-for-profit) provided methadone treatment or outpatient treatment. Four were church related and six received funding through government contracts, social security illness benefits, and housing assistance. The general lack of structured rehabilitation programs seemed to be the greatest weakness of the Australian public programs. A low percentage of patients completing detoxification entered counseling, and studies were not available to show the outcomes of detoxification without follow-up. The availability of consultations to hospitals and health care practitioners seemed to be an excellent advantage, but the lack of structured SAT beyond detoxification may have minimized that advantage. Nurses were involved in a variety of roles in Australia, and six of the program directors or managers we interviewed were nurses. Nurses were usually in clinical roles or management roles, rather than counseling roles.

Adult↗
PubMed2003

Health seeking behaviour of tuberculosis patients--role of the private practitioner.

India accounts for nearly 30% of the global tuberculosis burden. The goal of the Revised National TB Control Programme (RNTCP) is to cure at least 85% of new smear positive cases of TB and detect at least 75% of such patients. There are many reasons for patient delaying seeking healthcare. A Private Practitioner plays a major role in combating the disease but unfortunately the doctor-delay is more than patient-delay. Still patients seem to prefer Private Practitioners and they are often the first point of contact for a significant number of patients with TB.

Communicable Disease Control↗
PubMed2003

A comparison of the antimicrobial resistance patterns of gram-negative bacilli isolated from community-private and university-affiliated hospitals from Puerto Rico.

Few studies have been performed in Puerto Rico concerning the antimicrobial resistance pattern of clinically significant Gram-negative bacilli. The antimicrobial resistance patterns of 5,590 Gram-negative bacteria obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: to retrospectively evaluate the reported in vitro resistance of clinical isolates of E. coli, K. pneumoniae, E. cloacae, S. marcescens, P. aeruginosa and A. baumannii to selected standard antibiotics and to compare the antimicrobial resistance patterns between Community-Private (CPH) and University Affiliated hospitals (UAH). E. coli was the most common Gram-negative enteric bacilli in both CPH and UAH. In UAH, E. coli demonstrated a statistically significant higher resistance to the selected beta lactams and amikacin antibiotics but not to ciprofloxacin or gentamicin. For K. pneumoniae, the antimicrobial resistant pattern showed that UAH isolates were significantly more resistant to the tested antibiotics with the exception of ceftriaxone. In CPH, E. cloacae isolates were significantly more resistant to piperacillin-tazobactam, ciprofloxacin and gentamicin, while in UAH this organism was more resistant to amikacin. In UAH, S. marcescens isolates demonstrated a statistically significant higher resistance to all tested antibiotics with the exception of imipenem, which was similar in both hospitals group. Pseudomonas aeruginosa demonstrated a statistically significant higher resistance in UAH to all selected antibiotics with the exception of ciprofloxacin and gentamicin, which was similar in both hospitals group. Acinetobacter baumannii was the most resistant organisms in both hospitals group. UAH isolates were significantly more resistant than CPH isolates for all tested antibiotics. When compare with other large-scale antimicrobial resistance studies, the present study results suggest an apparent higher resistance in the Puerto Rican isolates. The high numbers of antimicrobial resistant Gram-negative bacilli in our study strongly suggest multiple mechanisms of antimicrobial resistance including the presence of extended spectrum and chromosomally derepressed beta-lactamases.

Cross Infection↗
PubMed2004

Patient questionnaires and formal education level as prospective predictors of mortality over 10 years in 97% of 1416 patients with rheumatoid arthritis from 15 United States private practices.

OBJECTIVE: To prospectively analyze patient questionnaire scores concerning functional disability as well as formal education level as potential predictors of premature mortality over 10 years in 1416 patients with rheumatoid arthritis (RA) from 15 private practice rheumatology settings in 11 diverse cities in the United States. METHODS: At baseline in 1985 and periodically over 10 years, patients completed mailed self-report multidimensional health assessment questionnaires (MDHAQ) that included functional disability scores, formal education level, and other demographic and clinical data. Vital status was determined 10 years after baseline. Potential predictors of 10 year mortality were analyzed using descriptive statistics and Cox proportional hazards models. RESULTS: Vital status was accounted for in 1378 patients, 97.3% of the cohort. The standard mortality ratio was 1.6, similar to most reported series of patients with RA, as 401 patients died versus 251 expected over 10 years. Evidence of "dose-response" relations was seen for age, formal education level, functional disability scores, and helplessness scores as predictors of mortality. In Cox proportional hazards models, age, sex, formal education level, functional disability, and helplessness scores remained significant independent predictors of 10 year mortality. CONCLUSION: Functional disability and low formal education level are significant predictors of premature mortality in people with RA under care in US private practice settings, as in most reported cohorts of patients with RA. This study shows that it is possible to account for more than 95% of patients over 10 years using mailed questionnaires to monitor patient status.

Adult↗
PubMedDate not supplied

Improved case detection of tuberculosis through a public-private partnership.

Case detection of tuberculosis under public DOTS programmes is still low and there is currently a search for new ways to improve these programmes. We investigated the impact of a public-private partnership DOTS programme on tuberculosis case detection in New Delhi, India. Time series of case detection in an intervention and a control area were analysed through segmented linear regression modelling. We found that a significant positive trend shift occurred in the intervention area as compared to the control area after the partnership was initiated. The study indicates that public-private partnership is feasible way to improve TB case detection.

Directly Observed Therapy↗
PubMed2004

Tuberculosis control in rural India: lessons from public-private collaboration.

SETTING: A rural tuberculosis (TB) Unit (population 350 794) in Pune district, Maharashtra State, India. OBJECTIVE: To develop a 'model' partnership between rural private medical practitioners (PMPs) and the Revised National Tuberculosis Control Programme (RNTCP). DESIGN: A partnership was developed between 100 PMPs in the study area and the district health and tuberculosis staff through facilitation by a non-governmental organisation (NGO). Participatory research methods were used to plan and implement the partnership. The process of creation and implementation of the partnership was analysed using quantitative and qualitative research methods. RESULTS: The partnership contributed to 30% of the cases detected in the TB Unit over a 5-month period. Six months after withdrawal of the NGO, referrals from the private sector to the RNTCP were continuing to a lesser extent, but there was a breakdown of the communication and documentation systems. CONCLUSION: The project highlights the importance of organisational and individual commitment to these partnerships, the key roles of the District Health Officer and the District Tuberculosis Officer in guiding and supporting these initiatives from the public sector, the potential role of process and outcome 'indicators' in monitoring partnerships and the important role of NGOs as intermediaries and facilitators.

Communicable Disease Control↗
PubMed2004

[The role of the Order of Veterinarians in the quality control of private veterinarians in France].

Instituted by the law of 23 August 1947, the missions of the Order of Veterinarians include monitoring compliance by all of its members (private veterinarians) with their professional obligations and with the rules laid down bythe Code of Practice of the profession. This code provides a national guide to good practice with which private veterinarians must comply, both in their personal behaviour and in their relations with their colleagues, the administration and their partners. Any violation of the provisions of the Code may result in disciplinary procedures being invoked by the administrative and judiciary authorities, or by any other interested person. This procedure leads to sanctions ranging from a warning to ten years suspension. In order to carry out its monitoring task, the Order needs to know the precise number and quality of its members and must then assess the quality of the service provided by these professionals in terms of respect for the Code of Practice. The Order must audit the competence of veterinarians, throughout their lives, by means of a continuing quality assurance mechanism for ongoing assessment of their knowledge; this mechanism has yet to be created. Finally, the Order must constantly listen to users of the profession, who must be provided with the best service at the lowest cost.

Animals↗
PubMed2004

Risk assessment practices of Texas private practitioners for sexually transmitted diseases.

This study describes the sexually transmitted disease (STD) risk assessment practices of a sample of private primary care practitioners in Texas. Elicitation of sexual history was not universal when these clinicians took the health history of their patients. Only 40% of the practices reported conducting a risk assessment for STD with all of their patients. In general, practices in obstetrics and gynecology, physicians providing care for persons infected with human immunodeficiency virus, and female physicians were more likely to indicate that they assess all of their patients for risks of STD. More than 90% of the practitioners conduct risk assessment for STD with all of those patients perceived to be at risk, but the criteria used for determining those patients vary greatly among practitioners. Private physicians in Texas provide care for a large proportion of individuals afflicted with STDs; our findings raise concerns about the lack of uniformity in the process of identifying patients at risk for STD.

Adolescent↗
PubMedDate not supplied

A survey of floss frequency, habit and technique in a hospital dental clinic & private periodontal practice.

The purpose of the study was to determine floss frequency, habits and techniques of patients entering a private periodontal office (office site) vs. a hospital dental clinic (hospital site). It was found that the flossing frequency in a hospital dental clinic is far less than in a private practice, and patients who do floss may not be using the proper flossing technique. Patients need more instruction and care with regard to their interproximal oral hygiene.

Adolescent↗
PubMedDate not supplied

Laser-assisted new attachment procedure in private practice.

Three private dental practices conducted a retrospective analysis of patients receiving the laser-assisted new attachment procedure (LANAP). Retrospective results were compared to clinical trial data from the University of Texas Health Sciences Center in San Antonio (UTHSCSA) to determine if outcomes from a controlled clinical trial can be duplicated in private practice. Results also are compared with published results of other surgical and nonsurgical therapies for inflammatory periodontal disease.

Adult↗
PubMed2004

Influence of compliance and smoking habits on the outcomes of supportive periodontal therapy (SPT) in a private practice.

PURPOSE: The purpose of this retrospective cohort study was to evaluate the effect of smoking habits and patient compliance on the outcomes of supportive periodontal therapy (SPT) (tooth loss and residual pockets defined by probing depth of > or = 5 mm) in a private practice situation. MATERIALS AND METHODS: Eighty-seven patients, who completed active periodontal treatment and then followed an SPT program for at least 5 years, were recruited from the patient pool of a private dental practice. After active periodontal therapy and at the follow-up examination 5-11 years later, pocket probing depths (PPD) and tooth loss were assessed, and the patients were divided into 4 subgroups based on their smoking history: non-smokers (NS); occasional smokers (OS); moderate smokers (S); and heavy smokers (HS). The patient cohort was also divided into 4 subgroups based on patient compliance (mean delay from the scheduled recall sessions): fully compliant (< 1 week); compliant within 1-3 weeks; compliant within 3-6 weeks; and not compliant (> 6 weeks). RESULTS: The mean tooth loss per patient and year ranged from 0.11 - 0.18 in the various subgroups with no significant differences between them. After a mean observation period of 7.3+/-1.5 years, the incidence of new sites with residual probing depth of > or =5 mm varied between 1.2% for the NS and 13.8% for the HS (p < 0.05,), and between 3.2% for the compliant and 5.8% for the non-compliant patients. CONCLUSION: Smoking habits significantly influenced the treatment outcomes of SPT, while compliance was less influential regarding the incidence of new residual pockets during 7.3 years of SPT.

Adult↗
PubMed2004

Private finance and sustainable growth of national health expenditures.

This analysis explores the role of the private sector relative to all health spending among Organization for Economic Cooperation and Development (OECD) countries. Bi-variate regression was employed for 31 countries using current data. It was found that the share of GDP allocated to health varies among countries, ranging from 5 percent in Turkey to 14 percent in the United States. Variation in per capita income explains much of this difference but other factors are important too. One appears to be the role of the private sector in financing health expenditures. Our analysis concludes that concern about rising health sector costs should be placed in a larger context: rising health care costs may be justified if benefits are large enough and cover the opportunity costs of alternative uses of resources.

Data Collection↗
PubMed2003

Adherence of the private sector to national tuberculosis guidelines in the Islamic Republic of Iran, 2001-02.

We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis (TB) and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > or = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > or = 36 years was the only significant risk factor for poor practice.

Adult↗