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Population-Based Versus Practice-Based Recall for Childhood Immunizations: A Randomized Controlled Comparative Effectiveness Trial
Objectives. We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children. Methods. This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD. Results. Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were$215 versus $ 1981 per practice and$17 versus $ 62 per child brought UTD. Conclusions. Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
Journal Article
In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps
This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes. [PUBLICATION ABSTRACT]
Journal Article
Navigating the Evolving Landscape of Private Cardiology Practice
The landscape of cardiology practice in the US is rapidly shifting from physician-owned models toward consolidation, hospital integration, and increasing private equity (PE) investment. Historically, community-based cardiovascular care relied on independent physician groups that fostered close relationships and localized service delivery. Over the past 2 decades, however, escalating practice costs, declining reimbursement, and rising infrastructure demands have eroded independence and pushed many practices toward mergers, acquisitions, or hospital employment. Although these arrangements offer stability and capital, they often reduce autonomy, limit flexibility, and contribute to higher costs without consistently improving outcomes. This commentary explores the evolving dynamics of private cardiology practice, the challenges imposed by PE ownership, and the consequences for physician independence, patient access, and quality of care. We review key financial and regulatory pressures, including reductions in Medicare reimbursement and administrative burdens under the Merit-based Incentive Payment System. Additionally, we highlight strategies that independent practices can adopt to preserve autonomy, such as diversification of services, participation in clinically integrated networks, and use of modern technologies such as telecardiology. Finally, we emphasize the importance of physician leadership, succession planning, and advocacy in ensuring that independent cardiology remains a viable component of US health care. Sustaining private cardiology is essential to preserving patient-centered care, operational flexibility, and clinical judgment in a consolidating health care environment.
Journal Article
Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia
Background
Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia.
Methods
We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic.
Results
Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics.
Conclusions
Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing inappropriate prescribing.
Journal Article
Physician’s sociodemographic profile and distribution across public and private health care: an insight into physicians’ dual practice in Brazil
Background
The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country’s medical workforce. Physicians’ simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services.
Methods
A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians’ sociodemographic characteristics and their engagement with public and private services.
Results
From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68–0.89]; PR 0.47 [0.38–0.56]), less experienced (PR 0.78 [0.73–0.94]; PR 0.44 [0.36–0.53]) and predominantly female (PR 0.79 [0.71–0.88]; PR 0.68 [0.6–0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48–0.69]) and mixed sectors (PR 0.31 [0.25–0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58–2.43]), specialized (PR 1.29 [1.17–1.42]) and male (PR 1.35 [1.21–1.51]), often working less than 20 h per week (PR 2.04 [1.4–2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16–1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11–1.37]).
Conclusion
The study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in socio-demographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians’ sociodemographic characteristics can help predict dual practice forms and prevalence in a country.
Journal Article
The BMJ was inconsiderate when publishing personal view on private practice
After reflecting and reading responses to Dean's personal view, I have mellowed towards a colleague whose genuine concerns about private practice and his ability to maintain his own personal standards in such a system are injudiciously portrayed as almost an admission of professional guilt. 1 This article was used more broadly as part of The BMJ's agenda, which seeks to attack any enterprise in medicine and anything that might deviate from the NHS.
Journal Article
Dr. Gyl's guide to a successful hearing care practice
This book is a must-have resource for private practice owners in hearing healthcare. Author Gyl Kasewurm, AuD, known in the audiology field as \"Dr. Gyl\", has owned and operated a practice for thirty-five years, generating ten times the annual revenue of a typical practice, despite being in a town of only 12,000 people. Readers will benefit from her unique expertise and insight whether they are just starting a new practice or current practice owners looking to implement new strategies to take their business to the next level.
eBook