Private GPs Research Articles

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

ObjectiveThe 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.DesignQualitative exploratory study.SettingRural district, Thatta in...

Models using private general practitioners to provide caesarean deliveries at five South African district public hospitals: insights for public-private contracting for obstetric care in rural areas

ABSTRACT Background Harnessing of private sector resources could play an important role in efforts to promote universal access to safe obstetric care including caesarean delivery in low- and middle-income countries especially in rural contexts but any such attempt would need to ensure that the care provided is appropriate and patterns of inappropriate care, such as high caesarean delivery rates, are not reproduced for the entire population. Objective To examine the contracting arrangements for using private general practitioners to provide caesarean delivery services in rural district hospitals in South Africa. Method We utilised a mixed-method study design to examine the contracting models adopted by five rural district hospitals in the Western Cape, South Africa. Between April 2021 and March 2022, we collected routine data from delivery and theatre registers to capture the profile of deliveries and utilisation of contracted private GPs. We also conducted 23 semi-structured qualitative interviews with key stakeholders to explore perceptions of the contracting arrangements. Results All five hospitals varied in the level of use of private general practitioners and the contracting models (three private in-sourcing models – via locum agencies, sessional contracts, and tender contracts) used to engage them. Qualitative interviews revealed insights related to the need for flexibility in the use of contractual models to meet local contextual needs, cost implications and administrative burden. Conclusion Structured appropriately, private public partnerships can fill important gaps in human resources in rural district hospitals. Policy makers should look to developing a ‘contracting framework’ which requires compliance with a set of underlying principles but allows for flexibility in developing context specific contracting arrangements. These underlying principles should include a ‘risk’ based delivery model, adherence to public sector- evidence-based protocols, time-based rather than per delivery/type of delivery remuneration models, group liability arrangements, and processes to monitor outcomes.

A survey of the training and working arrangements of general practitioners providing asthma and chronic obstructive pulmonary disease care in a rural area of Maharashtra State.

Chronic respiratory diseases (CRD), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems resulting in a substantial burden of disease for individuals. There is a need to understand the perceptions and practices of primary care physicians ("general practitioners [GPs]") who provide most of the health care in rural India. We surveyed all private and public practitioners listed as practising in a rural area of Western India with the aim of identifying GPs (GPs: graduates, registered and allowed to practice in India) to understand their training, working arrangements, and asthma/COPD workload. We administered a short questionnaire at educational meetings or via e-mail to all private and public practitioners listed as providing community-based services in the Junnar block, Pune district, Maharashtra. The survey asked about qualifications, experience, and working arrangements, and about current asthma and COPD workload. A descriptive analysis was performed. We approached 474 practitioners (434 from private sector and 40 from public sector). Eighty-eight were no longer practising in the study area. The response rate was 330/354 (93.2%) of private and 28/32 (87.5%) of public sector practitioners. We excluded 135 nonrespiratory hospital specialists and 23 private practitioners whose highest qualification was a diploma. Our final sample of 200 GPs (70% males) was 177 from private sector and 23 from public sector. The private GPs had more experience in clinical practice in comparison to public GPs (18.6 vs. 12.8 years). Eighty-four percent of GPs from the private sector only had Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) qualifications, though >90% provided "modern medicine" services. In the public sector, 43.5% GPs only had AYUSH qualifications, though all provided "modern medicine" services. A minority (9% of private GPs and 16% of public GPs) provided both services. Nearly two-thirds (62%) of private GPs had inpatient facilities compared to only 9% of public sector GPs. In both sectors, more GPs stated that they managed people with asthma than treated COPD (Private: 97% vs. 75%; Public 87% vs. 57%). Many GPs practising "modern medicine" only had qualifications in Ayurveda/Homeopathy and fewer GPs are involved in the management of COPD as compared to asthma. These are important factors that form the context for initiatives seeking to improve the quality of community-based care for people with CRD in Maharashtra state in India.

Knowledge, attitudes and practices regarding prediabetes among general practitioners in Reunion Island

BackgroundGeneral practitioners (GPs) are among the first health care providers to be involved in prediabetes care, and their actions can prevent patients’ transition from prediabetes to diabetes. However, data on knowledge and management of prediabetes in primary care remain scarce. AimTo describe the knowledge, attitudes and practices of GPs towards prediabetes. Design and settingThis descriptive cross-sectional study included all private GPs working in Reunion Island. MethodGPs were sent an electronic questionnaire that specifically sought to establish whether GPs knew the definition of prediabetes and whether their practices were in line with French guidelines for prediabetes screening and management. ResultsA total of 121 GPs completed the questionnaire. Of these, 95.0% knew the definition of impaired fasting glucose, but only 66.1% knew that of impaired glucose tolerance. Many GPs reported practices that are not recommended in guidelines. Thus, 59% of respondents declared that they monitored prediabetes with HbA1c and 10% said that they prescribed oral anti-diabetic drugs as prediabetes treatment. The risks factors associated with prediabetes were generally well known. Although 59.5% of respondents reported not having enough time to provide therapeutic education and medical follow up, only 19% referred their patients to a nutritionist or dietician. Lastly, 93.4% of respondents favoured the implementation of a local therapeutic education program targeting prediabetic individuals. ConclusionPrediabetes management in primary care can be made more effective by improving GPs’ knowledge of prediabetes and official guidelines, facilitating referral of prediabetic patients to lifestyle specialists and implementing local therapeutic education programs.

A qualitative study on pharmacists' perception on integrating pharmacists into private general practitioner's clinics in Malaysia.

Background:Private general practitioners in Malaysia largely operates as solo practices – prescribing and supplying medications to patients directly from their clinics, thus posing risk of medication-related problems to consumers. A pharmacy practice reform that integrates pharmacists into primary healthcare clinics can be a potential initiative to promote quality use of medication. This model of care is a novel approach in Malaysia and research in the local context is required, especially from the perspectives of pharmacists.Objective:To explore pharmacists’ views in integrating pharmacists into private GP clinics in Malaysia.Methods:A combination of purposive and snowballing sampling was used to recruit community and hospital pharmacists from urban areas in Malaysia to participate either in focus groups or semi-structured interviews. A total of 2 focus groups and 4 semi-structured interviews were conducted. Sessions were audio recorded, transcribed verbatim and thematically analysed using NVivo 10.Results:Four major themes were identified: (1) Limited potential to expand pharmacists’ roles, (2) Concerns about non-pharmacists dispensing medicines in private GP clinics, (3) Lack of trust from consumers and private GPs, (4) Cost implications. Participants felt that there was a limited role for pharmacists in private GP clinics. This was because the medication supply role is currently undertaken in private GP clinics without the need of pharmacists. The perceived lack of trust from consumers and private GPs towards pharmacists arises from the belief that healthcare is the GPs’ responsibility. This suggests that there is a need for increased public and GP awareness towards the capabilities of pharmacists’ in medication management. Participants were concerned about an increase in cost to private GP visits if pharmacists were to be integrated. Nevertheless, some participants perceived the integration as a means to reduce medical costs through improved quality use of medicines.Conclusion:Findings from the study provided a better understanding to help ascertain pharmacists’ views on their readiness and acceptance in a potential new model of practice.

Do Publicly Listed Private Equity Firms Make Bad Deals?

A number of private equity (PE) fund management firms (GPs) have sought listings on public stock exchanges; also, investors, regulators, and PE firms, are showing interest in permanent PE investment capital raised on public markets. However concerns have been expressed that both of these developments weaken the incentives for private equity firms to make good deals and make them work. In this study, we construct a novel and comprehensive dataset of buyout deal performance measures for public and private PE firms. We find little difference in deal size or performance for deals by private GPs and permanent PE firms. However, deals by public GPs are on average 3 times larger than those of private GPs, and they earn 22% higher deal multiples.

The care.data consensus? A qualitative analysis of opinions expressed on Twitter.

BackgroundLarge, integrated datasets can be used to improve the identification and management of health conditions. However, big data initiatives are controversial because of risks to privacy. In 2014, NHS England launched a public awareness campaign about the care.data project, whereby data from patients’ medical records would be regularly uploaded to a central database. Details of the project sparked intense debate across a number of platforms, including social media sites such as Twitter. Twitter is increasingly being used to educate and inform patients and care providers, and as a source of data for health services research. The aim of the study was to identify and describe the range of opinions expressed about care.data on Twitter for the period during which a delay to this project was announced, and provide insight into the strengths and flaws of the project.MethodsTweets with the hashtag #caredata were collected using the NCapture tool for NVivo. Methods of qualitative data analysis were used to identify emerging themes. Tweets were coded and analysed in-depth within and across themes.ResultsThe dataset consisted of 9895 tweets, captured over 18 days during February and March 2014. Retweets (6118, 62 %) and spam (240, 2 %) were excluded. The remaining 3537 tweets were posted by 904 contributors, and coded into one or more of 50 sub-themes, which were organised into 9 key themes. These were: informed consent and the default ‘opt-in’, trust, privacy and data security, involvement of private companies, legal issues and GPs’ concerns, communication failure and confusion about care.data, delayed implementation, patient-centeredness, and potential of care.data and the ideal model of implementation.ConclusionsVarious concerns were raised about care.data that appeared to be shared by those both for and against the project. Qualitatively analysing tweets enabled us to identify a range of concerns about care.data and how these might be overcome, for example, by increasing the involvement of stakeholders and those with expert knowledge. Our findings also highlight the risks of not considering public opinion, such as the potential for patient safety failures resulting from a lack of trust in the healthcare system. However, caution is advised if using Twitter as a stand-alone data source, as contributors may lie more heavily on one side of a debate than another. A mixed-methods approach would have enabled us to complement this data with a more representative overview.

The PPP 'without the GP' – a Western Cape story

Private GPs in the Western Cape claim they’ve been side-lined by the provincial health authority in a major new pharmacy-chain-friendly public sector drive to increase the region’s overall family planning and infant immunisation footprint. Instead of simply picking up free supplies of condoms and oral and injectable contraceptives, plus the standard range of infant vaccines from the nearest district hospital or provincial drug supply depot, (as they have in the past), GPs must now tender for a 2-year contract via an exacting 8-page form, and offer free consultations to relevant patients 1 day per week. The Western Cape branch of the South African Medical Association (SAMA), a large SAMA-affiliated GP group, and the 600-member independent practitioner association Cape Primary Care Qualicare (CPC Qualicare) have complained that the initial tender time-frame was too short (extended to 31 January this year), the application process too cumbersome and conditions too demanding and costly for any well-meaning GP.

Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation

ObjectiveTo assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis...

Primary care in Hong Kong: a lesson about competition

GPs in Britain viewing the growth of competition often use US primary care as the case study of the consequences of letting the market shape medical practice. There is another example from a place that was, until relatively recently, under British jurisdiction; Hong Kong. Primary care in Hong Kong is provided from at least six distinct sources: 1. The government-run hospitals provide general outpatient clinics (GOPCs) and accident and emergency (A&E) departments, to which patients can self-refer. Patients are charged for consultations, but the charge includes medication costs. 2. Private GPs are numerous. They provide the majority of primary care consultations, tend to work alone, and charge fees that also include medication costs. Although most patients still pay cash, insurance policies are becoming more common, and about 40% of working age citizens have some insurance/employer subsidy for medical care. 3. Private group practices, which in some ways are like health maintenance organisations (HMOs), have developed; some are run by international companies like BUPA and Blue Cross, and others by local organisations. 4. The third sector, non-government organisations among which the churches are major stakeholders, is the main provider of social care. It is very much locality-based, and it's connections with GPs and specialists gives it some features of a community-oriented primary care movement. It too has …

Tuberculosis suspicion and knowledge among private and public general practitioners: Questionnaire Based Study in Oman

BackgroundEarly detection of smear positive TB cases by smear microscopy requires high level of suspicion of TB among primary care physicians. The objective of this study is to measure TB suspicion and knowledge among private and public sector general practitioners using clinical vignette-based survey and structured questionnaire.MethodsTwo questionnaires were distributed to both private and public GPs in Muscat Governorate. One questionnaire assessed demographic information of the respondent and had 10 short clinical vignettes of TB and non-TB cases. The second questionnaire had questions on knowledge of TB, its diagnosis, treatment, follow up and contact screening based on Ministry of Health policy. TB suspicion score and TB Knowledge score were computed and analyzed.ResultsA total of 257 GPs participated in the study of which 154 were private GPs. There was a significant difference between private and public GPs in terms of age, sex, duration of practice and nationality. Among all GPs, 37.7% considered TB as one of the three most likely diagnoses in all 5 TB clinical vignettes. Private GPs had statistically significantly lower TB suspicion and TB knowledge scores than public GPs.ConclusionIn Oman, GPs appear to have low suspicion and poor knowledge of TB, particularly private GPs. To strengthen TB control program, there is a need to train GPs on TB identification and adopt a Private Public Mix (PPM) strategy for TB control.

ARV needy--private GPs 'the answer'.

ARV needy--private GPs 'the answer'.

The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden

BackgroundPeople of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates (which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context.MethodsWe used multilevel logistic regression analysis with individuals (first level) nested within countries of birth (second level). We analysed the entire population between the ages of 40 and 64 years (n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension.ResultsLiving alone (ORwomen = 1.72, 95% CI: 1.62–1.82; ORmen = 2.64, 95% CI: 2.46–2.83) and having limited educational achievement (ORwomen = 2.14, 95% CI: 2.00–2.29; ORmen = 2.12, 95% CI: 1.98–2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (ORwomen = 2.11, 95% CI: 1.98–2.25; ORmen = 2.16, 95% CI: 2.01–2.32) and utilisation of private GPs with a lower probability (ORmen = 0.76, 95% CI: 0.69–0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (ORmen = 1.61, 95% CI: 1.06–2.44).ConclusionThe country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation.

Specialist consultations in primary health care—A possible substitute for hospital care?

This study assesses how the use of hospitals is affected by GPs being given an opportunity to send their patients to private specialists for consultation instead of referring them exclusively to hospital outpatient clinics. In the City of Turku three populations were served for a period of over 34 months by different service models. The first model was implemented in municipal health centres by 10 GPs with a list system and an option to consult private specialists. In the second model there were four GPs in municipal health centres without a list system or the consultation option. The third model comprised four private GPs with a list system and the consultation option. Persons with private GPs with a list system had fewer visits to the hospital outpatient clinics and fewer bed days than persons served by a municipal GP, either with or without a list system. When GP's have the opportunity to send patients for consultation to private specialists, both the number of visits to hospital outpatient clinics and the number of bed days are reduced.

Classical versus relational approaches to understanding controls on a contract with independent GPs in South Africa

Contracts have played a central role in public sector reforms in developed countries over the last decade, and research increasingly highlights their varied nature. In low and middle income countries the use of contracts is encouraged but little attention has been paid to features of the setting that may influence their operation. A qualitative case study was used to examine different dimensions of a contract with private GPs in South Africa. Features of the contract are compared with the notions of classical and relational contracts. Formal aspects of the contract such as design, monitoring and resort to sanctions were found to offer little control over its outcome. The relational rather than classical model of contracting offered a more meaningful framework of analysis, with social and institutional factors found to play an important role. In particular, the individual nature of GP practices highlighted the role played by individual motivation where a contract exercised little formal control. Due to the similarity of factors likely to be present, results are argued to be relevant in many other LMIC settings, and policy-makers considering contracts for clinical services are advised to consider the possibility of experiencing a similar outcome.

Improved availability of specialist consultations in primary health care: impact on physician visits

Objective - r How do physician visits vary when GPs are given the opportunity to send their patients to private specialists for consultation rather than simply to hospital outpatient clinics. Design r - r An experimental study. Setting and subjects r - r In the City of Turku, 3 populations were served over 34 months by different service models. The first model was implemented in municipal health centres by 10 GPs with a list system and an option to consult private specialists. In the second model, there were four GPs in municipal health centres without a list system or the consultation option. In the third model, there were four private GPs with a list system and the consultation option. Outcome measures r - r Visits to doctors as reported by the population. Results r - r The populations on a GP's list had more physician visits than those not covered by a list system. Persons not on a health centre GP's list had fewer visits to the private sector and more visits to hospital than those covered by a list system. Conclusion r - r The possibility for a GP to send a patient for consultation to a private specialist improves the prerequisites for high-quality care without affecting the total number of physician visits.

Differences in work activities between private and community health centre GPs

Differences in work activities between private and community health centre GPs

The reaction of private physicians to price deregulation in France

French private physicians are paid on a fee-for-service basis and nearly all of them are under contract to the Social Security, which refunds part of the medical fee to the whole population. Previously the prices of medical services were fixed, but since 1980, a new option has been possible: a doctor can choose to fix the price of his services freely, provided he pays a higher social insurance contribution. But the amount refunded by Social Security does not vary, so that the consumer has to bear the extra charge. Our purpose here is to identify the factors that influence the physician's option. In Section 2, we define a model of the private physician's economic behaviour, of the classic income-leisure type. In Section 3, empirical tests are performed on a sample of observations in 95 ‘departements’, gathering information about private GPs on the one hand, and the whole population on the other. According to our results, GPs' decisions depend on characteristics of both supply of and demand for GPs' services. One of our conclusions is that GPs seem to make up for low activity levels with higher prices, on condition the income of their practice allows it.