Patients who attend a private practice vs a university outpatient clinic: how do they differ?

Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured. The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care. We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP). Eligible patients were >30 years, Swiss nationals or long term residents, with one or more chronic conditions and attending the same practice for >3 years. They were asked to complete a questionnaire on sociodemographic data, use of medical resources and reasons for choosing and remaining at the same practice. Semi-structured interviews were conducted with a randomly selected subset of 26 patients to further explore their preferences. 329 patient questionnaires were completed, 219 by PP and 110 by OC patients. OC patients tended to be of lower socioeconomic status than PP patients. The main reason for choosing a PP were personal recommendation, while a higher percentage of patients chose the OC because they could obtain a first appointment quickly. A higher percentage of PP patients accorded importance to physician communication skills and trust, whereas a higher percentage of OC patients favoured investigation facilities. Qualitative data suggested that although OC and PP patients reported different reasons for consulting, their expectations on the medical and relationship level were similar. Our study suggests that the two groups of patients belong to different social backgrounds, have different patterns of care-seeking and attach importance to different aspects of care continuity. However, patients' expectations and perceptions of the physician-patient relationship are similar.

Quality assessment in private practice : the clinician as service provider

Assessment of quality in the private practice setting may be difficult. The author has taken the view that service delivery is a key outcome of private clinician practice. A method of assessing service delivery in a private consultant physician practice setting is described.

Periodontal and general health in long-term periodontal maintenance patients treated in a Norwegian private practice: a descriptive report from a compliant and partially compliant survivor population

BACKGROUND There is weak evidence to support the benefit of periodontal maintenance therapy in preventing tooth loss. In addition, the effects of long-term periodontal treatment on general health are unclear. METHODS Patients who were compliant and partially compliant (15 to 25 years' follow-up) in private practice were observed for oral and systemic health changes. RESULTS A total of 219 patients who were compliant (91 males and 128 females) were observed for 19.1 (range 15 to 25; SD ± 2.8) years. Age at reassessment was 64.6 (range: 39 to 84; SD ± 9.0) years. A total of 145 patients were stable (0 to 3 teeth lost), 54 were downhill (4 to 6 teeth lost), and 21 patients extreme downhill (>6 teeth lost); 16 patients developed hypertension, 13 developed type 2 diabetes, and 15 suffered myocardial infarcts (MIs). A minority developed other systemic diseases. Risk factors for MI included overweight (odds ratio [OR]: 9.04; 95% confidence interval [CI]: 2.9 to 27.8; P = 0.000), family history with cardiovascular disease (OR: 3.10; 95% CI: 1.07 to 8.94; P = 0.029), type 1 diabetes at baseline (P = 0.02), and developing type 2 diabetes (OR: 7.9; 95% CI: 2.09 to 29.65; P = 0.000). A total of 25 patients who were partially compliant (17 males and eight females) were observed for 19 years. This group had a higher proportion of downhill and extreme downhill cases and MI. CONCLUSIONS Patients who left the maintenance program in a periodontal specialist practice in Norway had a higher rate of tooth loss than patients who were compliant. Patients who were compliant with maintenance in a specialist practice in Norway have a similar risk of developing type 2 diabetes as the general population. A rate of 0.0037 MIs per patient per year was recorded for this group. Due to the lack of external data, it is difficult to assess how this compares with patients who have periodontal disease and are untreated.

Comparison of cost and outcome of care in patients with low back pain who are managed by physicians or physical therapists in private practice

The purpose of this study was to determine if there were differences in the cost and outcome of care in patients with low back pain who were managed by physicians or physical therapists in private practice in the state of Arizona. A secondary purpose was to describe the current status of private practice physical therapy clinicians who treat patients with low back pain.^ A Survey on Practice was mailed to 194 physical therapists who were listed by the American Physical Therapy Association as being in private practice in Arizona. Eighty-three percent of the surveys were returned after three attempts. Of those which were returned, 72 were complete and included in the analysis.^ The 72 practices were screened to determine those eligible for the second phase of the study. Those eligible for the second phase numbered 52 clinics. Twenty-six practices agreed to participate; however, only 21 did participate. Clinics which participated were sent packets of information which were to be kept on each patient seen with a complaint of low back pain during a three month period. Packets contained a patient-oriented survey on functional activity to be completed before and after the physical therapy course of treatment, as well as a log which was completed by the physical therapist on the type of care given to the patient and an assessment of the outcome of treatment. The patient was asked to fill out a satisfaction survey relative to the care received from the physical therapist and physician, if applicable.^ Although 259 patients were entered into the study, 210 patient logs were available for analysis. Results indicated that generally, there was no difference in cost or outcome as measured by the final functional score, change between the initial and final functional scores, or the therapist-rated outcome between the patients who were managed by physicians or physical therapists when controlling for age and length of time the patient was experiencing pain. Patients were more satisfied with care received from physical therapists as compared to physicians. Age and length of pain were good predictors of the type of referral patients received according to a logistic regression procedure. The initial disability score (IRS) and the time spent in the facility predicted therapist-rated outcome, a good or poor final disability score (FRS), and a good or poor change score. In addition, age predicted FRS and change scores. The time that the therapist spent in direct contact with the patient also predicted the change score.^ These findings of no difference in the cost and outcome of care were discussed as they relate to the practice of medicine and physical therapy. ^

Private practice option : National Health Service Corps guidebook.

Mode of access: Internet.

Guide for the development of an employment contract for private practice assignees of the National Health Service Corps.

"August 1987"-- Cover.

The meaning of professional excellence for private practitioners in occupational therapy

OT AUSTRALIA's Accredited Occupational Therapist Program is promoted using the message 'Assuring professional excellence'. It is widely assumed that professional excellence is understood. Yet, this concept encompasses complex themes, including competence and clinical reasoning. In this paper, the meaning of professional excellence is examined by investigating the perspectives of private practitioners. Private practitioners were chosen as they represent the diversity of the occupational therapy field, and may pre-empt trends within broader practice. Sixteen key informants were interviewed to obtain their perspectives on professional excellence. Common themes that arose from the findings include the significance of experience in practice, and the importance of understanding one's limitations in knowledge and expertise. Findings are discussed in relation to OT AUSTRALIA's aim to assure standards of practice.

Professional competence for private practitioners in occupational therapy

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi-structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.

Nurses’ utilisation of complementary therapies : a pilot study exploring scope of practice

The increasing use of complementary therapies (CTs) by the public requires nurses to be fully informed about the use and safety of these modalities. In addition, nurses need to be aware of what constitutes complementary therapy practice, its overlap with nursing practice and how to respond appropriately to patients' requests for access to and information about CTs. A pilot study that aimed to describe nurses' knowledge about, and the use of CTs was conducted in four hospitals in southeast Queensland, Australia. One hundred and twenty-nine nurses (65% response rate) of varying levels of qualification and expertise completed a questionnaire. Over 80% of the participants indicated that they engaged in some form of complementary therapy (CT) activity. The entire sample worked in acute care hospitals but 5% engaged in CTs while employed in a second job. These nurses worked in either individual private practice or a multidisciplinary clinic setting. Only 2% of the sample had formal qualifications in a specific CT. Many nurses seemed unsure about what should be defined as a CT. The most common CTs engaged in by nurses were massage, music therapy and relaxation techniques but some nurses also participated in acupuncture, acupressure, hypnotherapy and osteopathy. Some nurses were confused about the difference between CT and usual nursing care. In addition, there were knowledge deficits relating to institutional policies and professional standards. Our findings suggest that nurses require more education about the scope of CT and how it differs from nursing practice. Nurses also require access to clear policies about the safe use of CTs in specific practice settings and about appropriate referral of clients to complementary therapists with accredited qualifications.

Clinical evaluation of root filled teeth restored with or without post-and-core systems in a specialist practice setting

AIM: To assess survival rates and complications of root-filled teeth restored with or without post-and-core systems over a mean observation period of >or=4 years. METHODOLOGY: A total of 325 single- and multirooted teeth in 183 subjects treated in a private practice were root filled and restored with either a cast post-and-core or with a prefabricated titanium post and composite core. Root-filled teeth without post-retained restorations served as controls. The restored teeth served as abutments for single unit metal-ceramic or composite crowns or fixed bridges. Teeth supporting cantilever bridges, overdentures or telescopic crowns were excluded. RESULTS: Seventeen teeth in 17 subjects were lost to follow-up (17/325: 5.2%). The mean observation period was 5.2 +/- 1.8 (SD) years for restorations with titanium posts, 6.2 +/- 2.0 (SD) years for cast post-and-cores and 4.4 +/- 1.7 (SD) years for teeth without posts. Overall, 54% of build-ups included the incorporation of a titanium post and 26.5% the cementation of a cast post-and-core. The remaining 19.5% of the teeth were restored without intraradicular retention. The adjusted 5-year tooth survival rate amounted to 92.5% for teeth restored with titanium posts, to 97.1% for teeth restored with cast post-and-cores and to 94.3% for teeth without post restorations, respectively. The most frequent complications included root fracture (6.2%), recurrent caries (1.9%), post-treatment periradicular disease (1.6%) and loss of retention (1.3%). CONCLUSION: Provided that high-quality root canal treatment and restorative protocols are implemented, high survival and low complication rates of single- and multirooted root-filled teeth used as abutments for fixed restorations can be expected after a mean observation period of >or=4 years.

Prevalence of systemic diseases in Brisbane general and periodontal practice patients

Background: Periodontitis has been associated with a number of systemic diseases such as atherosclerosis, coronary heart diseases, and respiratory diseases. This study aimed to determine whether there is a significant difference in the prevalence of systemic diseases (a) in patients referred for periodontal care compared to the general practice population, (b) in patients attending a public hospital and private practices, (c) in patients attending public and private periodontal practices, and (d) among patients with periodontitis of varying severity. Methods: Charts of 1000 adult patients were selected from four clinics (University of Queensland (UQ) School of Dentistry Admissions Clinic, UQ School of Dentistry Periodontics Clinic, Private Periodontal Practice, and Private General Dental Practice). The prevalence of medical conditions was evaluated using validated self-reported health questionnaires. The periodontal condition was assessed from the most recent relevant radiographs in the files. Results: Periodontal patients had a higher prevalence of systemic diseases compared to the general practice population. Public patients had a greater prevalence of systemic diseases compared to patients in private practice for both general practice and periodontal patients. In patients with advanced periodontitis, bronchitis, hepatitis and rheumatoid arthritis were most prevalent. Patients with periodontitis also took more medications and were more likely to suffer from multiple conditions compared to the general dental population. Conclusions: Patients attending public dental facilities have an increased prevalence of systemic disease compared to those attending private practices. Furthermore periodontal patients have a greater prevalence of disease compared to general practice patients. Patients with moderate or advanced periodontitis show an increase in the prevalence of some systemic diseases previously reported to be risk factors for periodontal disease.

The relationship between BCOM1 gene variants and macular pigment optical density in persons with and without age-related macular degeneration

Background: Recent evidence indicates that gene variants related to carotenoid metabolism play a role in the uptake of macular pigments lutein (L) and zeaxanthine (Z). Moreover, these pigments are proposed to reduce the risk for advanced age-related macular degeneration (AMD). This study provides the initial examination of the relationship between the gene variants related to carotenoid metabolism, macular pigment optical density (MPOD) and their combined expression in healthy humans and patients with AMD. Participants and Methods: Forty-four participants were enrolled from a general population and a private practice including 20 healthy participants and 24 patients with advanced (neovascular) AMD. Participants were genotyped for the three single nucleotide polymorphisms (SNPs) upstream from BCMO1, rs11645428, rs6420424 and rs6564851 that have been shown to either up or down regulate beta-carotene conversion efficiency in the plasma. MPOD was determined by heterochromatic flicker photometry. Results: Healthy participants with the rs11645428 GG genotype, rs6420424 AA genotype and rs6564851 GG genotype all had on average significantly lower MPOD compared to those with the other genotypes (p < 0.01 for all three comparisons). When combining BCMO1 genotypes reported to have “high” (rs11645428 AA/rs6420424 GG/rs6564851 TT) and “low” (rs11645428 GG/rs6420424 AA/rs6564851 GG) beta-carotene conversion efficiency, we demonstrate clear differences in MPOD values (p<0.01). In patients with AMD there were no significant differences in MPOD for any of the three BCMO1 gene variants. Conclusion: In healthy participants MPOD levels can be related to high and low beta-carotene conversion BCMO1 genotypes. Such relationships were not found in patients with advanced neovascular AMD, indicative of additional processes influencing carotenoid uptake, possibly related to other AMD susceptibility genes. Our findings indicate that specific BCMO1 SNPs should be determined when assessing the effects of carotenoid supplementation on macular pigment and that their expression may be influenced by retinal disease.

The feasibility, delivery and cost effectiveness of drink driving interventions : a qualitative analysis of professional stakeholders

Many intervention programs have been designed to decrease the rate of drink driving by altering the behavioural characteristics that may lead a person to drink and drive. However, most programs target high risk and repeat offenders. There is very little research on the feasibility and effectiveness of first offender programs. This project is part of a larger program of research that focuses on first time offenders, in order to reduce the rate of subsequent drink driving which may result in a repeat offence. A number of professional stakeholders were approached and interviewed with a view to capturing and reflecting current drink driving related concerns while developing an intervention in the context of Australian drink driving related legislation. The qualitative interviews involved open ended questioning which led to the themes discussed in the analysis. Included in the interviews were senior representatives from the Magistrates Court, Queensland Transport, Probation & Parole, Queensland Corrective Services, Royal Automobile Club Queensland (RACQ), Intraface Consulting (drug & alcohol EAP), Brisbane Police Prosecution Corps, Queensland Police Service and private practice psychology. Issues such as delivery of interventions, feasibility and cost-effectiveness were discussed, as were potential content and design. It was generally agreed that a tailored online intervention imposed as a sentencing option would be the most effective for first time offenders in terms of cost, ease of delivery and feasibility. The development of an online intervention program for first offenders is widely supported by professional stakeholders.