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PubMed1985

Genital herpes infections in private practice in the United States, 1966 to 1981.

We analyzed data on genital herpes infections in the United States from 1966 to 1981 collected by the National Disease and Therapeutic Index survey. The number of private physician-patient consultations for genital herpes increased tenfold during this period. The number of patient visits for newly diagnosed infections increased 7.5-fold. Women aged 20 to 24 years and men aged 25 to 29 years were more likely to consult a private physician for genital herpes than were patients in other age brackets. Our analysis suggests an increasing national incidence of genital herpes infections and supports the concept that genital herpes infections are epidemic in the United States.

Adult↗
PubMedDate not supplied

Patterns of care given migrant workers in Utah by private physicians and clinics.

This comparison of the care given migrant workers in Utah by private physicians with that provided by clinics demonstrates that clinics can provide more services and meet more of their needs. For a population group in need of an organization that can function specifically for them, the clinic offers many advantages. The clinic's role can also be expanded to become a focal point in the community for a comprehensive health care program for the disadvantaged. Although the cost of such a program may exceed the cost of traditional curative care from individual private physicians, the potential gains make it worth attempting. If long-term health is valued above short-term palliation, then the clinic would appear to be the best method of achieving this goal.

Adolescent↗
PubMed1984

Naltrexone treatment for addicted health-care professionals: a collaborative private practice experience.

Sixty physicians and other health-care professionals with narcotic dependency were treated with naltrexone, 300 to 350 mg/week, in private physicians' offices. Patients remained on naltrexone treatment for an average of 8 months. On a global scale rating the degree of improvement in drug abuse, professional activities, and psychosocial adjustment, 29 patients were rated much improved and 31 either moderately or slightly improved. When these two groups were compared, it was found that more patients in the much improved group did not drink (p less than .01) and remained in naltrexone treatment longer than 6 months (p less than .01). Patients in the much improved group were also older (p less than .01). Naltrexone, used in the private practice setting, appears to be a useful treatment adjunct for addicted health-care professionals.

Adult↗
PubMed1983

[Pelvic inflammatory disease in private practice. An indirect estimation of the importance of the phenomenon in the French population].

A significant increase in the incidence of pelvic inflammatory disease in women aged 15-45 over two decades has been notified by many authors. We have therefore used the data of a survey in private practice in order to evaluate the size of the problem in France taking into consideration that the majority of cases of PID are managed primary primary care systems (G.P. and private specialists). Compared with other pathological problems PID rarely appears in practice (0.6% of contacts with physicians) but the total number of contacts during a year can be estimated at 745 000 in 1975 throughout the country. The highest frequency is observed in the 25-29 age group. There is no difference between professional women and women who have no profession, nor between rural and urban areas. Half of all cases had been notified by general practitioners and the others by gynaecologist/obstetricians. About two-thirds of cases present as acute problems. With this information it is possible to discuss extrapolation to the whole area so as to estimate the prevalence and incidence of PID in France. If a woman has 3 contacts a year with her doctor when she has PID it can be calculated that in 1975 the prevalence was about 2.1% of women aged between 15 and 44 (+/- 0.5). If all acute problems are considered as new cases, the incidence can be estimated at about 1.3% (+/- 0.4) of women aged between 15 and 44.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Concerns of mothers seeking care in private pediatric offices: opportunities for expanding services.

A surplus of general pediatricians has been predicted for 1990. This surplus could provide both opportunity and need for practitioners to identify areas of maternal concern that might guide expansion of marketable physician services. For this purpose, maternal concerns were assessed by interviewing 207 mothers seeking care in private pediatric offices. Only 30% of mothers were most worried about their child's physical health. The remaining 70% were most concerned about problems falling into six categories of parenting, behavior, and development (psychosocial concerns): personality/social development, discipline, mental development, mother-child interaction time, adjustment to divorce and other life changes, and adolescent transition. Although the majority of these concerns conceivably could be handled in private offices, only 28% of these mothers had discussed their greater psychosocial concern with their pediatrician. A search for explanations of this failure to communicate indicated mothers often were not aware that their pediatrician could help, or they questioned his ability or interest in assisting them. Characteristics that correlated significantly with communication were higher family socioeconomic levels, and greater physician self-perceived ability and interest in these psychosocial problems. Parenting, behavior, and development concerns represent an opportunity for expanding services if some of these obstacles can be overcome.

Attitude of Health Personnel↗
PubMed1984

Use of private offices in education of residents in internal medicine.

Of the 440 accredited residency programs in internal medicine, 129 assign residents to private offices. From this group, 29 program directors with 47 resident-preceptor teams matched to the same offices submitted a complete set of questionnaires for analysis. The results provide information concerning the selection process for this assignment, its design and development, the nature of the educational activities, and evaluation and financing. The results suggest that the private office may be an effective learning experience for medical residents and an underused educational resource. A particular strength of the experience may be the frequent and effective resident-preceptor interactions, which seem to focus mostly on problem identification and clinical decision making.

Ambulatory Care Facilities↗
PubMed1982

Improving hypertension control in a private medical practice.

Hypertension is one of the most common diseases seen by the practicing physician. Yet, because of noncompliance, conditions of many hypertensive patients are not effectively controlled by treatment. The purpose of this study was to test the efficacy of a patient education program in reducing the blood pressure (BP) of hypertensive patients in a private, solo medical practice. The intervention program focused on three behavioral objectives-pill taking, appointment keeping, and dietary sodium reduction while stressing the need for taking responsibility for one's own care. It was hypothesized that patients receiving an educational intervention stressing self-care would benefit more than those receiving the usual medical care. A substantial reduction in BP was considered to be the measure of successful treatment. Thirty-nine hypertensive patients receiving drug therapy from a private, solo medical practice were randomized into either a treatment group or a control group. A comparison of means disclosed no pretreatment differences between the groups' average BPs. After following up both groups for six months, mean changes in BP were compared for both treatment and control patients using a two-sample t test for independent samples. The BP fell in the treatment group (-13 mm Hg, systolic; -8 mm Hg, diastolic) but rose slightly in the control group (3 mm Hg, systolic 0.5 mm Hg, diastolic). The difference in changes was significant for both the systolic and diastolic BP.

Adult↗
PubMed1995

A multiple case study comparison of normal private preparatory school and substance abusing/mood disordered adolescents and their families.

This multiple case study of ten families of normal private preparatory school adolescents and five families of substance abusing/mood disordered adolescents was an effort to identify factors that may suggest a relationship between the abuse of substances in adolescents who also have mood disorders and the following family factors: parental marital discord, degree of family satisfaction, and family problem-solving styles. The fifteen families completed four assessment instruments and participated in a videotaped problem-solving exercise. The results of this study showed that all members of the substance abusing/mood disordered adolescents' families rated themselves as dysfunctional in all major areas of family life. In contrast, the normal private preparatory school families reported satisfaction with most areas of family functioning. Communication styles also differed considerably between the two small groups of families. These results appear to support the importance of family evaluation and treatment when addressing the issue of adolescent substance abusers with mood disorders.

Adolescent↗
PubMed1994

Trends in work effort among private general dental practitioners.

Trends in the distribution and volume of dental services provide an empirical base upon which hypotheses on future service provision can be tested. The aim of this study was to examine changes in the distribution and volume of service provided in private general dental practice, and compare these with an existing conceptual model. A weighted, stratified random sample of Australian dentists was surveyed in 1983 (730 respondents, response rate 73 per cent) and 1988 (855 respondents, response rate 75 per cent). The data were weighted to provide population estimates for private general dental practitioners in 1983 and 1988. Service-mix data were converted to relative value units, a common scale based on work effort, and annual estimates of this work effort were calculated. Work effort was divided into low, medium and high level interventions. Medium level interventions comprised the greatest volume of work effort, followed closely by low level interventions, with high level interventions having the smallest volume. The pattern of work effort was in contrast to the conceptual model of service distribution, with low level interventions higher and high level interventions lower than expected. While there was a significant increase in work effort among high level interventions, there was no increase in work effort among low level interventions and no decrease in work effort among medium level interventions over the five year period 1983-88 as expected in the conceptual model for changing service provision.

Adult↗
PubMed1994

Smoking restrictions in private workplaces in Singapore.

This survey aims to determine the number and profile of private workplaces in Singapore which have a smoking restriction policy. The response rate was 43%. Of the companies which responded, 59% had some form of smoking restriction. Private companies are more likely to have a smoking restriction policy: (a) where smoking poses inherent fire risks, such as those dealing with inflammable chemicals or gases; (b) where smoking poses inherent detrimental effects to the quality of the products, such as those dealing with precision electronic microcomponents, where a smoke-free and dust-free environment is essential; (c) are larger companies; and (d) have strong management support in initiating and enforcing smoking restriction. Future programmes should give more emphasis to the service industries such as construction, insurance, banking and finance, and smaller companies (with fewer than 100 employees). They should involve the management who play an important role in implementing smoking restriction at their workplace.

Air Conditioning↗
PubMed1994

Colposcopy in a private family practice: a one year experience.

OBJECTIVE: To describe results achieved by family physicians performing colposcopy in our private practice. METHODS: A chart review was performed one year after initiating colposcopy services. RESULTS: Forty-five patients underwent 47 colposcopic exams, most often for mild dysplasia or persistent atypia on Papanicolaou smears. Of the 21 patients with persisting atypia on smear, 16 (76.2%) showed dysplasia on biopsy. Twenty-five patients (55.6%) underwent cryotherapy, which successfully eradicated the abnormality in 16 of the 20 (80%) for whom follow-up is complete. Ten patients (22.2%) were referred to gynecologists for further evaluation and/or treatment. Six patients (13.3%) had not received the recommended follow-up after either colposcopy or cryotherapy. CONCLUSIONS: Family physicians in private practice performing colposcopy and cryotherapy can provide complete care for 75% of patients with abnormal Papanicolaou smears. Patients with squamous atypia on smear may have dysplasia on biopsy more often than previously reported. A recall system and regular chart audits are recommended to improve follow-up.

Adolescent↗
PubMed1994

Selection of restorative materials in dental treatment of children and adults in public and private dental care in Finland.

To obtain information on the present selection of dental restorative materials and factors related to it, questionnaires were sent to a random sample of public health centres (47) and private dental practitioners (716) in May 1992. The dentists were asked to collect information on all fillings they placed during 3 and 1 working days, respectively. The study material consisted of 9886 fillings placed by 855 dentists. Glass ionomer was the major filling material in children younger than 17 years, ninety-one per cent of the fillings in deciduous teeth and 47% of those in permanent teeth were inserted using that material. In adults, composite was the most frequently used material, fifty-two per cent of the fillings placed by private practitioners and 43% of those placed in health centres. In total, amalgam was used in 15% of fillings placed for patients 0-16 years old and in 29% of fillings in adults. The results show that in children, glass ionomer is the most frequently used filling material and the use of amalgam is very limited. In adults as well, amalgam seems to be increasingly replaced by other filling materials.

Adolescent↗
PubMedDate not supplied

Private practice.

Private practice can both enrich clinical work in hospital and aid the teaching of medical students, but care must be taken not to abuse it. The final article in this series is designed to help those considering embarking on private practice.

Consultants↗
PubMed1993

Immunization barriers in Minnesota private practices: the influence of economics and training on vaccine timing.

OBJECTIVE: Identify barriers to immunization and evaluate the timing of immunization in private practice settings. METHODS: Design was a comparison of childhood immunization data with a survey of physicians who administered the vaccines. Setting was primary care offices in rural and urban/suburban Minnesota. Subjects were children under 7 years old who were receiving either Diphtheria, Tetanus, and Pertussis vaccine, Diphtheria and Tetanus vaccine, or the first Measles, Mumps and Rubella vaccine and their primary care physicians. Main outcome measures were time from birth to the third Diphtheria, Tetanus, and Pertussis vaccine (DTP) and from birth to the first Measles, Mumps, and Rubella vaccine (MMR) and their determinants. RESULTS: The third Diphtheria, Tetanus, and Pertussis vaccine and first Measles, Mumps, and Rubella vaccine were late in 32% and 41% of children, respectively. We observed a significant difference, based upon insurance status, in Diphtheria, Tetanus, and Pertussis vaccine timing (p = 0.0001) but not in Measles, Mumps, and Rubella vaccine timing. Significant correlates of earlier Diphtheria, Tetanus, and Pertussis immunization include physician residency training, suburban/urban practice locale, and the likelihood that the physician would refer children based upon insurance coverage to health departments for immunization. CONCLUSIONS: Important determinants of immunization in the private sector include reimbursement and physician training about prevention.

Child↗
PubMed1993

Pension vesting and preretirement lump sums among full-time private sector employees.

Vesting among full-time private sector employees has increased dramatically over the past two decades. With further increases expected, it seems likely that almost all workers covered by a pension plan will eventually receive some kind of benefit. Coverage, however, remains a problem. According to the most recently available data, only 46 percent of full-time private employees in 1988 were covered by a pension plan on their current jobs, 35 percent were vested, and an additional 4 percent were vested from a previous job. Vesting rates would have been higher if some workers had not cashed out their retirement benefits when they left previous jobs, but the impact is slight; most lump-sum recipients were also vested or covered on their current jobs. Vesting is higher among older workers and among men, though the gender gap has narrowed appreciably over time. Based on trends in vesting and 1988 rates for all types of workers aged 50-59, the analysis suggests that pension receipt rates among the elderly will continue to increase over the next decade.

Adolescent↗
PubMed1993

[Prospective payment per case and length of stay at coordinated private hospitals].

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

Hospitals, Private↗
PubMedDate not supplied

[The privatization of public services. The case of health services in Costa Rica].

This article analyzes the role of the State and public enterprises in the development of nations, from a particular standing point, and inquires into the privatization issue, reviewing both its concept and the possible mechanisms for its implementation. Also, emphasis is made on the selling of public enterprises as one of the several ways to privatize. Within this context, some measures for the reorganization of the Costa Rican National Health System are proposed. These measures uphold fundamental values of social justice. This article is based on a theoretical-conceptual framework from an innovative experience in health services management in Costa Rica, in which a self-managing cooperative society (a nonprofit enterprise) manages, by contract with national health care public institutions, an urban local health care system.

Costa Rica↗
PubMed1995

Patterns of symptomatic change in depressed patients in a private inpatient mood disorders program.

This naturalistic study of 352 depressed patients admitted to a mood disorders program in a private psychiatric hospital demonstrated that, for the majority of patients, combining cognitive group therapy with ongoing supportive individual, psychoeducational, milieu, and pharmacological interventions resulted in rapid overall improvement and discharge within a few weeks. Improvement was manifested across cognitive and vegetative factor scores of the Beck Depression Inventory. However, patterns of symptom remission differed for subgroups defined by different lengths of stay. For example, patients hospitalized for 4 weeks showed good initial response, followed by a plateau in improvement, and, finally, continued response. These patients eventually reached the same level of functioning at discharge as did more rapidly responding patients with briefer stays. In contrast, a subset of patients (10% of the sample) hospitalized 5 weeks or more showed less overall improvement (especially in vegetative symptoms), plateauing at a moderately symptomatic level. These data suggest that in a minority of depressed individuals, continuing physiological disturbances may underlie dysthymia or residual depression. However, in contrast to the high rates (20-30%) of chronicity reported from tertiary care settings, these data indicate the relatively good initial treatment response of depressed patients admitted to a private psychiatric hospital.

Adolescent↗