Dual Practice Research Articles

Policies, Progress, and Prospects for Internet Telemedicine in China

ABSTRACT Around the world, the adoption of digital technologies in health care has accelerated considerably in the wake of the COVID-19 pandemic. Prior to the emergence of the pandemic, China had already embarked on a private sector, technology enterprise-led creation of an innovative internet health care ecosystem, which has dramatically transformed China’s health care landscape. In this article, we describe the evolution of China’s internet health market, focusing on internet telemedicine. We trace its early origins with the establishment of information networks in the 1980s, to the emergence of a fast-growing internet health market in the 2010s that leveraged the capabilities of technology enterprises in e-commerce, logistics, and payment systems. Private health care platforms have played a central role throughout this transformative process. The supplyside of the market has a unique public-private mix structure, with the coexistence of public and private internet hospitals, and with the majority of telemedicine services provided by public hospital doctors working on private platforms in a dual practice capacity. We conclude with a discussion of the prospects of internet telemedicine, including how it should be optimized and harnessed to improve China’s health system. Finally, we set out areas where more research is needed.

Navigating delayed diagnoses, self-neglect, and lost livelihoods: a qualitative exploration of fisherfolk’s health perspectives and management of non-communicable diseases in Kerala, India

IntroductionNon-Communicable Diseases (NCDs) place a significant burden on India's healthcare system, accounting for approximately 62% of all deaths in the country in 2017. The southern Indian state - Kerala - has some of the highest rates of NCDs. Within the state, the fisherfolk community has a high prevalence of risk factors such as tobacco use and alcohol consumption. Working in the fisheries industry demands physical exertion, night shifts alongside extended periods of time at sea (for seafaring fisherfolk). Evidence is scant on how these conditions relate to the health-seeking experiences of fisherfolk, particularly in the context of NCDs. We conducted a qualitative study in two districts of Kerala to fill this gap.MethodsIn-depth individual and small group interviews– as per participant preference – with male and female fishing community members living with NCDs were conducted between October 2022 and February 2023 in two districts of Kerala. Interviews were conducted to explore community members’ experiences with health-seeking for NCDs. Transliterated English transcripts were coded using ATLAS.ti software and analysed using thematic analysis with inductive generation of codes, with indexing against Levesque, Harris, and Russell’s 2013 access to healthcare framework.ResultsThirty-three interviews with 42 participants were conducted. We found that NCDs were usually diagnosed late- either when admitted/consulted for other illnesses or when the symptoms became unbearable. Health-seeking patterns differed between seafaring and inland fishing subgroups, who were sampled from two districts in the state. Seafaring fisherfolk preferred public facilities for regular checkups and medicines while in-land fisherfolk relied on private facilities, although it was considered expensive. Ability to seek care was impacted by the working hours of the health centre which did not suit their working hours. Health constaints and related expenses also impacted their financial status and occupation, with some opting for less strenuous jobs.ConclusionThis study highlights the NCD-related health-seeking experiences of the fisherfolk community in Kerala, India. Fisherfolk reported self neglect, delayed diagnosis, cost and livelihood constraints owing to the onset of NCDs, even as dual practice and medicine access in the public sector were appreciated. Overall, larger studies and policymaking processes should consider in depth the experiences faced by particular economic groups like fisherfolk, who may face unique health and care-seeking challenges.

Dual enrollment equity pathways: A research‐based framework for expanding college and career opportunity for underserved students

AbstractThis article introduces “dual enrollment equity pathways” (DEEP)—a research‐based framework for rethinking à la carte dual enrollment as a more equitable on‐ramp to college programs of study that lead to high‐opportunity careers for students historically underserved in dual enrollment. Using interview data collected from six sites (six community colleges and 12 of their high school partners) that have expanded access and early college success of underrepresented student groups through à la carte dual enrollment, the manuscript describes key themes and emerging evidence of DEEP related to each of the four practice areas of the DEEP framework: (1) outreach to underserved students and schools; (2) aligning dual enrollment to college degrees and careers in fields of interest; (3) early career and academic exploration, advising, and planning; and (4) high‐quality college instruction and academic support. The chapter concludes with considerations for how the DEEP framework influences dual enrollment practice.

“We are a rehabilitation unit, at least on paper” – Competing representations of recovery-oriented rehabilitation in dual diagnosis treatment policy and practice

Within dual diagnosis treatment, principles of recovery are increasingly acknowledged. Nevertheless, recovery-oriented rehabilitation often becomes an abstract concept, leaving professionals in various dilemmas. This article examines competing representations of recovery-oriented rehabilitation across Danish dual diagnosis treatment policy and practice from a post-structural, analytical perspective inspired by governmentality and problematization studies. The empirical foundation consists of a qualitative ethnographic study including conducting and examining 12 national policies relevant to contemporary Danish dual diagnosis treatment practice and 23 interviews with health/welfare professionals employed at a Danish in-patient, dual diagnosis rehabilitation unit. The analysis points to a complexity between three sets of competing representations reflected in 1) the conceptual relationship between rehabilitation and recovery, 2) perceptions of knowledge based on experience or evidence, and 3) ideals of optimization and emancipation. Finally, the article discusses convergences between the competing and, at times, conflictual ideals, attempting to explain the conceptual fluffiness, discrepancies, and dilemmas experienced by professionals in dual diagnosis treatment within broader epistemological and ideological debates in social sciences and humanities.

Dual degree pharmacy practice faculty scholarship: Some answers but many more questions

Dual degree pharmacy practice faculty scholarship: Some answers but many more questions

Insurance barriers and inequalities in health care access: evidence from dual practice

BackgroundWe investigate access disparities in pharmaceutical care among German patients with type 2 diabetes, focusing on differences between public and private health insurance schemes. The primary objectives include investigating whether patients with private health insurance experience enhanced access to antidiabetic care and analyzing whether the treatment received by public and private patients is influenced by the practice composition, particularly the proportion of private patients.MethodsWe estimate fixed effect regression models, to isolate the effect of insurance schemes on treatment choices. We utilize data from a prescriber panel comprising 681 physicians collectively serving 68,362 patients undergoing antidiabetic treatments.ResultsThe analysis reveals a significant effect of the patient's insurance status on antidiabetic care access. Patients covered by private insurance show a 10-percentage-point higher likelihood of receiving less complex treatments compared to those with public insurance. Furthermore, the composition of physicians' practices plays a crucial role in determining the likelihood of patients receiving less complex treatments. Notably, the most pronounced disparities in access are observed in practices mirroring the regional average composition.ConclusionsOur findings underscore strategic physician navigation across diverse health insurance schemes in ambulatory care settings, impacting patient access to innovative treatments.

An eight-week single-blind randomised controlled trial on dual task balance training and motor imagery practice in ischaemic stroke survivors.

The purpose of this study was to find the effects of motor imagery on balance and mobility of stroke patients.This was a single-blind randomised controlled trial which included a total of 30 patients. These patients were assigned into two group: experimental (n=15) and control (n=15) by sealed envelope method. Functional Reach Test (FRT), Time Up and Go Test (TUGT), Berg Balance Scale (BBS), and Movement Imagery Questionnaire (MIQ) were used as assessment tools. The overall mean age of the participants was 52.63 ±8.78 years. Between groups analysis showed non-statistically significant difference (p>0.05) in FRT but significant difference in TUGT, BBS, and MIQ-3 (p<0.009) after eight weeks of training. Within group analysis showed statistically significant difference (p<0.05) for all outcome measures. This study concluded that motor imagery is an effective treatment strategy for improving balance and mobility in stroke patients and brings better results as compared to conventional treatments.

Managing the manosphere: The limits of responsibility for government social media adoption

The prevalence of hate, threats, gender trolling, and other problematic communication patterns in social media prompts concerns about the responsibility associated with government social media adoption. In addressing this issue, this paper adopts a feminist perspective to enrich our understanding of how governments assume responsibility for their adoption of social media. The study contains a sentiment and thematic analysis of responses to a government video campaign on Facebook, which seeks to heighten public awareness about men's violence against women by highlighting problems surrounding sexist jokes. The video targets two audiences in terms of gender, resulting in various outcomes in sentiments, trolling, and trolling management. Results show disparities in sentiments between males and females, the diverse strategies employed in trolling, and how both users and the local government manage trolling. The local government deploys different strategies for trolling management, encompassing both engaging and non-engaging approaches. Notably, engagement is constrained to the targeted male audience and male trollers. The primary responsibility for trolling management is delegated to users, predominantly women, who become proxies for the local government. This dual practice of ignoring women as relevant stakeholders and utilizing them as proxies is considered a failure of responsibility. The study contributes to the advancement of citizen engagement research by delving into the intricate dynamics of trolling and trolling management within the specific context of government social media. Moreover, it sheds light on issues of responsibility inherent in the adoption of social media by governmental entities.

Heterogeneity in physician's job preferences in a dual practice context – Evidence from a DCE

Many countries are facing challenges in recruiting and retaining physicians, particularly in regions where the public and private sectors compete for doctors. Understanding the factors influencing physicians’ job choices can help inform policies aimed at attracting and retaining this valuable workforce. This study aims to elicit the strength of physicians' preferences regarding various job-related aspects, including earnings, time flexibility, discussion of clinical cases, frequency of facilities and equipment updates, training opportunities and autonomy in decision making.To achieve this, a Discrete Choice Experiment (DCE) was administered to 697 physicians. Each participant completed a series of eight choice tasks, where they had to choose between two hypothetical jobs differing in these attributes with levels mirroring positions in the public and private sectors in Portugal. The resulting choices were analysed using mixed logit, generalized multinomial logit and latent classes models to account for diverse unobserved variations in physicians' preferences and to explore preference heterogeneity across different observable characteristics.Jobs that offered more autonomy and training opportunities were strongly preferred, as physicians would require additional compensation to work with reduced autonomy (equivalent to 28.62% of gross income) or less frequent training (equivalent to 22.75%). This study also shows that the ranking of the job characteristics is similar between physicians working exclusively in the public sector and those engaged in dual practice. Nevertheless, public sector physicians place more emphasis on the availability of frequent training possibilities and frequent updates of facilities and equipment compared to their counterparts in dual practice.These findings contribute to existing knowledge by highlighting the significance of non-monetary attributes and shedding light on the preferences of physicians across various employment scenarios. They offer valuable insights for policy development aimed at influencing physicians' allocation of time between sectors.

Cost volume profit analysis for full paying patient services in Malaysia: A study protocol.

Dual practice within public hospitals, characterised by the concurrent provision of public and private healthcare services within public hospitals, has become a widespread phenomenon. With the participation of selected public hospitals, dual practice within public hospitals, also known as Full Paying Patient services, was an initiative the Ministry of Health Malaysia took in 2007 to retain senior specialist physicians in Malaysia. The revenue generated from the Full Paying Patient services aims to provide an avenue for public sector specialists to supplement their incomes while alleviating the Government's burden of subsidising healthcare for financially capable individuals. However, the effectiveness of Full Paying Patient services in recouping service delivery costs and yielding a profit is still uncertain after 16 years of implementation. This study is designed to evaluate the impact of Full Paying Patient inpatient services volume, revenue, and cost on profit versus loss at selected hospitals from 2017 to 2020. From the perspective of healthcare providers, we plan to perform a cost volume profit analysis. This analysis enables us to determine the break-even point, at which total revenues match total costs, along with no-loss and no-profit thresholds for Full Paying Patient services. This study has the potential to provide insights into how variations in service volume, cost, and pricing impact healthcare providers' profitability. It also offers critical financial information regarding the volume of services required to reach the break-even point. A comprehensive understanding of service volume, cost and pricing is imperative for making informed decisions to fulfil the objectives and ensure the sustainability of the FPP services.

An approach to the characteristics of ophthalmologists’ daily work in five Peruvian Amazonian departments

Abstract Objective: The objective of the study was to describe the characteristics of the daily work of ophthalmologists in five Peruvian Amazonian departments, including aspects of professional practice, eye health services, and the effectiveness of the strategies implemented in the fight for vision. Materials and Methods: A descriptive case study based on a survey prepared and executed by the clinic’s team of ophthalmologists in the teaching and research area. Results: Of the 16 participating ophthalmologists, 56.3% have dual practice in the public and private sectors. The primary pathologies identified from their professional practice include cataracts, glaucoma, and refractive errors. More than 80% indicate that information on visual health in the Peruvian Amazonian departments is unavailable, insufficient, and outdated. Regarding the availability of visual health services, 68.8% agree that such services are accessible, whereas 75% agree that clinical and surgical ophthalmologists are available. However, 81.3% disagree that subspecialty ophthalmologists are readily available. Furthermore, over 80% disagree that visual health services are accessible to all population sectors geographically. In addition, more than 60% disagree that the information provided to patients regarding diagnosis and treatment has a culturally relevant approach. Key criteria for designing and implementing strategies to fight for vision include epidemiological analysis and fieldwork. Among the main strategies employed, there is a notable emphasis on the consultation process and coordination with various stakeholders. Notably, the applied strategies have increased through early detection and prevention actions. Lessons learned from this case study highlight the importance of training medical and nonmedical personnel as good practice while cautioning against the inappropriate handling of patient information. Conclusions: The findings provide valuable insights into the characteristics of ophthalmologists’ field of action and shed light on various aspects, such as the focus of professional practice, prevalent pathologies encountered in daily care, dimensions of information, availability, access, and cultural relevance of visual health services. In addition, the study examines the criteria used, strategies implemented, resulting outcomes, and lessons learned in the fight for vision.

Factors influencing engagement in online dual practice by public hospital doctors in three large cities: A mixed-methods study in China.

In the digital age, a rising number of public sector doctors are providing private telemedicine and telehealth services on online health care platforms. This novel practice pattern - termed online dual practice - may profoundly impact health system performance in both developed and developing countries. This study aims to understand the factors influencing doctors' engagement in online dual practice. Using a mixed-methods design, this study concurrently collects quantitative demographic and practice data (n = 71 944) and semi-structured interview data (n = 32) on secondary and tertiary public hospital doctors in three large Chinese cities: Beijing, Shanghai and Guangzhou. We use the quantitative data to examine the prevalence of the online dual practice and its associated factors via the binary logit regression model. The qualitative data are used to further explore associated factors of online dual practice via thematic analysis. The findings about associated factors from the two parts were merged using the categories of personal, professional, and organisational characteristics. Our quantitative analysis shows that at least 47.1% of public hospital doctors are involved in online dual practice. The shares in Beijing, Shanghai, and Guangzhou are 43.7%, 53.1%, and 44.8%, respectively. This practice is more prevalent among doctors who are male, senior, and non-managerial. Different specialties, hospital ownership, hospital levels, and locations are also significantly associated with this practice. The qualitative analysis further suggests that financial returns, perceived effectiveness of telemedicine, and hospital directors' attitude towards telemedicine may affect doctors' engagement with online dual practice. Online dual practice is prevalent among doctors at tertiary and secondary public hospitals in Beijing, Shanghai, and Guangzhou. Personal, professional, and organisational characteristics are all associated with doctors' choice to engage in online dual practice. The findings in this study provide implications for promoting telemedicine adoption and developing relevant regulatory policies in China and other countries.

Understanding Impacts of Online Dual Practice on Health System Performance: A Qualitative Study in China

ABSTRACT The outbreak of the COVID-19 pandemic has boosted the global development of online healthcare platforms. An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice—online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. Following a purposive sampling, we interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. The benefits include improved accessibility due to increased labor supply of public hospital doctors, better remote access to high-quality services, and lower privacy concerns. It can improve efficiency and quality by optimizing patient flows, reducing repetitive tasks, and improving the continuity of care. However, the potential distraction from designated work at public hospitals, inappropriate use of virtual care, and opportunistic physician behaviors may undermine overall accessibility, efficiency, and quality. Countries should mitigate these adverse consequences via regulations that are appropriate to their healthcare system context, policy priority, and governance capacity.

A Traditional Literature Review on Physicians’ Dual Practice – Literature Review

Research motivation: The current study seeks to establish the trends in physicians’ dual practice and present existing knowledge gaps that need to be filled based on studies done in other contexts. Research Design/methodology: The desktop research review approach was used in the investigation. This entailed a thorough evaluation of publications on practitioners' DP.

Physician Multi-Site Practice in China: Doctor practices, public views and legitimacy based on a controversial case

Aim: Physician multi-site practice (PMP), or dual practice, is commonplace worldwide. Since the mid-2000s, the Chinese government has issued a series of laws and regulations to promote PMP with a goal of improving access to high-quality medical services. However, PMP is widely conducted illegally in China, i.e., without official registration of practicing doctors. This article provides a more nuanced understanding of PMP in China. Approach: This article takes a case study approach. It presents a high-profile case exposed through Chinese social media as well as public perceptions through the lens of online comments given by over thirty thousand netizens on a nationally controversial case. Findings: Netizens saw benefits to PMP despite being illegal. A culturally-rooted Chinese construction of the triple concepts of ‘Qing’ (sensibility, feeling or sentiment), ‘Li’ (propriety, norm or reason) and ‘Fa’ (rule, regulation or law) is employed to explore the issue of legitimacy of PMP in the Chinese context and explain why PMP has not yet been implemented effectively, and why members of the general public strongly support illegal PMP. Conclusion: While doctors and the public support illegal PMP, it will be challenging for the Chinese government to gain traction with official PMP policy.

Dualna praksa, faktori i rešenja za zdravstvene radnike

Dual practice is a phenomenon found in most countries, but it is noticeably more frequent in low-income countries, such as ours. It has been gaining more and more importance lately due to the fact that it may contribute to reducing the already insufficient number of professional health workers in healthcare systems. The reasons that lead to dual practice have not been sufficiently studied. Research results mainly point to economic factors as predictors, but apart from these factors, it is necessary to investigate the prevalence, real consequences, managing this phenomenon, as well as the assessment of the impact of policy measures implemented in this area. Although dual practice is seen as a possible systemic solution to issues such as limited resources (and revenues) in the public sector, low regulatory capacity and the interaction between market forces and human resources, if poorly regulated, it can lead to a conflict of interest as well as resource drain from the public to the private sector. An optimal regulation of the situation and the mobility of health workforce depends on the exceptional circumstances of the country, government capabilities, and the improvement of the health system. At the international level, governments react differently to the phenomenon of dual practice. To recognize the role of dual practice and mobility in the health workforce market, experts advocate more data on dual practice of healthcare workers and the need to integrate these data into national health workforce accounts. The need to develop a national health policy for monitoring dual practice in our country and to develop strategies for mitigating negative effects was highlighted. This paper analyzes the available literature on dual practice, the factors that influence the emergence of this phenomenon, and possible solutions for health workers.

Estimating the Monetary Value of Hours Lost to the Nigerian Public Healthcare System When Full-Time Government Employee Doctors Engage in Dual Practice

Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its potential to reduce the contracted hours in the public sector and shift attention to private work. Purpose: The purpose of this secondary research is to estimate the monetary value of hours lost to the Nigerian public healthcare system when full-time government employee doctors are engaged in private practice. It attempts to quantify the amount of resource outflow from the public system due to absences and lateness arising from competition for time between the public system’s contracted hours and private practice. Methods: Sensitivity analysis in Excel 2010 was used to calculate doctors’ hourly pay in the public sector using the 2015 Consolidated Medical Salary Structure for medical and dental officers in Nigeria’s federal public service. The parameters used for the calculation were the official 40-hour working week and the average monthly gross pay of doctors on different grade levels. Hypothetical scenarios of hours lost due to absences associated with DP were created. The value of different hypothetical hour losses by the percentage of doctors assumed to engage in dual practice across all doctor grade levels was then computed. Results: The estimated annual value of hours lost from dual practice to a single public tertiary care hospital was N4,851,754 or 15,855 USD (best case scenario) and N19,407,017 or 63,422 USD (worst case scenario) for the normal routine work and N1,800,133 or 5883 USD (best case scenario) and N3,600,266 or 11,766 USD (worst case scenario) for the on-call duty. Conclusion: The government may have been paying salaries for large volumes of work not rendered in the public sector. The overall financial impact of dual practice in the Nigerian public system might be negative.

Including mental health care in a model of European health system.

The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.

Novel opportunities for intercultural music education: Integrating singing and a language-aware approach in Learn-Finnish-by-Singing choirs

The topic of language awareness in intercultural music education has received surprisingly little attention in discussions on meaningful and responsive musical practices, despite language being an ubiquitous issue that every music educator encounters when entering a multilingual learning environment. This study explores a language-aware perspective that is embedded in a dynamic and dialogical choir practice drawing on the direct social needs of adult choir participants with culturally and linguistically diverse backgrounds. The analysis sets the practitioner experiences, planning, and implementation of the choir practice against the theorisation of activity systems and the concepts of boundary object and boundary crossing, in particular. The theoretical exploration considers how a dual meaning choir practice (a) integrates musical and linguistic activity, (b) crosses boundaries between the disciplines of music and language education, and (c) justifies change in music educational thinking. The study suggests that a dual meaning choir practice provides meaningful musical activity for adult immigrants, expanding the understanding of musical practice and the profession of music educator by blurring the dichotomous thinking of music and music education as being either instrumentalized or existing only for purely musical purposes. The study further advocates that a hybrid musical practice can widen professional understanding with novel insights, out-of-the-box perspectives, and new opportunities.

Perception of Health Care Practitioners on Dual Practice in Kenya

Purpose: The purpose of this study was to establish the perception of health care practitioners on dual practice in Kenya. Methodology: The current study adopted the descriptive method of study. The study targeted all health care practitioners from the Kenya Medical Practitioners and Dentists Council (KMPDC) doctors’ retention register.