L'activité odontologique hospitalière dans l'offre de soins en zone sous-dotée : exemple en Basse-Normandie.

INTRODUCTION: Demand for dental care in Basse-Normandie has been severely affected by the reduced availability of local services. One of the missions of hospital dental services is to respond to these difficulties in accessing care. PURPOSE OF THE RESEARCH: The objective of this study is to determine how hospital activity fits into the local dental care offer. To do this, we compared the activity of the dental service of the Caen hospital with that of private practices. RESULTS: The proportion of young patients, particularly those under fifteen, was greater at the university hospital than in private practice (20.9 percent vs 12.9 percent, p < 1.10 -5). The activity of private practices included a higher proportion of fixed prosthetic care and oral prophylaxis procedures, in contrast to surgical procedures, direct restorative care, and consultations, which account for a higher proportion of hospital activity (10 percent vs 22.5 percent, p < 1.10-5). CONCLUSIONS: The dental service at Caen hospital differs from private practices in Basse-Normandie in that its activity is oriented toward primary care or emergency care. This activity seems to reflect a high individual caries risk, probably associated with social vulnerability. The unit therefore seems to respond to a need for primary care.

Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico.

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.

Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study.

Introduction Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.

[Dual practice in the Spanish health system: problem or solution? SESPAS Report 2024]. / La práctica dual público-privada en la sanidad española. ¿Solución o problema? Informe SESPAS 2024.

The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system.

A clinical audit in a UK-based acupuncture private practice: assessing patient demographics, outcomes and experience.

OBJECTIVES: The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. METHODS: Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. RESULTS: Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1-4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = -0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. CONCLUSIONS: Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements.

An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California.

BACKGROUND: Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. METHODS: Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. RESULTS: Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. CONCLUSIONS: Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.

Screening and prevention of preterm birth: how is it done in clinical practice?

Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Primary care dentistry: An Australian perspective.

INTRODUCTION: Primary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system. METHODS: This paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns. RESULTS: Primary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups. CONCLUSIONS: Australians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case. CLINICAL SIGNIFICANCE: Australia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

Understanding IT in Healthcare: Relevance and Training Needs of IT in Private Medical Practice.

BACKGROUND: The integration of Information Technology (IT) into private medical practice is crucial in modern healthcare. Physicians managing office-related IT without proper knowledge risk operational inefficiencies and security. OBJECTIVES: This study determines the relevance of specific IT topics in medical practice and identifies the training needs of physicians for enhancing IT competencies in healthcare. METHODS: In March 2023 a cross-sectional online survey was conducted with physicians comprising nine IT-related topics in Tyrol, Austria. RESULTS: The survey results highlighted a strong perceived relevance and high demand for IT education among physicians working in their medical practice, especially in areas of core medical IT and security. The majority of responses indicated high relevance (76.7%) and high demand (69.7%) for IT topics in medical practice. CONCLUSION: The findings underscore a significant need for targeted IT training and support in medical practices, particularly in areas related to the medical practice and security. Addressing these needs could lead to improved healthcare delivery and better management of technological resources in the healthcare sector.

Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies.

BACKGROUND: Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS: We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS: A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION: The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.

Racial Diversity of Patient Population Represented on United States Plastic Surgeons' Webpages.

ABSTRACT: Current literature demonstrates a lack of racial diversity in plastic surgery media. However, to our knowledge, no study has yet examined the racial diversity of Webpage content as if from a patient-search perspective. The objective of this study is to determine if there is a racial discrepancy between the US Census, American Society of Plastic Surgeons (ASPS) statistics, and the media featuring implied patients on US plastic surgeons' Webpages from a patient-focused approach. A Google search was completed using the term "(state) plastic surgeon." The first 10 relevant Web sites were collected for each state, and homepages were analyzed. In line with previous studies, the implied patients in media were classified into 1 of 6 skin tone categories: I, ivory; II, beige; III, light brown; IV, olive; V, brown; and VI, dark brown. These correlate to Fitzpatrick phototypes; however, the Fitzpatrick scale measures skin's response to UV exposure. Skin tone was used as a guide to measure racial representation in the media, with the caveat that skin tone does not absolutely correlate to racial identity. Categories I-III were further classified as "white" and IV-VI as "nonwhite." These data were compared with the 2020 ASPS demographics report and US Census. Four thousand eighty individuals were analyzed from 504 Webpages, the majority of which were those of private practice physicians. A total of 91.62% of individuals were classified as "white" and 8.38% "nonwhite." The distribution by category was as follows: I = 265, II = 847, III = 2626, IV = 266, V = 71, and VI = 5. Using χ2 analyses, a statistically significant difference was found between the racial representation within this sample and that of the 2020 US Census nationally (P < 0.001), regionally (P < 0.001), and subregionally (P < 0.001); the 2020 ASPS Cosmetic Summary Data (P < 0.001); and the 2020 ASPS Reconstructive Summary Data (P < 0.001). This study highlights the significant difference between racial representation on plastic surgeons' Webpages and the demographics of patients they serve. Further analyses should identify the impact of these representational disparities on patient care and clinical outcomes, as well as examine how best to measure racial diversity and disparities in patient-oriented media.

[Swedish dental care support and organization today - and a future perspective]. / Så fungerar tandvården i dag.

In Sweden, dental care is carried out in regional operations, public dental care (Folktandvården), or in private practice. The patient is free to choose a public or private care provider. Up to and including the age of 23, all dental care is free of charge for the patient. From the age of 24, there is a state dental care subsidy to limit patient costs. There is free pricing in dental care, both for public and private actors. The article describes more in detail how the dental care support is structured in its various parts. Furthermore, the organization of dental care is presented, and a future perspective. A developed collaboration between dental and medical care and other health care seems increasingly obvious.

Oral health through primary healthcare in a developed economy dominated by private dental practitioners: A leap forward in Hong Kong?

After two and a half decades of preparation, and prompted by advocacy from the World Health Organization in 2014, the Health Bureau of Hong Kong recently implemented the city's primary healthcare blueprint. Integrated within it is an approach to primary oral healthcare. This review provides a brief background and discusses the development of primary oral healthcare in Hong Kong - a developed economy in Asia dominated by private dental services.

Promoting access to care in pyometra treatment: pathways to collaboration between high-quality, high-volume spay-neuter clinics and private practices.

OBJECTIVE: To compare results from 2 previously published surveys aimed at determining how pyometra is treated in high-quality, high-volume spay-neuter clinics (HQHVSNCs) and private practices (PPs), with a specific focus on identifying opportunities for partnership between the clinic types to improve access to care in pyometra treatment. SAMPLE: Responses from 123 PPs and 87 HQHVSNCs. METHODS: A previously published survey of PPs conducted from June to July 2021 and a similar previously published survey of HQHVSNCs conducted from June to July 2020 were compared regarding demographics, pyometra treatment availability, estimated outcome, alternative outcome, disruption, cost, and protocol between HQHVSNCs and PPs. A comparison was also run of the surveys' responses regarding referral of a pyometra to an HQHVSNC by a PP. RESULTS: Although PPs estimated that economic euthanasia is the most likely alternative outcome for 13% of patients unable to access care at their practice, 80% would be reluctant to refer to an HQHVSNC. The 3 primary reasons indicated by PPs with a reluctance to refer were a perceived lack of prompt appointment availability (20%), lack of aftercare (18%), and lack of adequate equipment (14%). In contrast, most HQHVSNCs estimated that they generally accept referrals the same day (50%) or the next day (30%) and 95% of HQHVSNCs reported having the resources needed to treat most pyometras. CLINICAL RELEVANCE: There are several opportunities for partnership between PPs and HQHVSNCs in the treatment of pyometra. The most frequent concerns expressed by PPs regarding referral to HQHVSNCs were not shared by HQHVSNCs or could be ameliorated by referral to an HQHVSNC for surgery and transfer back to the PP for aftercare.

ChatGPT in private practice: The opportunities and pitfalls of novel technology.

OBJECTIVE: This article explores the transformative impact of OpenAI and ChatGPT on Australian medical practitioners, particularly psychiatrists in the private practice setting. It delves into the extensive benefits and limitations associated with integrating ChatGPT into medical practice, summarising current policies and scrutinising medicolegal implications. CONCLUSION: A careful assessment is imperative to determine whether the benefits of AI integration outweigh the associated risks. Practitioners are urged to review AI-generated content to ensure its accuracy, recognising that liability likely resides with them rather than with AI platforms, despite the lack of case law specific to negligence and AI in the Australian context at present. It is important to employ measures that ensure patient confidentiality is not breached and practitioners are encouraged to seek counsel from their professional indemnity insurer. There is considerable potential for future development of specialised AI software tailored specifically for the medical profession, making the use of AI more suitable for the medical field in the Australian legal landscape. Moving forward, it is essential to embrace technology and actively address its challenges rather than dismissing AI integration into medical practice. It is becoming increasingly essential that both the psychiatric community, medical community at large and policy makers develop comprehensive guidelines to fill existing policy gaps and adapt to the evolving landscape of AI technologies in healthcare.

Insight into Private General Physicians' Practices: an Exploratory Qualitative Study in a Rural District of Pakistan.

OBJECTIVE: The study aimed to assess private general physicians'(GPs) healthcare practices, identifying perceived malpractices, the support they receive, and barriers they experience in providing healthcare services. DESIGN: Qualitative exploratory study. SETTING: Rural district, Thatta in Province of Sindh, Pakistan. PARTICIPANTS: 15 GPs. RESULTS: Our results include increased motivation among GPs for continued professional development, the high influence of pharmaceutical companies on providers' prescribing practices, perceived malpractices by GPs, and the prevalence of quackery and ineffective regulatory mechanisms for private GPs in a rural district. CONCLUSION: Our findings have implications for the capacity building of GPs by academic institutions, enforcement of regulatory measures by the authorities, and the introduction of measures to curb practices by unqualified practitioners. Finally, more research will be needed to further understand the perceptions of GPs, their needs and the service delivery interventions that will enhance the quality of care they provide.

Real-life practice of reflectance confocal microscopy in France: A prospective multicenter study.

BACKGROUND: Studies demonstrating the potential utility of reflectance confocal microscopy (RCM) have been performed under experimental conditions. OBJECTIVE: To provide an overview of RCM practice in real-life. METHODS: A multicenter, prospective study carried out in 10 university dermatology departments in France. RESULTS: Overall, 410 patients were enrolled. One-half of the patients (48%) were referred by private practice dermatologists. They were referred for diagnosis (84.9%) or presurgical mapping (13%). For diagnosis, the lesions were located on the face (62%), arms and legs (14.9%), and trunk (13.6%), and presurgical mapping was almost exclusively on the face (90.9%). Among those referred for diagnosis, the main indication was suspicion of a skin tumor (92.8%). Of these, 50.6% were spared biopsies after RCM. When RCM indicated surgery, histology revealed malignant lesions in 72.7% of cases. The correlation between RCM and histopathology was high, with a correlation rate of 82.76% and a kappa coefficient of 0.73 (0.63; 0.82). LIMITATIONS: This study was performed in the settings of French tertiary referral hospitals. CONCLUSION: This study shows that in real-life RCM can be integrated into the workflow of a public private network, which enables a less invasive diagnostic procedure for patients.

[Respiratory physiotherapy in private practice: Interest and prescription modalities]. / Kinésithérapie respiratoire libérale : intérêts et modalités de prescription.

INTRODUCTION: Respiratory diseases represent a major public health issue and impact both quality of life and life expectancy of the patients. STATE OF ART: Several interventions used in respiratory physiotherapy have been shown to reduce dyspnoea, improve quality of life and reduce hospitalisation in many respiratory diseases. However, respiratory physiotherapy remains poorly known to the medical community and may be under-prescribed. PERSPECTIVES: In order to improve the interdisciplinarity around the patient with respiratory impairment, we describe the interests and prescription modalities of liberal respiratory physiotherapy. In the context of respiratory physiotherapy acts, the precision of drafting prescription directly conditions the means implemented by the physiotherapist regarding care provided to the patient. CONCLUSION: The increased knowledge of prescribers, both concerning the prescription methods and the precise content of the rehabilitation sessions is one of the keys to their success.