Private Healthcare Practitioners Research Articles

Can the Emergency Medical Service (EMS) System Help in Improving the Healthcare Access - Evidence from Maharashtra EMS.

For many people in the remote regions of India, medical help is inaccessible as 66% of rural Indians do not have access to critical medicine and 31% of the population travel more than 30 km seeking health care in rural India. Timely non-availability of doctors in healthcare facilities, especially in primary health centers (PHCs), leads to more dependency on the private healthcare practitioners for the out-patient department services. This needs immediate attention. The healthcare authority in Maharashtra has allowed doctors in 108 emergency ambulances to provide consulting services. The current study is based on the total consultations managed by the doctors on-board on the 108 ambulances in the state of Maharashtra in the years 2020, 2021, and 2022. The data are procured from the state-run Emergency Response Centre, and the analysis is done by using the basic statistical technique in MS Excel and SPSS16.0. More than 9.35 lakh medical consultations were provided with an average 856 consultations per ambulance in the year 2022, showing a significant growth of 452% over the consultations in 2020. The base location of the 32% ambulance (298) in the PHCs has improved the round the clock accessibility in 16% of the total PHCs in the state of Maharashtra. The availability of the doctors in the state-run emergency ambulances for general healthcare services has improved the adherence of Indian Public Health Standards, and such practice must be examined for implementation in other states.

Taxation and Incentives in Private Health Services Delivery in Nigeria: Opinion of Private Health Practitioners.

Tax relief and incentives are utilized to encourage the private health sector to provide services that are advantageous to community health. The aim of this study was to explore the issues related to taxes paid, incentives provided, returns on investment, satisfaction with practice, and plans of private health practitioners who were conference attendees in Port Harcourt in 2021. A descriptive cross-sectional study was carried out at two national events in Port Harcourt, Rivers State, Nigeria in October, and December 2021, among conference attendees using self-administered questionnaires. Data obtained was analyzed using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 and presented in tables. A total of one hundred and sixty-six (166) respondents were involved in the study. One hundred and four (62.7%) respondents believed they experienced multiple taxation from agencies of government. Most respondents paid at least fifty thousand and above as taxes to various levels of government. One hundred and forty-two (85.5%) respondents believed they did not receive any incentive from governments for their private health businesses. Fifty-three (31.9%) were not satisfied, while55 (33.1%) respondents were managing to survive in the business environment. Private healthcare practitioners in Nigeria experience multiple taxation and a lack of incentives from governments. Dissatisfaction with the return on investment is prevalent. Inclusive health sector reform that will partly reduce the potential for brain drain is therefore needed.

“I didn't even know headspace had the drug thing until today”: A socio-ecological analysis of access to drug and alcohol interventions in integrated youth health care services

BackgroundWith 150 centers Australia-wide, the headspace National Youth Mental Health Foundation is an exemplary integrated youth health service. Headspace centers provide medical care, mental health interventions, alcohol and other drug (AOD) services, and vocational support to Australian young people (YP) aged 12 to 25 years. Co-located headspace salaried youth workers, private health care practitioners (e.g. psychologists, psychiatrists, and medical practitioners) and in-kind community service providers (e.g. AOD clinicians) form coordinated multidisciplinary teams. This article aims to identify the factors influencing the access to AOD interventions for YP, in the Australian rural headspace setting; as perceived by YP, their family and friends, and headspace staff. MethodsThe study purposively recruited YP (n = 16), their family and friends (n = 9), and headspace staff (n = 23) and management (n = 7) in four headspace centers in rural New South Wales, Australia. Recruited individuals participated in semistructured focus groups about the access to YP AOD interventions in the headspace setting. The study team thematically analyzed the data through the lens of the socio-ecological model. ResultsThe study identified convergent themes across groups and found several barriers to the access of AOD interventions; 1) YP's personal factors, 2) YP's family and peer attitudes, 3) practitioner skills, 4) organizational processes and 5) societal attitudes were all identified as negatively impacting access to YP AOD interventions. Practitioners' client-centered stance, and the youth-centric headspace model were factors that were considered as enablers of engagement of YP with an AOD concern. InterpretationWhile this Australian example of an integrated youth health care model is well placed to provide YP AOD interventions, a mismatch existed between practitioner capability and YP needs. The sampled practitioners described limited AOD knowledge, and low confidence in providing AOD interventions. At the organizational level, multiple AOD intervention supply and utilization issues occurred. Taken together, these problems likely underlie previous findings of poor service utilization and low user satisfaction. ConclusionClear enablers exist for AOD interventions to be better integrated into headspace services. Future work should determine how this integration can be achieved and what early intervention means in relation to AOD interventions.

An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda

BackgroundApproximately 50 % of the population in Uganda seeks health care from private facilities but there is limited data on the quality of care for malaria in these facilities. This study aimed to document the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid-Western region of Uganda, an area of moderate malaria transmission.MethodsThis was a cross sectional study in which purposive sampling was used to select fifteen private-for-profit facilities from each district. An interviewer-administered questionnaire that contained both quantitative and open-ended questions was used. Information was collected on availability of treatment aides, knowledge on malaria, malaria case management, laboratory practices, malaria drugs stock and data management. We determined the proportion of health workers that adequately provided malaria case management according to national standards.ResultsOf the 135 health facilities staff interviewed, 61.48 % (52.91–69.40) had access to malaria treatment protocols while 48.89 % (40.19–57.63) received malaria training. The majority of facilities, 98.52 % (94.75–99.82) had malaria diagnostic services and the most commonly available anti-malarial drug was artemether-lumefantrine, 85.19 % (78–91), followed by Quinine, 74.81 % (67–82) and intravenous artesunate, 72.59 % (64–80). Only 14.07 % (8.69–21.10) responded adequately to the acceptable cascade of malaria case management practice. Specifically, 33.33 % (25.46–41.96) responded correctly to management of a patient with a fever, 40.00 % (31.67–48.79) responded correctly to the first line treatment for uncomplicated malaria, whereas 85.19 % (78.05–90.71) responded correctly to severe malaria treatment. Only 28.83 % submitted monthly reports, where malaria data was recorded, to the national database.ConclusionsThis study revealed sub-optimal malaria case management knowledge and practices at private health facilities with approximately 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, it is recommended that the NMCD distributes current guidelines and tools, coupled with training; continuous mentorship and supportive supervision; provision of adequate stock of essential anti-malarials and RDTs; reinforcing communication and behavior change; and increasing support for data management at private health facilities.

Disparities in mothers\u2019 healthcare seeking behavior for common childhood morbidities in Ethiopia: based on nationally representative data

BackgroundChildhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their under five children.MethodsThe study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design.ResultsOnly 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI.ConclusionsThe findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.

Depression, Anxiety, and Stress among Private Health Care Practitioners in Delhi NCR Region During Covid-19 Pandemic: A Cross-Sectional Study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a globally prevalent public health pandemic due to a viral COVID-19 infection. This cross-sectional observational study aimed at evaluating the depression, anxiety, and stress levels among private health care practitioners in the Delhi NCR region during the COVID-19 pandemic. The questionnaire included sociodemographic characteristics and Depression, Anxiety, and Stress Scale (DASS)-21. Dentists exhibited the highest level of depression (83.89%), anxiety (89.3%), and stress (89.95%), followed by medical personnel and AYUSH workers. Most of the study cohort showed moderate levels of DASS scale. Fear of contracting the infection and fear of infection transmission to family/friends were the most common causes of mental distress. COVID-19 pandemic has imparted adverse effects on the mental health status of health professionals. The risk factors should be acknowledged, and necessary interventions should be implemented to maintain psychological well-being.

Knowledge and attitude of private oral health-care practitioners about antimicrobial drugs prescription in the management of periodontal diseases: A cross-sectional observational survey

Background and Aim: The present study aimed to evaluate the knowledge and attitude of antimicrobial drugs prescribing by oral private health-care practitioners in the management of periodontal diseases across Mandi, Himachal Pradesh, India. Design: This was a descriptive cross-sectional percentage-based survey. Materials and Methods: A descriptive observational cross-sectional Study was conducted with the pretested and structured questionnaires which were sent physically to private oral health-care practitioners of Mandi district of Himachal Pradesh, India. The study was carried out for 2 months. A self-orchestrated questionnaire comprising 10 questions was sent by dental students to private practitioners of Mandi to assess their awareness along with a point of view concerning antimicrobial drugs prescribing for periodontal diseases. Facts entered in an Excel file were examined using SPSS version 22. Illustrative stats were carried out. Results: The survey was responded by 100 private practitioners providing oral health care who accomplish the questionnaire. Most of the private practitioners were in the age group of 20 and 60 years, and 63% were male and 37% were female. There was a statistically significant difference between knowledge on prescribing antimicrobial drugs by private oral health-care providers in Mandi, Himachal Pradesh, India. Amoxicillin Alone, amoxicillin with clavulanic acid and metronidazole was the most prescribing drug followed by clindamycin by private oral healthcare Practitioners in the management of periodontal diseases. Conclusion: Most of the private oral health-care providers practicing in Mandi, Himachal Pradesh, routinely prescribed prophylactic antimicrobial drugs, and the observational survey outcome shows that although the private practitioners do know about the antimicrobial drugs, they should be very careful while prescribing antimicrobial drugs in the management of periodontal diseases. Because of increasing microbial resistance, an immediate remedy is the need of the hour to tackle the devastating consequences of antimicrobial drugs resistance.

Service quality: A subliminal pathway to service differentiation and competitive advantage in private healthcare marketing in Ghana

The study investigates the role of service quality in Ghana’s private hospitals and its effect on patients’ satisfaction and loyalty. A sample of 622 respondents was drawn using convenience sampling. Structural equation modeling using smart PLS was used to test the measures. The study found a significant positive relationship between service quality and patient satisfaction and also a significant positive relationship between patients’ satisfaction and loyalty and that patients’ satisfaction mediates the relationship between service quality and patients’ loyalty. The study provides a useful guide to policy formulation for private healthcare practitioners.

Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain)

IntroductionThe objective of this study was to investigate the knowledge and capabilities of dentists and dental students in their last year of study in regard to risk factors of medication-related osteonecrosis of the jaw (MRONJ) in Spain. Material and methodWe conducted a cross-sectional study consisting of a questionnaire survey in Asturias, Spain. The study was divided into three groups: dentists who worked for the public dental health care system (n=32), dentists who worked exclusively as private health care practitioners (n=136), and dental students in their last year (year five) of study (n=38). The quantitative differences in the scores obtained in the resolution of clinical cases between students and dentists were evaluated. Differences between dentists were evaluated depending on number of years in practice, activity (private or public care), and area of specialty. The study tracked the possible differences in the general knowledge of MRONJ among dentists and students and the participants’ adherence to the dental clinic guidelines regarding the MRONJ. ResultsStudents from year five reached a higher score than those dentists with private practice activity (P=0.01). Significant differences between the students and the public health care dentists were not recognized, nor between the latter and the private health care dentists. The lowest percentage of correct answers among participants was related to implant surgery in patients treated with oral aminobisphosphonates. The dentists with more than 20 years of professional experience obtained significantly lower-than-average scores in the resolution of the clinical cases based on clinical guidelines (P=0.01). We did not observe any differences in the average test scores obtained by dentists dependent on their area of expertise. ConclusionsKnowledge of side effects of antiresorptive drugs decreases with years of professional practice. Training efforts on MRONJ should focus especially on those dentists who practice privately, who have over 20 years of professional experience, and who perform implant surgery on patients at risk of MRONJ.

Servant leadership and job satisfaction within private healthcare practices

PurposeThe purpose of this study is to investigate the influence of servant leadership on job satisfaction within private healthcare practices.Design/methodology/approachCriterion sampling has been used to draw a sample of private healthcare practitioners and their employees. The data collected from 241 useable questionnaires have been statistically analysed. Factor analysis and Cronbach’s alpha coefficients have been used to assess the validity and reliability of the measuring instrument, and multiple regression analyses have been performed to test the influence of the dimensions of servant leadership on job satisfaction.FindingsThe findings show that private healthcare practitioners display the dimensions of servant leadership investigated in this study. Furthermore, a significant positive relationship between developing others and job satisfaction for both sample groups, but only between caring for others and job satisfaction for the employee sample group, was reported. Acts of humility and servanthood by practitioners were not found to influence job satisfaction.Practical implicationsEducators can use the findings of this study to identify gaps in the leadership training of healthcare practitioners, and healthcare regulators can use the recommendations provided to implement appropriate interventions to ensure that healthcare practitioners fulfil their mandate of practising in an appropriate manner.Originality/valueThis study contributes to the limited understanding of servant leadership among private healthcare practitioners and it provides recommendations on how private healthcare practitioners can improve their servant leadership behaviour.

The Risks of American Single-Payer for Women’s Health

Single-payer health insurance, also known as Medicare for All, refers to medical care that is financed by a government agency and delivered by private healthcare practitioners. The concept of single-payer health care has gradually gained support among leading progressives throughout the nation, and legislation has been proposed in both chambers of Congress to implement Medicare For All. However, one version of single-payer previously proposed in the House may have unintended consequences for reproductive healthcare. Due to the Hyde Amendment, passing single-payer legislation could ultimately ensure that insurance coverage of abortions becomes unavailable for American women. One piece of legislation proposed in the Senate has corrected this error with wording that addresses other laws restricting Medicare funding for reproductive health services, such as the Hyde Amendment. Further revisions of current drafts may be necessary before implementation to determine and change other potential impacts of single-payer legislation.

Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

BackgroundDespite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities.ObjectiveThe objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India.DesignWe mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed.ResultsIn total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1–10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city.ConclusionsThe study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care.

Prevalence and Health Care-Seeking Behavior for Childhood Diarrheal Disease in Bangladesh.

In Bangladesh, the burden of diarrheal diseases is significant among children <5 years old. The objective of this study is to capture the prevalence of and health care–seeking behavior for childhood diarrheal diseases (CDDs) and to identify the factors associated with CDDs at a population level in Bangladesh. We use a logistic regression approach to model careseeking based on individual characteristics. The overall diarrhea prevalence among children <5 years old was found to be 5.71%. Some factors found to significantly influence the health care–seeking pattern were age and sex of the children, nutritional score, age and education of mothers, wealth index, and access to electronic media. The health care service could be improved through working in partnership with public facilities, private health care practitioners, and community-based organizations, so that all strata of the population get equitable access in cases of childhood diarrhoea.

Analyzing privacy requirements: A case study of healthcare in Saudi Arabia

Developing legally compliant systems is a challenging software engineering problem, especially in systems that are governed by law, such as healthcare information systems. This challenge comes from the ambiguities and domain-specific definitions that are found in governmental rules. Therefore, there is a significant business need to automatically analyze privacy texts, extract rules and subsequently enforce them throughout the supply chain. The existing works that analyze health regulations use the U.S. Health Insurance Portability and Accountability Act as a case study. In this article, we applied the Breaux and Antón approach to the text of the Saudi Arabian healthcare privacy regulations; in Saudi Arabia, privacy is among the top dilemmas for public and private healthcare practitioners. As a result, we extracted and analyzed 2 rights, 4 obligations, 22 constraints, and 6 rules. Our analysis can assist requirements engineers, standards organizations, compliance officers and stakeholders by ensuring that their systems conform to Saudi policy. In addition, this article discusses the threats to the study validity and suggests open problems for future research.

National health insurance scheme: How receptive are the private healthcare practitioners in a local government area of Lagos state

Background:National Health Insurance Scheme (NHIS) is one of the health financing options adopted by Nigeria for improved healthcare access especially to the low income earners. One of the key operators of the scheme is the health care providers, thus their uptake of the scheme is fundamental to the survival of the scheme. The study reviewed the uptake of the NHIS by private health care providers in a Local Government Area in Lagos State.Objective:To assess the uptake of the NHIS by private healthcare practitioners.Materials and Methods:This descriptive cross-sectional study recruited 180 private healthcare providers selected by multistage sampling technique with a response rate of 88.9%.Result:Awareness, knowledge and uptake of NHIS were 156 (97.5%), 110 (66.8%) and 97 (60.6%), respectively. Half of the respondents 82 (51.3%) were dissatisfied with the operations of the scheme. Major reasons were failure of entitlement payment by Health Maintenance Organisations 13 (81.3%) and their incurring losses in participating in the scheme 8(50%). There was a significant association between awareness, level of education, knowledge of NHIS and registration into scheme by the respondents P-value < 0.05.Conclusions:Awareness and knowledge of NHIS were commendable among the private health care providers. Six out of 10 had registered with the NHIS but half of the respondents 82 (51.3%) were dissatisfied with the scheme and 83 (57.2%) regretted participating in the scheme. There is need to improve payment modalities and ensure strict adherence to laid down policies.

Clumsy patient-friendly regulations could strip 25 000 of MPS cover

The Medical Protection Society (MPS), a financial and legal haven for 25 000 South African health care practitioners and reliable source of recompense for countless casualties of care, may be legislated out of the country. Unless negotiations scheduled over the next 14 months result in amendments to the regulations, due to kick in this December, the MPS will from December 2011 be unable to protect its members from the legal consequences of any post-2011 adverse event. The new requirement is that private health care practitioners must sign up for cover using only insurers or indemnifiers registered under Section 7 of the Short-term Insurance Act, something the MPS, which is not a short-term insurer, cannot do.

Private practitioners and their role in the resurgence of malaria in Mumbai (Bombay) and Navi Mumbai (New Bombay), India: serving the affected or aiding an epidemic?

The increased emphasis on privatization of the health care sector in many developing countries by international financial institutions and national governments expects an expanding role for private health care practitioners in the management of major communicable diseases such as tuberculosis, malaria, acute respiratory infections (ARIs) and sexually transmitted diseases (STDs). Largely unexamined in the Indian context, however, is the socio-cultural context, the micro-level political environment in which private practitioners carry out their activities, and the quality of care they provide to their patients. Examining these aspects is significant given the impressive growth of the country’s private health sector during the past decade. This paper reports the results of an ethnographic study carried out in Mumbai (Bombay) and Navi Mumbai (New Bombay), India on private general practitioners (GPs) and their role in the management of malaria at a time when these two neighboring cities were in the midst of the worst malaria epidemic in over 60 years. Described are the characteristics of a sample of 48 private practitioners from the two cities, and their clinics. This is followed by a discussion of the data gathered through untructured interviews with practitioners and patients, and complemented by observational data on doctor-patient encounters gathered at 16 clinics over a 9-month period. The findings of the study suggest that many practitioners in Mumbai and Navi Mumbai were poorly qualified and did not play a supportive role in the two cities’ public health departments to bring the epidemic under control. The majority of the practitioners adopted diagnostic and treatment practices that were not consistent with the guidelines laid down by WHO and India’s National Malaria Eradication Programme. Very few practitioners, especially those practicing in low-income areas, relied on a peripheral blood-smear test to make a diagnosis. Practitioners whose clientele was mostly the poor commonly resorted to giving one-day treatment to febrile patients that included injectable antimalarials and broad spectrum antibiotics. Such practitioners justified their mode of diagnosis and treatment by asserting that they were only responding to the demands placed on them by their patients who could not afford a blood-smear test or a full prescription. The paper argues that practitioners who acquiesced to patient demands were at once exacerbating the health problems of their patients and jeopardizing the prospects for the epidemic to be brought under control. Driven primarily by the need to retain the patronage of patients and maintain one’s popularity in a highly competitive health arena, many providers practiced medicine that was unethical and dangerous. The paper concludes by discussing the ramifications of this study for malaria control in Mumbai and Navi Mumbai, and highlights a few salient health policy issues concerning the growth of the private health sector in India and its regulation.

The use of private health care providers in rural Bangladesh: A response to Claquin

This study examines the distribution and differential use of private health care practitioners in one area of Bangladesh. It highlights the importance of gender, age and class factors as these impinge upon the utilization of different health care providers. Based on the complexity of these factors in influencing the utilization of health services, the feasibility of Claquin's recommendation to employ a palli chikitshok cadre of fee-for-service doctors in rural Bangladesh is reassessed. It is concluded that, as presently envisaged, the employment of these health providers would serve to solidify the rural elite structure and further remove quality health care from poor rural villagers.

A publicly funded pharmacy program under Medicaid in New York City.

The New York City Medicaid Pharmacy program is the largest of its kind in the country. In 1968, 17.9 million dollars were paid to private licensed pharmacies, participating in Medicaid, for the delivery of pharmacy services to Medicaid enrollees. This sum represented 12 per cent of all funds paid for personal health care services provided by private health care practitioners in 1968. From the inception of Medicaid in May 1966, the pharmacy program has grown to include 2,330 private pharmacies, or 71 per cent of pharmacies available in New York City. An analysis made of a one–day sample of 22,000 prescriptions received for payment January 5, 1968, disclosed that the average Medicaid prescription cost was $3.59. The New York City Medicaid Pharmacy Watchdog System to monitor potential and alleged abuses is described. Professional pharmacy issues, such as generic drugs, formulary, and professional fees are discussed.