Physicians In Private Practice Research Articles

Intersectoral cooperation between university hospitals and physicians in private practice in Germany– where the potential for optimization lies

BackgroundIntersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants’ experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation.MethodsWe performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel.ResultsA total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care.ConclusionThe following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or “get-togethers”, regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.

Racial Diversity of Patient Population Represented on United States Plastic Surgeons' Webpages.

Current literature demonstrates a lack of racial diversity in plastic surgery media. However, to our knowledge, no study has yet examined the racial diversity of Webpage content as if from a patient-search perspective. The objective of this study is to determine if there is a racial discrepancy between the US Census, American Society of Plastic Surgeons (ASPS) statistics, and the media featuring implied patients on US plastic surgeons' Webpages from a patient-focused approach. A Google search was completed using the term "(state) plastic surgeon." The first 10 relevant Web sites were collected for each state, and homepages were analyzed. In line with previous studies, the implied patients in media were classified into 1 of 6 skin tone categories: I, ivory; II, beige; III, light brown; IV, olive; V, brown; and VI, dark brown. These correlate to Fitzpatrick phototypes; however, the Fitzpatrick scale measures skin's response to UV exposure. Skin tone was used as a guide to measure racial representation in the media, with the caveat that skin tone does not absolutely correlate to racial identity. Categories I-III were further classified as "white" and IV-VI as "nonwhite." These data were compared with the 2020 ASPS demographics report and US Census. Four thousand eighty individuals were analyzed from 504 Webpages, the majority of which were those of private practice physicians. A total of 91.62% of individuals were classified as "white" and 8.38% "nonwhite." The distribution by category was as follows: I = 265, II = 847, III = 2626, IV = 266, V = 71, and VI = 5. Using χ2 analyses, a statistically significant difference was found between the racial representation within this sample and that of the 2020 US Census nationally (P < 0.001), regionally (P < 0.001), and subregionally (P < 0.001); the 2020 ASPS Cosmetic Summary Data (P < 0.001); and the 2020 ASPS Reconstructive Summary Data (P < 0.001). This study highlights the significant difference between racial representation on plastic surgeons' Webpages and the demographics of patients they serve. Further analyses should identify the impact of these representational disparities on patient care and clinical outcomes, as well as examine how best to measure racial diversity and disparities in patient-oriented media.

Physician marriage survey reveals sex and specialty differences in marital satisfaction factors

Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. “Other” specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse’s work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex’s impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study

IntroductionNational guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30–65 years. MethodsWe explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. ResultsA national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30–65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician–gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. ConclusionsMost clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.

Variations in Management of Zone 1 Open Globe Injuries Across Corneal Specialists.

The aim of this study was to describe variations in practice patterns for the management of zone 1 open globe injuries among corneal specialists worldwide. This cross-sectional study was performed using an online survey distributed to members of The Cornea Society. Responses were collected between September 9, 2021, and September 30, 2021. Of 94 responses included in analysis, respondents averaged 18.2 ± 14.5 years of postfellowship experience. Among respondents, 53 (56.4%) were affiliated with an academic institution and 41 (43.6%) with private practice. Ophthalmologists practicing in the United States were significantly more likely to use an eye shield preoperatively (98.5% vs. 85.7%, P = 0.03) and less likely to perform primary lensectomy in cases of lens involvement (40.9% vs. 75.0%, P = 0.002) compared with those practicing outside the United States. Ophthalmologists in practice fewer than 10 years were more likely to administer preoperative systemic antibiotics (91.4% vs. 66.1%, P = 0.006) and tetanus prophylaxis (88.6% vs. 67.8%, P = 0.03), and to obtain preoperative computed tomography scans (85.7% vs. 54.2%, P = 0.002) compared with more senior physicians. Ophthalmologists at academic institutions were more likely to perform preoperative B-scan (30.2% vs. 9.8%, P = 0.02), use general anesthesia (90.6% vs. 70.7%, P = 0.03), and admit for postoperative antibiotics (28.3% vs. 9.8%, P = 0.04), and were less likely to perform surgery overnight (45.3% vs. 70.7%, P = 0.02) compared with private practice physicians. There is significant variation in the practice patterns for the management of zone 1 open globe injuries among corneal specialists, which presents an opportunity to investigate whether certain treatment options lead to better outcomes in these injuries.

Association Between Facility and Clinician Characteristics and Family Planning Services Provided During U.S. Outpatient Care Visits.

Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics. Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects. The analytic sample included 53,489 patient visits with reproductive-age (15-49years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p=.02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p=.00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services. Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences.

Abstract P435: Barriers For Secondary Hypertension Screening In The Us: A National Physician Survey

Background: Although US and international expert guidelines recommend screening for secondary hypertension in patients with treatment-resistant hypertension (RHTN) and other high-risk groups, screening is conducted in &lt;3% of candidates. Objective: To determine barriers for secondary hypertension screening across US practices. Participants and Measurements: Internists, family practitioners, cardiologists, nephrologists, and endocrinologists, randomly selected from active members of the American Medical Association were surveyed on barriers for secondary hypertension screening. Results: Response rate was 67% (425 of 633 response-eligible physicians). The leading reported barriers preventing secondary hypertension screening included visit time constraints (43.5%), poor ancillary support (29.4%), and testing-related logistics (27.5%). Physicians practicing in large medical groups or staff-model HMO were more likely than physicians in private practice to not have access to specialists (adjusted OR, 95% CI: 4.01 [1.19-13.47]), and to be unfamiliar with screening results interpretation and next steps (2.11 [1.03-4.32]), but less likely to report poor ancillary support (0.47 [0.28-0.79]) or reimbursement concerns (0.29 [0.13-0.63]). Primary care physicians were more likely than endocrinologists (16.67 [2.04-100.00]) and nephrologists (10.00 [1.32-100.00] to lack familiarity with testing interpretation and subsequent steps. Physicians in practices covered primarily by Medicare were more likely to report poor ancillary support (2.02 [1.16-3.53]), and lack of access to specialists (4.96 [1.04-23.52]) as compared to physicians in practices covered primarily by private health insurance. Conclusions: Our findings suggest an urgent need to address major barriers to secondary hypertension screening, including ensuring adequate clinic visit time, ancillary support, and timely access to specialists.

Effects of the Pandemic on the Care of Patients With Colorectal Cancer.

During the COVID-19 pandemic, there was a decrease in the rates of diagnosis and treatment of cancer. However, only a few detailed analyses have been made to date regarding the effect of the pandemic on the care of cancer patients in Germany. Such studies are needed as the basis for well-founded recommendations on health-care delivery priorities during pandemics and other, comparable situations of crisis. This review is based on publications that were retrieved by a selective search of the literature for controlled studies from Germany on the effects of the pandemic on colonoscopies, first diagnoses of colorectal cancer (CRC), surgical procedures for CRC, and CRC-related mortality. Compared to 2019, the rate of screening colonoscopies performed by physicians in private practice was 1.6% higher in 2020 and 4.3% higher in 2021. On the other hand, the rate of diagnostic colonoscopies in the inpatient setting was 15,7% lower in 2020, while that of therapeutic colonoscopies was 11.7% lower. According to the data evaluated here, first diagnoses of CRC were 2.1% less common in January to September in 2020 than they had been in 2019; according to routine data collected by the statutory health insurance provider GRK, surgery for CRC was 10% less common in 2020 than in 2019. With regard to mortality, sufficient data from Germany were lacking to draw definite conclusions. International modeling data suggest an increase in mortality due to decreased colorectal screening rates during the pandemic that may at least be partially compensated for by intensified screening strategies following the pandemic. Three years after the onset of the COVID-19 pandemic, there is still only a limited evidence base for an evaluation of the effects of the pandemic on medical care and on the outcomes of patients with CRC in Germany. The implementation of central data and research infrastructures will be necessary for further study of the long-term effects of this pandemic, as well as to enable optimal preparedness for future crisis situations.

Digitale Transformation deutscher Gesundheitseinrichtungen

ZusammenfassungEinleitungDie digitale Transformation umfasst u. a. die Projektierung und Implementierung digitaler Anwendungen, Technologien und Maßnahmen und stellt inzwischen das Tagesgeschäft aller Organisationen und Einrichtungen im Gesundheitswesen dar. Im vorliegenden Beitrag werden die aktuellen Tätigkeitsinhalte der digitalen Transformation in Gesundheitseinrichtungen aus Sicht des Qualitätsmanagements dargestellt.MethodenEs erfolgte eine deutschlandweite Befragung von 141 Mitgliedern der Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgung (niedergelassene Ärztinnen und Ärzte, Vertretende von Krankenhäusern, Krankenkassen sowie weiteren Einrichtungen des Gesundheitswesens) über alle Felder der digitalen Transformation, bestehende Projekte und in der Implementierung befindliche digitale Technologien. Anhand von 6 Themenblöcken bewerteten die Teilnehmenden die zeitliche Abfolge und inhaltliche Relevanz für deren Organisation.Ergebnisse82 % der Befragten gaben an, dass die digitale Transformation den Arbeitsalltag beeinflusst bzw. verändert. Die häufigsten Projekte umfassen Themen aus dem Prozess- und Schnittstellenmanagement (53 %) sowie zur Verbesserung der Patientensicherheit (52 %). Häufigste konkrete Vorhaben stellen die elektronische Patientenakte und Themen, die im Zuge des Krankenhauszukunftsgesetzes beauftragt wurden, dar.DiskussionLaut Aussage der Befragten verändert die digitale Transformation Strukturen und Prozesse von Gesundheitseinrichtungen und macht zusätzliche Kompetenzen erforderlich, damit digitale Technologien zielführend und nachhaltig implementiert werden können. Eine strukturierte Koordination der Kompetenzen aller Professionen einer Gesundheitseinrichtung ist erforderlich, um digitale Technologien im Alltag von Gesundheitseinrichtungen zu verankern.

Income of physicians in private practice in Germany: Results of a micro census

Daten zum Einkommen von Ärzt:innen in Deutschland sind bisher nur teilweise verfügbar. Die Einkommen der niedergelassenen Ärzteschaft werden vor allem aus den Praxiserträgen abgeleitet, was aber große Interpretationsspielräume eröffnet. Ziel des Artikels ist es, diese Lücke zu schließen. Hierfür werden die Einkommensangaben aus dem Mikrozensus 2017 ausgewertet - mit besonderem Fokus auf niedergelassene Ärzt:innen. Neben dem persönlichen Einkommen erfolgt eine Darstellung der Einkommenssituation auf Haushaltsebene. Die Einkommensziffern werden nach Tätigkeitsumfang, Tätigkeitsgruppe (Allgemein-/Fach-/Zahnärzte), Geschlecht und Stadt/Land differenziert. Das verfügbare persönliche Nettoeinkommen niedergelassener Ärzt:innen beträgt bei Vollzeittätigkeit im Mittel knapp 7.900 € pro Monat. Fachärzt:innen liegen bei 8.250 €, Allgemein- und Zahnärzt:innen bei ca. 7.700 €. Eine finanzielle Benachteiligung von Landärzt:innen lässt sich nicht feststellen, Allgemeinärzt:innen aus Gemeinden<5.000 Einwohnerinnen und Einwohner haben mit 8.700 € sogar das höchste Durchschnittseinkommen - bei einer mittleren Arbeitszeit von 51 Stunden pro Woche. Ärztinnen arbeiten häufiger in Teilzeit als Ärzte. Ein niedrigeres Einkommen resultiert überwiegend aus einem geringeren Tätigkeitsumfang. Data on the income of physicians in Germany are only partially available to date. The income of physicians in private practice is derived primarily from practice income, but this opens up considerable scope for interpretation. The aim of this article is to close this gap. For this purpose, the income data from the 2017 micro census were evaluated, with a special focus on physicians in private practice. In addition to personal income, the income situation was presented at the household level. The income figures were differentiated according to the scope of activity, activity group (general practitioners/specialists/dentists), gender and city/country. The disposable personal income of physicians in private practice was just under € 7,900 per month on average for full-time employment. Specialists earned € 8,250, while general practitioners and dentists earned about € 7,700. Rural physicians were not found to suffer from financial disadvantages; general practitioners from municipalities with<5,000 inhabitants even had the highest average income of € 8,700, with an average working time of 51 hours per week. Female physicians worked part-time more often than did male physicians. A lower income resulted primarily from a lower scope of activity.

Covid-19 pandemic induced traumatizing medical job contents and mental health distortions of physicians working in private practices and in hospitals

The Covid-19 pandemic during its early phases posed significant psychological threats particularly for medical frontline personal. It is unclear whether the medical workforce with the passage of time has adapted to these threats or have generalized to wider medical settings. An online survey was conducted reaching 1476 physicians in Germany with valid data from 1327 participants. Depression and anxiety were screened with the PHQ-2 and the GAD-2. Among a subtotal of 1139 (86.6%) physicians reporting personal treatment experiences with Covid-19 patients, 553 (84.8%) worked in a private practice (PP) and 586 (88.3%) in a hospital (HP). Covid-19 provoked profound conflicts between professional and ethical values: more physicians in PPs than HPs reported external constraints on their medical care being in conflict with the code of medical ethics (39.1 vs. 34.4%, p < 0.002) and significantly more HPs failed to maintain the dignity of their patients during the pandemic (48 vs. 27%, p < 0.0001). Comparison with reference groups among physicians with comparable size and settings during the first wave of Covid-19 revealed a significant increase in the prevalence of depression (23.0%) and anxiety (24.16%). Feelings of helplessness (63.3% in HPs and 53.4% in PPs) were associated with female sex, minor years of medical experience, sleeping problems and being encountered to unsettling events. Exposure to unsettling events and helplessness was significantly mediated by sleep disturbances (ß = 0.29, SE = 0.03, p < 0.0001). Covid-19 induced stress job content issues have broadened to medical disciplines beyond frontline workers. Emotional perturbations among physicians have attained a critical magnitude.

Abstract P1-05-10: Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey

Abstract Background: Clinical stage at diagnosis is one of the most relevant prognostic factors for breast cancer (BC). In Mexico, more than half of BC patients are diagnosed at stage III-IV due to delays in referral, diagnosis, and treatment. The median time between symptom presentation and treatment initiation is 7 months; with the longest delay occurring between the first consultation and treatment start. The cause of this delay is not well defined. Our objective is to investigate if physicians in Mexico are aware of referral pathways in their respective institutions for patients with clinical suspicion and confirmation of BC. Methods: Physicians were asked to answer an anonymous and voluntary survey that included 20 questions aimed at collecting general sociodemographic data, their plan of action when BC is suspected or diagnosed, and the perception of delays and barriers in breast cancer care. The survey was promoted on exclusive social networks of Mexican health professionals. Results: In total, 802 surveys were collected. Of these, 98% were physicians, with the highest proportion (50%) being gynecologists, family, and general practitioners. The average age was 41 years, and 36% reported practicing in the public sector, 35% in the private sector, and 29% in both sectors. When faced with clinical signs and symptoms suggestive of BC, 41% of physicians in the public sector would request a breast imaging study and refer to another specialist. In contrast, 39% of specialists in the private sector preferred to request a breast imaging study and reevaluate the results. Specialties to which physicians refer patients when suspicious in public and private sectors were gynecology 41% and 29%, surgical oncology 24% and 36%, and medical oncology 17% and 19%, respectively. In the case of a confirmed BC diagnosis, physicians preferred to refer patients to oncologic surgery in 40% and 45%, medical oncology in 40% and 32%, and gynecology in 9% and 10%, respectively. Of the healthcare professionals that were surveyed, 36% in the public sector and 67% in the private sector ignored the existence of referral pathways for BC clinical suspicion and confirmation in their institution. Regarding the time interval from the onset of symptoms to treatment initiation, 64% of the private practice physicians estimated a waiting time of &amp;lt; 30 days. In contrast, only 22% considered this time interval in the public sector, 30% answered between 31-90 days, and 17% replied &amp;gt; 90 days. Most respondents from the private sector considered factors associated with the patient as the main cause for this delay. Respondents from the public sector added to this opinion that factors related to the public health services were a contributor to the delays (Table 1). Lack of knowledge about the referral pathways was significantly associated with perceiving greater delays in care (p &amp;lt;0.001). Conclusion: The results of this study indicate that there is no consensus among healthcare professionals in Mexico about an action plan when breast cancer is suspected or diagnosed. Although a proportion of the respondents acknowledge the presence of established referral pathways, long waiting times and delays persist between the first evaluation and the start of treatment. Associated factors include the saturation and limited resources of public health services. The development of a universal program and its promotion among all health professionals is imperative to improve BC care in Mexico. Table 1. Factors associated of delay in the care of clinical suspicion and confirmation of BC. Citation Format: Daniela Vazquez-Juarez, Raul Andrade-Moreno, Cynthia Villareal Garza. Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-10.

Identification of new cases of tuberculosis during the COVID-19 pandemic using model strategic management

Introduction: Tuberculosis (TB) is a world health problem that causes the third-largest death after cardiovascular and respiratory diseases. One of the causes of transmission of environmental factors is controlling the mobilization of individuals suffering from tuberculosis. This research aims to develop a strategic model of finding new TB cases based on region.&#x0D; Method: This descriptive research utilizes primary and secondary data. Variables consist of geographical and demographic characteristics, resources, tuberculosis prevalence, and indicators of tuberculosis response processes. The TB management planning model document is based on the experiences of health centers Perak Timur, Wonokromo, and Siwalankerto in maximizing TB case detection.&#x0D; Results: The management model outlines policies and procedures based on the variables. For example, the detection of new TB patients became a priority at the health center in Perak Timur. In contrast, the health center in Wonokromo focused on developing cadres and private practice physicians.&#x0D; Conclusions: This research provides an overview of the aspects that need attention and improvement by discovering different new cases in each region.&#x0D;

Decision-Making Behaviour in Physician-Rating Portals: Results of a Vignette Study in the New Federal States of Germany

The extent to which relevant information is taken into consideration in the decision process for or against the choice of certain physicians when searching for physicians via physician-rating portals is largely unknown. In particular, the question of whether longer travel distances to a doctor's office are accepted in favour of a good rating is investigated in this study. In a vignette study, 192 respondents from new German states were shown ten hits each from a fictitious search for a primary care physician. A total of 1881 choice probabilities were evaluated with cluster-corrected regressions. A good rating and a short distance to the doctor's office were the most important determinants of a positive probability of choice. Longer distances were not accepted in favour of a good rating. Arabic-sounding names strongly reduced the probability of choice, although the respondents only assigned subordinate importance to the doctors' names as a basis for decision-making. The area served by physicians in private practice does not increase if they receive good grades on rating portals. Service quality is important, but not the most important factor in the rating score.

Performance of a vascular anomaly center: a retrospective analysis of 461 cases over seven years.

Vascular malformations are rare diseases that are best managed in multidisciplinary vascular anomaly centers (VAC). So far, there are few published data on the logistic structure, patient allotment, and internal workflow in an interdisciplinary VAC. To demonstrate the referral structure and patient allotment in a European VAC. A retrospective cohort study was conducted. All patients treated in the VAC since its establishment in April 2014 until June 2020 were identified. A total of 461 patients were included in this study. Most often, a venous malformation was diagnosed (49.9%), followed by arteriovenous malformations (8.7%) and syndromal vascular malformations (8.2%). Only 45.1% of referral diagnoses were correct. Of referrals, 35.1% were internal on-campus references, 28.0% were external references through physicians in private practice, and 19.7% came via external cooperating hospitals. Of the patients, 17.1% were self-admissions without a referral. The most important referring clinics are internal medicine, pediatric, and vascular surgery. A substantial proportion of referrals came from private practices. Recruiting these cooperation partners should be considered a high priority when establishing a new VAC. The rate of misdiagnosis is high, and more education of fellow clinicians is urgently needed. Therefore, patients with vascular malformations should be referred to and treated in dedicated centers for vascular anomalies.

Effects of pharmaceutical promotions on antibiotics prescribing behavior of Nigerian private medical practitioners

Objectives: About 80% of pharmaceutical marketing efforts are directed toward physicians who are important decision-makers to patients’ medication needs. Pharmaceutical marketing can affect drug prescriptions, which, in turn, may adversely impact prescription practices. This study investigated the effect of pharmaceutical promotions on the antibiotic prescribing behavior of private practice physicians. Materials and Methods: A cross-sectional and descriptive design was employed. Self-administered questionnaires, scaled on a linear 5-point Likert Scale, were distributed among 268 physicians attending the 44th annual scientific conference of the Association of Nigerian Private Medical Practitioners at Ibadan, in Southwest Nigeria. Results: The study achieved a response rate of 94%, and 243 completely filled questionnaires were included for data analysis using R version 4. Cronbach’s alpha reliability of the research instrument was found to be 0.991, indicating an excellent internal consistency. Most of the physicians were male (71%), medical officers (83%), and 49% were between the ages of 51 and 60 years. About 65% had over 20 years of practice experience. A majority, 211 (87%), have prescribed antibiotics under the influence of pharmaceutical companies’ promotions. However, Fisher’s exact tests demonstrated a weak association between relevant independent variables and the dependent variable (P &gt; 0.05). Conclusion: Product detailing by pharmaceutical sales representatives was the most popular form of promotion and company-sponsored presentations had the greatest influence on the physicians’ prescription practice. It is, therefore, recommended that pharmaceutical promotions should be well regulated to guard against unethical practices.

Variability in Patient-Incurred Costs and Protocols of Regenerative Medicine Procedures for Musculoskeletal Conditions in the United States.

Background: The use of regenerative medicine as an "off label" treatment for musculoskeletal conditions has increased in recent years. However, the literature is sparse regarding the costs of these treatments to patients. Purposes: We sought to determine the patient-incurred costs for regenerative medicine treatments performed by physicians for musculoskeletal conditions in the United States, according to primary specialty, geographic region, practice setting, and years in practice. We also sought to characterize pre- and posttreatment protocols and image guidance use. Methods: We performed a cross-sectional study with data collection occurring between April 2020 and April 2021. It began with the distribution of an online survey through an email campaign by the American College of Sports Medicine to its members. Approximately 90 emails were sent by our research team as well. Throughout the year, various participant recruitment methods were used (through Twitter, for example). Survey data included physician demographics, practice/training information, types/costs of regenerative medicine treatments performed, and pre-/postprocedure protocols. Results: One hundred physicians who self-reported performing standalone regenerative medicine procedures participated in this online survey. According to the responses, the most common treatments performed were platelet-rich plasma (PRP; 100%), bone marrow concentrate (BMC; 41%), microfragmented adipose grafting (36%), prolotherapy (33%), and bone marrow aspirate (BMA; 21%) administered to the peripheral joints, tendons/muscles, ligaments, and/or spine. Overall, the respondents reported large variations in treatment costs to patients; BMA and BMC were the most expensive and had the largest ranges in costs for all anatomical locations. Costs for PRP were lower than those for BMA and BMC, with less variation. Physicians in private practice reported higher PRP, BMC, and BMA costs in the peripheral joints than those in academic settings. Most physicians recommended avoiding non-steroidal anti-inflammatory drugs pre- and postprocedure, and 74% recommended physical therapy postprocedure. Conclusions: Findings from a survey of physicians who provide regenerative medicine procedures as off-label treatment for musculoskeletal conditions suggest that there is variation in related patient-incurred costs. Future studies should explore associations between treatment costs and outcomes.

Post-COVIDLMU: implementation and evaluation of an interdisciplinary and cross-sectoral healthcare and research network for evidence-based treatment of patients with severe post-COVID syndrome

Post-COVIDLMU ist ein interdisziplinäres und sektorenübergreifendes Versorgungs- und Forschungsnetzwerk des LMU(Ludwig-Maximilians-Universität)-Klinikums. Der Schwerpunkt liegt auf der Behandlung und Erforschung komplexer und schwerer Post-COVID(„coronavirus disease“)-Syndrom-Fälle bei Erwachsenen. Die Behandlung dieser Patientengruppe erfolgt interdisziplinär unter Einbezug zahlreicher Fachkliniken des LMU-Klinikums. Ergänzt wird das universitäre Behandlungsangebot durch moderne telemedizinische Sprechstunden, interdisziplinäre Fallkonferenzen unter Beteiligungsmöglichkeit der zuweisenden Kollegen*innen sowie der Möglichkeit für Patient*innen, an Studien der medizinischen Forschung zum Post-COVID-Syndrom teilzunehmen. Das LMU-Klinikum kooperiert eng mit niedergelassenen Ärzten*innen sowie verschiedenen Rehaeinrichtungen in Deutschland.

Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138

INTRODUCTION: This study compared perinatal outcomes of deliveries performed by resident and private practice physicians. METHODS: This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery. RESULTS: The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36). CONCLUSION: In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.

Psychological distress among outpatient physicians in private practice linked to COVID-19 and related mental health during the second lockdown

BackgroundOutpatient physicians in private practice, as inpatient physicians, are on the frontline of the COVID-19 pandemic. Mental-health consequences of the pandemic on hospital staff have been published, but the psychological distress among outpatient physicians in private practice due to COVID-19 has never been specifically assessed. MethodsA French national online cross-sectional survey assessed declared psychological distress among outpatient physicians in private practice linked to COVID-19, sociodemographic and work conditions, mental health (Copenhagen Burn-out Inventory, Hospital Anxiety and Depression Scale, and the Insomnia severity Index), consequences on alcohol, tobacco, and illegal substance misuse, and sick leave during the 2nd COVID-19 wave. FindingsAmong the 1,992 physicians who answered the survey, 1,529 (76.8%) declared psychological distress linked to COVID-19. Outpatient physicians who declared psychological distress linked to COVID-19 had higher rates of insomnia (OR = 1.4; CI95 [1.1–1.7], p = 0.003), burnout (OR = 2.7; CI95 [2.1; 3.2], p < 0.001), anxiety and depressive symptoms (OR = 2.4; CI95 [1.9–3.0], p < 0.001 and OR = 1.7; CI95 [1.3–2.3], p < 0.001) as compared to physicians who did not. They also had higher psychotropic drug use in the last twelve months, or increased alcohol or tobacco consumption due to work-related stress and were more frequently general practitioners. InterpretationThe feeling of being in psychological distress due to COVID-19 is highly frequent among outpatient physicians in private practice and is associated with mental health impairment. There is a need to assess specific interventions dedicated to outpatient physicians working in private practice.