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1.
N Z Med J ; 133(1527): 15-25, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332325

RESUMEN

AIM: This paper outlines the results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2018 workforce census. Here we report the responses of New Zealand radiation oncologists and trainees in order to understand characteristics of the New Zealand radiation oncology workforce. METHOD: The workforce census was conducted online during July-September 2018. Distribution was by Survey Monkey to all radiation oncologists (fellows, life members, educational affiliates, retired) and trainees on the RANZCR membership database, including members from Australia, New Zealand and Singapore. All responses were aggregated for analysis. This paper addresses only responses from New Zealand members. The census was designed to explore issues relevant to the New Zealand workforce, and questions from previous workforce censuses were repeated in order to monitor trends. RESULTS: The response rate for New Zealand radiation oncologists was 73.3% (44/60). The majority (67%) were male. The average age was 50.8 years. Three-fifths (59.5%) reported New Zealand ethnicity. One-third obtained their specialist qualifications outside of Australia and New Zealand. Most worked in the public sector only (63.4%), with only two in exclusive private practice. Most radiation oncologists attained a consultant post immediately on completion of training, but there were 26 who pursued an overseas fellowship. Most worked one full-time equivalent or greater (FTE), with 17.5% working less than 1.0 FTE. Radiation oncologists reported working a median of 50.0 hours per week, with half working over 10 hours above their contracted hours. Most time was spent on clinical duties with minimal time spent on research. Radiation oncologists reported seeing an average of 235 new patients per year (median: 230). Leadership positions were held by 21/43 respondents. Within 15 years, 55% of the current workforce reported an intention to retire, including 30% of those currently practising highly specialised brachytherapy. Females in the workforce were less likely to work fulltime and spent less time in research and management activities. All trainees reported full-time work, although 50% expressed a desire for part-time training. Half of the trainees reported working 6-10 hours on call, and 60% reported two or less hours of protected teaching per week. Despite this, 90% of trainees were satisfied with their career choice. CONCLUSIONS: Radiation oncology is a small specialty in New Zealand, with a significant reliance on overseas-trained specialists. The specialty continues to work significant overtime hours while time spent on research and non-clinical duties remains low. The growth in staffing between the 2014 and 2018 census has been low. Trainee numbers do not appear sufficient to meet the demand for replacing staff, due to retirements and the reduction of hours. Radiation intervention rates are low in New Zealand, but growth would be reliant on an expansion of the workforce beyond simply replacing staff losses. The radiation oncology workforce in New Zealand remains vulnerable, and careful consideration must be given to expansion and retention to ensure a viable workforce for the future.


Asunto(s)
Fuerza Laboral en Salud/estadística & datos numéricos , Oncólogos de Radiación/estadística & datos numéricos , Oncología por Radiación/educación , Oncología por Radiación/estadística & datos numéricos , Adulto , Braquiterapia/estadística & datos numéricos , Censos , Empleo/estadística & datos numéricos , Becas/estadística & datos numéricos , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Práctica Privada/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Oncólogos de Radiación/provisión & distribución , Jubilación/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
2.
Australas Psychiatry ; 28(6): 644-648, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32997521

RESUMEN

OBJECTIVE: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April-May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018-2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. RESULTS: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%-20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations increased from April into May. CONCLUSIONS: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April-May 2020.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Mental , Pandemias , Neumonía Viral , Práctica Privada , Consulta Remota/métodos , Telemedicina/métodos , Comunicación por Videocoferencia , Adulto , Australia/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/estadística & datos numéricos , Innovación Organizacional , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Práctica Privada/organización & administración , Práctica Privada/estadística & datos numéricos , Servicios Urbanos de Salud/organización & administración
3.
Eur J Radiol ; 132: 109285, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32957001

RESUMEN

PURPOSE: The COVID-19 pandemic has led to an urgent reorganisation of the healthcare system to prevent hospitals from overflowing and the virus from spreading. Our objective was to evaluate the socioeconomic and psychological impact of the COVID-19 outbreak on radiologists. MATERIAL AND METHODS: French radiologists were invited to answer an online survey during the pandemic through mailing lists. The questionnaire was accessible for nine days. It covered socio-demographic information, exposure to COVID-19 at work and impact on work organisation, and included the Insomnia Severity Index and Hospital Anxiety and Depression Scale. Outcomes were moderate to severe insomnia, definite symptoms of depression or anxiety. Risk and protective factors were identified through multivariate binary logistic regression. RESULTS: 1515 radiologists answered the survey. Overall, 674 (44.5 %) worked in a highCOVID-19 density area, 671 (44.3 %) were women, and 809 (53.4 %) worked in private practice. Among responders, 186 (12.3 %) expressed insomnia, 222 (14.6 %) anxiety, and 189 (12.5 %) depression symptoms. Lack of protective equipment, increased teleradiology activity and negative impact on education were risk factors for insomnia (respectively OR [95 %CI]:1.7[1.1-2.7], 1.5[1.1-2.2], and 2.5[1.8-3.6]). Female gender, respiratory history, working in COVID-19 high density area, increase of COVID-19 related activity, and impacted education were risk factors for anxiety (OR[95 %CI]:1.7[1.2-2.3], 2[1.1-3.4], 1.5[1.1-2], 1.2[1-1.4], and 2.1[1.5-3]). Conversely, working in a public hospital was a protective factor against insomnia, anxiety, and depression (OR[95 %CI]:0.4[0.2-0.7], 0.6[0.4-0.9], and 0.5[0.3-0.8]). CONCLUSIONS: During COVID-19 pandemic, many radiologists expressed depression, anxiety and insomnia symptoms. Working in a public hospital was a protective factor against every psychological symptom. Socio-economic impact was also major especially in private practice.


Asunto(s)
Infecciones por Coronavirus/economía , Infecciones por Coronavirus/psicología , Hospitales Públicos/economía , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/psicología , Práctica Privada/economía , Radiólogos/economía , Radiólogos/psicología , Factores Socioeconómicos , Adulto , Betacoronavirus , Femenino , Francia , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Práctica Privada/estadística & datos numéricos , Radiólogos/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(4): 251-256, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32712116

RESUMEN

OBJECTIVE: To analyze the impact of the first month of lockdown related to the 2020 SARS-Cov-2 epidemic on the consulting activity of private ENT physicians in Réunion Island. MATERIAL AND METHODS: A multicenter prospective study analyzed the consulting activity of 12 ENT physicians in full-time private practice. The main endpoints were the number, characteristics and conditions of consultations. Secondary endpoints comprised presenting symptoms, diagnosis, prescriptions, adverse effects, and progression of monthly consulting turnover. RESULTS: Six hundred and ninety three consultations were performed during the study period (Appendix 1), with 50% emergency consultations. In 57.9% were face-to-face, 28.4% by phone and 13.7% video. In face-to-face consultation, the physician wore gloves in 53.8% of cases and a mask in 92.2%: surgical mask in 71.6% of cases and FFP2 in 28.4%. The three most frequent symptoms (48.5% of cases) were otalgia, hearing impairment, and vertigo. The three most frequent diagnoses (60.6% of cases) were otitis, intra-auricular foreign body (including wax), and pharyngeal infection. The three most frequently prescribed complementary exams (74.3% of cases) were imaging, hearing work-up, and specialist opinion. The three most frequently prescribed treatments (52.7% of cases) were intra-auricular drops, oral antibiotics, and nasal spray. The incidence of adverse effects was 0.001%. None of the physicians or patients seemed to have been infected by Covid-19 during the study period. There was a 47.3-91% (median, 75.6%) drop in monthly consultation turnover. CONCLUSION: The present study underscored the availability and adaptability of ENT physicians in the Réunion Island in an epidemic context, although economic impact was detrimental.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Otolaringología , Enfermedades Otorrinolaringológicas , Neumonía Viral/epidemiología , Práctica Privada/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Enfermedades Otorrinolaringológicas/diagnóstico , Enfermedades Otorrinolaringológicas/terapia , Pandemias , Estudios Prospectivos , Reunión , Factores de Tiempo
6.
N Z Med J ; 133(1513): 11-22, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32325464

RESUMEN

AIM: To describe and consider the findings of a workforce survey of New Zealand Oral and Maxillofacial Surgeons (OMS) which was conducted in 2017-18, and to compare those to findings from a similar survey undertaken in 2001. METHODS: A questionnaire was used to obtain information on the qualifications, sociodemographic characteristics and and practising circumstances of all practising OMS in New Zealand. Data were analysed using SPSS (version 24). After the computation of descriptive statistics, cross-tabulations were used to identify differences in proportions (with those tested for statistical significance using Chi-squared tests), and analysis of variance was used to examine differences in means. RESULTS: All 39 OMS took part. There were 17 medically qualified surgeons who also held a surgical fellowship, comprising just under half of the workforce. Overall, one in eight surgeons worked solely in the public sector, while just under one-quarter worked solely in private; the remainder worked in both sectors. Dentoalveolar procedures were by far the most common undertaken (with considerably more done by older surgeons than younger ones), followed by implants, the treatment of facial trauma, skin lesions and surgery for malignancy. Orthognathic surgery and dentoalveolar trauma procedures were the least commonly reported. Only two-thirds of surgeons participated in public on-call work. While 95% of surgeons were indeed satisfied with their work, the lowest rate was observed among those working solely in the public sector, where it was 80%; among those working exclusively in private, it was 100%. Between 2001 and 2017-18, the proportion of medically qualified surgeons rose from just over one-quarter to more than two-thirds. The proportion of surgeons working solely in private practice rose from one in seven to almost one-quarter. There were marked increases in the mean number of malignancies dealt with and implants provided. CONCLUSION: The findings highlight a number of problems-some long-standing, others emerging-in New Zealand's OMS system. Fewer surgeons are participating in public sector provision and there is stress on those who remain. Workforce planners should be aware that more resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.


Asunto(s)
Cirujanos Oromaxilofaciales , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Cirujanos Oromaxilofaciales/organización & administración , Cirujanos Oromaxilofaciales/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Encuestas y Cuestionarios , Recursos Humanos
7.
J Dermatolog Treat ; 31(5): 436-438, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32237998

RESUMEN

Objectives: The COVID-19 outbreak is a serious threat to public health and social distancing on the part of individuals can help contain the epidemic. It is unknown if dermatologists are assisting with the public health officials' recommendations for social distancing by closing their practice or limiting their practice to the treatment of emergency conditions. This study examines the activity level of dermatology practices during the United States COVID-19 outbreak.Methods: We performed scripted phone calls to 60 dermatology practices in six different counties in the United Stated during the COVID-19 outbreak. We assessed if practices are open and if they are serving patients with urgent and non-urgent conditions.Results: Of the 60 dermatologists selected for the study, 55 were successfully contacted (92% contact rate). Of these practices, 29 (53%) were open, 17 (31%) were only seeing urgent patients and 9 (16%) were closed. New York, New York had 2 (20%) open offices which was the lowest proportion of any county (p = .04). Counties with higher prevalence had fewer open offices (p < .01, R2 = .7).Conclusions: Many practices have restricted their level of operation especially in higher areas of COVID-19 prevalence, likely to help facilitate social distancing.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Dermatología , Pandemias , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Centros Médicos Académicos/estadística & datos numéricos , Betacoronavirus , Brotes de Enfermedades , Urgencias Médicas , Humanos , Prevalencia , Práctica Privada/estadística & datos numéricos , Estados Unidos/epidemiología
9.
J Am Board Fam Med ; 32(6): 868-875, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31704755

RESUMEN

PURPOSE: The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors. METHODS: A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits. RESULTS: The overall prevalence of offering e-visits was 9.3% (n = 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system-owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners. CONCLUSION: Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.


Asunto(s)
Visita a Consultorio Médico/tendencias , Médicos de Familia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Telemedicina/tendencias , Estudios Transversales , Femenino , Humanos , Masculino , Visita a Consultorio Médico/economía , Visita a Consultorio Médico/estadística & datos numéricos , Médicos de Familia/economía , Médicos de Familia/tendencias , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/economía , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/tendencias , Práctica Privada/economía , Práctica Privada/estadística & datos numéricos , Práctica Privada/tendencias , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/estadística & datos numéricos , Telemedicina/economía , Telemedicina/estadística & datos numéricos , Estados Unidos
10.
Reumatol. clín. (Barc.) ; 15(5): e10-e13, sept.-oct. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-189410

RESUMEN

Se conoce el estado de la reumatología privada en España, pero no hay información sobre el tipo de pacientes atendidos. Este estudio describe la experiencia de varios años de práctica de reumatología privada a tiempo parcial en la comunidad autónoma de Madrid. Se recogieron los datos demográficos y descriptivos de consulta de pacientes atendidos de forma consecutiva durante 3 años. De un total de 706 pacientes atendidos, casi la mitad (46%) solo acudió una vez a consulta y el 12% de los pacientes que se citaron no llegaron a presentarse a la cita. La mayor parte de los pacientes fueron mujeres (72,4%) con una edad media de 44,3 años (rango 3-93). Los diagnósticos más frecuentes fueron artrosis (20,9%), osteopenia/osteoporosis (16,8%), artromialgias inespecíficas (13,4%) y reumatismos de partes blandas (9,6%). La mayoría de los pacientes, un 83,1% (587 pacientes), eran clientes de las compañías MAPFRE, Adeslas y Asisa. Aproximadamente una cuarta parte de las pruebas complementarias que se piden en consulta no se revisan en consultas posteriores


The status of private rheumatology is known, but there is no information on the kind of patients seen. This study describes the experience over a 3-year period in a private rheumatology practice in the Autonomous Community of Madrid. We collected demographic and descriptive data. Of 706 patients seen, almost half (46%) were there for their first visit, and 12% of patients who had asked for an appointment did not attend. The majority of patients were women (72.4%) with a median age of 44.3 years old (range 3-93). The most frequent diagnoses were osteoarthritis (20.9%), osteopenia/osteoporosis (16.8%), arthralgia (13.4%) and soft tissue disorder (9.6%). The majority of the patients had private insurance with Spanish companies, such as MAPFRE, Adeslas and Asisa. At least one quarter of ancillary tests ordered in the first visit were not revised on a second visit


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Reumatología/estadística & datos numéricos , Enfermedades Óseas Metabólicas/epidemiología , Diagnóstico por Imagen/estadística & datos numéricos , Pacientes no Presentados/estadística & datos numéricos , Osteoartritis/epidemiología , Osteoporosis/epidemiología , Reumatólogos/estadística & datos numéricos , España
11.
Chron Respir Dis ; 16: 1479973119879678, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31558049

RESUMEN

Pirfenidone and nintedanib are oral antifibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF). Real-world data on factors that influence IPF treatment decisions are limited. Physician characteristics associated with antifibrotic therapy initiation following an IPF diagnosis were examined in a sample of US pulmonologists. An online, self-administered survey was fielded to pulmonologists between April 10, 2017, and May 17, 2017. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Participants answered questions regarding timing and reasons for considering the initiation of antifibrotic therapy after an IPF diagnosis. A total of 169 pulmonologists participated. The majority (81.7%) considered initiating antifibrotic therapy immediately after IPF diagnosis all or most of the time (immediate group), while 18.3% considered it only some of the time or not at all (delayed group). Pulmonologists in the immediate group were more likely to work in private practice (26.1%), have a greater mean percentage of patients receiving antifibrotic therapy (60.8%), and decide to initiate treatment themselves (31.2%) versus those in the delayed group (16.1%, 30.5%, and 16.1%, respectively). Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time versus using a "watch-and-wait" approach. Distinguishing characteristics between pulmonologists in the immediate group versus the delayed group included practice setting, percentage of patients receiving antifibrotic therapy, and the decision-making dynamics between the patient and the pulmonologist.


Asunto(s)
Antineoplásicos/uso terapéutico , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Indoles/uso terapéutico , Pautas de la Práctica en Medicina , Neumología/estadística & datos numéricos , Piridonas/uso terapéutico , Antineoplásicos/administración & dosificación , Toma de Decisiones Clínicas , Humanos , Indoles/administración & dosificación , Participación del Paciente , Práctica Privada/estadística & datos numéricos , Piridonas/administración & dosificación , Encuestas y Cuestionarios , Factores de Tiempo , Estados Unidos , Espera Vigilante/estadística & datos numéricos
12.
Vaccine ; 37(42): 6180-6185, 2019 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-31495594

RESUMEN

Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how costs compared with payments for adult vaccinations in a sample of U.S. physician practices. We recruited a convenience sample of 19 practices in nine states in 2017. We conducted a time-motion study to assess the time costs of vaccination activities and conducted a survey of practice managers to assess materials, management, and dose costs and payments for vaccination. We received complete cost and payment data from 13 of the 19 practices. We calculated annual income from vaccination services by comparing estimated costs with payments received for vaccine doses and vaccine administration. Median annual total income from vaccination services was $90,343 at family medicine practices (range: $3968-$249,628), $28,267 at internal medicine practices (-$32,659-$141,034) and $2886 at obstetrics and gynecology practices (-$73,451-$23,820). Adult vaccination was profitable at the median of our sample, but there is wide variation in profitability due to differences in costs and payment rates across practices. This study provides evidence on the financial viability of adult vaccination and supports actions for improving financial viability. These results can help inform practices' decisions whether to provide adult vaccines and contribute to keeping adults up-to-date with the recommended vaccination schedule.


Asunto(s)
Práctica Privada/economía , Vacunación/economía , Vacunación/estadística & datos numéricos , Adulto , Costos y Análisis de Costo , Femenino , Costos de la Atención en Salud , Humanos , Renta , Medicina Interna/economía , Medicina Interna/estadística & datos numéricos , Medicaid , Medicare , Obstetricia , Práctica Privada/estadística & datos numéricos , Estados Unidos , Vacunas/administración & dosificación , Vacunas/economía
13.
BMC Res Notes ; 12(1): 543, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31455388

RESUMEN

OBJECTIVE: Indonesia ranks second globally in the number of cases not reported to the National Tuberculosis Control Program, accounting for 11% of the total cases lost worldwide. In 2016, the Ministry of Health has issued Regulation Number 67 on tuberculosis control, which requires mandatory tuberculosis notification. We aimed to assess the prospective acceptability of mandatory tuberculosis notification among solo private practitioners and private primary care clinics in Yogyakarta. RESULTS: Our study highlighted critical issues which need to be addressed in ensuring acceptability of mandatory tuberculosis case notification. We found that that private practitioners do not notify tuberculosis cases due to a lack of policy knowledge. Mandatory tuberculosis notification and its potential penalties were also felt as burdensome by private practitioners. There were ethical concerns among the private practitioners in our study about patient's privacy and patients potentially lost to other healthcare facility. Private practitioners emphasized the need for intervention coherence and cooperation. We also observed pattern variations of these constructs across characteristics of private practitioners.


Asunto(s)
Notificación de Enfermedades/métodos , Notificación Obligatoria , Atención Primaria de Salud/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Tuberculosis/epidemiología , Adulto , Anciano , Notificación de Enfermedades/legislación & jurisprudencia , Femenino , Política de Salud/legislación & jurisprudencia , Humanos , Indonesia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Tuberculosis/diagnóstico , Tuberculosis/prevención & control
14.
J Altern Complement Med ; 25(10): 1009-1014, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31460773

RESUMEN

Background: Yoga practice is becoming increasingly popular around the world, yet little is known regarding why people adopt the practice of yoga or how their reasons for practice change with continued practice. Furthermore, whether those who practice different types of yoga have different motives remains unknown. Methods: To address these issues, the authors conducted a national cross-sectional online survey of 1,702 yoga practitioners in Germany, asking about demographic information and motives for initiating and continuing yoga practice. Results: The most common primary reasons for starting yoga were relaxation (26.6%) and prevention (25.5%), which were also the most common secondary reasons. Nine hundred and forty-one (55.3%) reported a different primary reason for maintaining than for adopting yoga practice. Prevention (38.4%) and spirituality (26.4%) were the most commonly reported primary reasons for maintaining yoga practice. More highly educated participants and those practicing longer than 5 years at the time of the survey were more likely to have reported a different current primary reason for yoga practice than that for which they started practicing. Conclusions: These results shed light on yoga's appeal to novices and regular practitioners, with important implications for making yoga appealing to beginners as well as promoting the practice as a long-term lifestyle behavior.


Asunto(s)
Terapias Mente-Cuerpo/organización & administración , Práctica Privada/estadística & datos numéricos , Yoga , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Motivación , Adulto Joven
15.
J Allergy Clin Immunol Pract ; 7(8): 2560-2567, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31336177

RESUMEN

As technology improves and telehealth companies continue to innovate, the ways in which physicians can provide care for their patients are constantly expanding. Providing quality health care is no longer constrained by local commutes and a brick-and-mortar footprint, but instead can be provided at a local, regional, and national level in ways that were not feasible in the past. The possibilities are endless as we enter a brave new world where medicine and technology meet. But what exactly is telemedicine and how can it be incorporated into a busy clinical allergy practice? What are the barriers to entry and how can telemedicine be used to enhance patient care by providing more options and driving revenue all at the same time? At its core, telemedicine is simply the remote treatment of patients using telecommunication tools such as telephones, smartphones, and computers. Of course, the implementation of this basic concept is much more nuanced and complex, with virtual visits acting as the sounding board for a host of additional synergistic health applications including wearable devices and mobile apps. This new model of health care delivery has the potential to uproot but at the same time enhance the conventional doctor-patient relationship, and if used correctly address many of the challenges that have historically plagued health care. Telemedicine and telehealth technologies can be used to strengthen medical services and overcome many of the barriers that have previously existed by providing safe, accessible, cost-effective, and convenient health care at the touch of a button.


Asunto(s)
Hipersensibilidad/epidemiología , Práctica Privada/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Humanos , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud , Estados Unidos/epidemiología
16.
Acad Med ; 94(10): 1561-1566, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31192802

RESUMEN

PURPOSE: A family physician's ability to provide continuous, comprehensive care begins in residency. Previous studies show that patterns developed during residency may be imprinted upon physicians, guiding future practice. The objective was to determine family medicine residency characteristics associated with graduates' scope of practice (SCoP). METHOD: The authors used (1) residency program data from the 2012 Accreditation Council for Graduate Medicine Education Accreditation Data System and (2) self-reported data supplied by family physicians when they registered for the first recertification examination with the American Board of Family Medicine (2013-2016)-7 to 10 years after completing residency. The authors used linear regression analyses to examine the relationship between individual physician SCoP (measured by the SCoP for primary care [SP4PC] score [scale of 0-30; low = small scope]) and individual, practice, and residency program characteristics. RESULTS: The authors sampled 8,261 physicians from 423 residencies. The average SP4PC score was 15.4 (standard deviation, 3.2). Models showed that SCoP broadened with increasing rurality. Physicians from unopposed (single) programs had higher SCoP (0.26 increase in SP4PC); those from major teaching hospitals had lower SCoP (0.18 decrease in SP4PC). CONCLUSIONS: Residency program characteristics may influence family physicians' SCoP, although less than individual characteristics do. Broad SCoP may imply more comprehensive care, which is the foundation of a strong primary care system to increase quality, decrease cost, and reduce physician burnout. Some residency program characteristics can be altered so that programs graduate physicians with broader SCoP, thereby meeting patient needs and improving the health system.


Asunto(s)
Internado y Residencia/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Alcance de la Práctica , Adulto , Factores de Edad , Femenino , Médicos Graduados Extranjeros/estadística & datos numéricos , Geografía , Práctica de Grupo/estadística & datos numéricos , Hospitales de Enseñanza , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Práctica Privada/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Sexuales , Población Urbana/estadística & datos numéricos
17.
Health Policy ; 123(7): 666-674, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31151826

RESUMEN

In most developed countries, the average income of female physicians remains much lower than that of their male counterparts. This paper analyses how much of the gender earnings gap among French self-employed physicians can be attributed to women's family responsibilities, choice of medical specialty, and opportunity to charge extra billings. The question is of growing concern for regulators because it may influence patients' future access to care. We used an exhaustive administrative database that merges information on the medical activity, earnings, and family structure of self-employed doctors in 2005, 2008, and 2011. Using the 2011 database, results suggest that when demographic and professional characteristics are controlled, female physicians still exhibit an annual earnings gap that varies according to family structure: having young children worsens the situation of female physicians, particularly GPs. Using our panel datasets from 2005, we show that there is a 'carer effect' of having children for female doctors that exacerbates the gender income gap, particularly for GPs. We do not highlight any real strategic behaviour of female specialists authorised to charge extra fees to increase their extra billings after a birth to maintain their previous income.


Asunto(s)
Renta/estadística & datos numéricos , Médicos/economía , Factores Sexuales , Adolescente , Adulto , Niño , Preescolar , Familia , Femenino , Francia , Médicos Generales/economía , Médicos Generales/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Práctica Privada/economía , Práctica Privada/estadística & datos numéricos
18.
Ann Dermatol Venereol ; 146(5): 354-362, 2019 May.
Artículo en Francés | MEDLINE | ID: mdl-30954294

RESUMEN

BACKGROUND: Psoriasis affects 0.2-0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. PATIENTS AND METHODS: This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. RESULTS: In all, 207 children (girls: 60.4 %; mean age: 10.5±4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG≥4 at peak) was associated with excess weight (P=0.01). CONCLUSION: Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.


Asunto(s)
Psoriasis/epidemiología , Dermatosis del Cuero Cabelludo/epidemiología , Adolescente , Niño , Preescolar , Comorbilidad , Estudios Transversales , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Francia/epidemiología , Humanos , Hipertensión/epidemiología , Lactante , Masculino , Enfermedades de la Uña/epidemiología , Sobrepeso , Obesidad Pediátrica/epidemiología , Práctica Privada/estadística & datos numéricos
20.
BMC Health Serv Res ; 19(1): 238, 2019 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-31014323

RESUMEN

BACKGROUND: In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. METHODS: A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. RESULTS: 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. CONCLUSIONS: The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.


Asunto(s)
Aceptación de la Atención de Salud/psicología , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Prestación de Atención de Salud , Emigración e Inmigración , Femenino , Humanos , Israel , Modelos Logísticos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Percepción , Médicos/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven
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