Rural Private Practice Research Articles

Motivations and experiences among dentists in rural private practice: A qualitative study.

Despite the critical importance of access to dental care for rural residents and concerns about a shrinking rural dentist workforce, few studies have examined rural dentist motivations to practice in rural areas. The aim of this study was to explore practicing rural dentists' motivations and experiences qualitatively through semi-structured interviews to help inform and guide recruitment and retention efforts in rural areas. Dentists were included in the sample frame if they were general dentists in private practice and had a primary practice located in a rural Iowa county. Rural dentists with publicly available email addresses were contacted by email to participate. Semi-structured interviews were administered to 16 private practice general dentists. All interviews were audio recorded, transcribed, and coded using pre-set and emergent codes. Participants were most commonly male (75%), under age 35 (44%), white (88%), and practiced in a partnership arrangement (44%). The main codes regarding dentists' experiences and motivations to practice in a rural area included familiarity with a rural area, community, financial factors, and clinical care delivery. Having been raised in a rural area was a major influence in most dentists' decisions about where to locate. The importance of rural upbringing in this study underscores the need to consider rural upbringing in dental student admissions. Additional findings, such as financial benefits of a rural practice and other practice-related factors can be used to inform recruitment efforts.

Dietitians' experiences and perspectives regarding access to and delivery of dietetic services for people with type 2 diabetes mellitus

AimsDietetic intervention improves glycaemic control of type 2 diabetes mellitus (T2DM). The aim of this study was to explore the views of Australian dietitians with respect to the nutritional management of people with T2DM, patient access to dietitians and any suggested improvements for access to and delivery of dietetic services. MethodsSemi-structured interviews were conducted via telephone with 31 dietitians counselling people with T2DM and consulting a minimum of two sessions per week in private and/or non-private practice. ResultsParticipants came from urban and rural areas, public and private practice and with a range of years of practice. Themes that emerged from the interviews included the importance of dietetic services for people with T2DM; the referral pathways and beliefs about lack of referrals to dietitians; the perceptions on adequacy of the current dietetic services available for people with T2DM; and the recommendations on services available for people with T2DM. ConclusionConsidering the evidence that diet is key in the prevention and management of T2DM, it is suggested current funding and service provision be reviewed with a focus on treating the aetiology of diabetes.

Rare disease: a national survey of paediatricians’ experiences and needs

ObjectiveTo describe the experiences of Australian paediatricians while caring for children with rare diseases, and their educational and resource needs.DesignA brief online survey was developed and deployed to a representative...

Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.

Exploring a public-private partnership new-graduate physiotherapy recruitment program: a qualitative study.

Difficulty in attracting allied health staff to rural areas is well known. In 2012, a small rural health facility and local private practice created an informal public-private partnership to recruit two new-graduate physiotherapists. Graduates were employed part-time in both the public and private sectors. This qualitative case study employed an appreciative enquiry framework to explore this partnership model. Three focus groups were held, and a combination of content and thematic analysis was used to derive and organise themes arising from the data. A regional public health service and private physiotherapy practice in the Bega Valley region of south-eastern New South Wales, Australia. New-graduate and second-year physiotherapists (n = 5), private sector managers (n = 3), and public sector managers (n = 4). Perceived benefits of the partnership model and improvements that could be made to further develop the model. Organisational benefits of a shared public-private role included the ability to attract high-quality applicants to difficult-to-fill positions, reduced the risk of new-graduate attrition due to social isolation, enhanced networking between sectors, and enhanced staff skill development through a broad range of clinical and non-clinical experiences. The model relied on management flexibility and has potential to expand to other areas and professions. Dedicated funding support, targeted recruitment strategies and increased planning to ease the transition into the workplace would further enhance the model. An informal public-private partnership to overcome established workforce shortages has proven successful to the benefit of the new graduates and both the public and private sectors.

A Cost-Minimization Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Payer, Patient, and Societal Perspectives in the United States

The cost difference is evaluated between delayed sequential cataract surgery (DSCS) and immediate sequential cataract surgery (ISCS) in the United States for patients covered by Medicare. To perform a cost-minimization analysis comparing ISCS with DSCS in the United States from the payer, patient, and societal perspectives for the West Tennessee region and nationally. A cost-minimization analysis using cataract surgery volume and eligibility estimates, 2012 Medicare reimbursement schedules, and actual or estimated patient cost data for the West Tennessee region and nationally was performed comparing ISCS with DSCS. The West Tennessee model was set in a mixed small city and rural private practice setting and was extrapolated to a national model. Ambulatory surgery center and hospital outpatient department setting costs were evaluated. West Tennessee and national Medicare payer costs per patient and the total national Medicare payer cost for DSCS and for ISCS, as well as West Tennessee and national Medicare patient (direct medical, travel, and lost wages) costs for DSCS and for ISCS. Nationally, Medicare was estimated to reduce costs by approximately $522 million with the switch from DSCS to ISCS in 2012. With a change to ISCS, a West Tennessee Medicare patient was estimated to reduce costs by $174 for direct medical costs, $40 for travel costs, and $138 for lost wages (total cost reduction range, $329-$649). The total Medicare-based societal cost reduction was $783 million. Payers and patients would benefit from an economic standpoint by switching from DSCS to ISCS. Patients and their families would benefit from fewer visits. This becomes important given the increasing number of future cataract surgical procedures that will be performed as the baby boomer generation ages, especially given the fact that Medicare is already financially strained. Further research is needed to evaluate the effect of switching to ISCS from the physician and surgical facility perspectives.

Sonographic determination of normal Conus Medullaris level and ascent in early infancy

Controversial reports exist in the literature regarding both the spinal level of the conus medullaris (CM) in normal infants and the age at which the CM achieves its adult level. Autopsy studies have demonstrated ascent continuing into early infancy while more recent imaging study series' suggest the adult conus level is attained by the 40th postmenstrual week. The authors conducted a retrospective review of 1,273 screening lumbar ultrasound studies performed over 5 years at a pediatric tertiary referral center. All patients were infants referred for initial imaging to rule out the presence of a tethered spinal cord. Referral sources included urban academic, urban private practice, and rural private practice pediatricians. After excluding studies lacking sufficient documentation (n = 90) and those reported as abnormal (n = 106), 1,077 remained for review. The CM level and patient age in days were recorded from each study. Statistical analysis was performed using unpaired t testing and ANOVA for continuous variables; chi-square for categorical data. The mean CM level for infants in group I (ages 0-30 days) was compared to those in groups II (31-60 days) and group III (61-100 days). Group I had a mean CM level of 0.125 and 0.2 vertebral segments lower than groups II and III (p = 0.0005 and <0.0001, respectively). ANOVA comparison of all three groups confirmed a rostral migratory trend (p < 0.001). The prevalence of CM level caudal to L2 in group I was 13 %, group II 11.4 %, and group III 4.7 %; also indicating a significant rostral trend (p = 0.004). Rostral migration of CM level continues through the first few months of post-natal life, albeit of limited extent. Documentation of continued ascent in a neonate may obviate the need for magnetic resonance imaging.

Private practice in rural areas: An untapped opportunity for dietitians

The purpose of this study was to describe the current demography of rural dietetic private practice and to determine the drivers and barriers for further development. A sequential explanatory mixed methods approach was used. Document searches and semistructured in-depth individual interviews were used to collect quantitative and qualitative data. Six rural case study sites of dietetic service delivery in rural northern New South Wales. Forty key informants including past and present dietitians, dietetic managers and health service managers were recruited, of these a subset of 15 interviews included discussion or comments about private practice in rural areas. Themes identified from the interview transcripts, Medicare enhanced primary care consultation data and public/private dietetic staffing levels from document searches. Private practice staffing ranged between 0% and 26% of the dietetic workforce across the six sites in 2006. Themes relating to the drivers and barriers for private practice were identified: financial factors, job satisfaction, opportunities for private practice and establishing private practice. There is an opportunity for growth of private practice to meet the gap in public dietetic services in rural areas.

The Albury-Wodonga syndrome. A tale of two cities.

An epidemic of acutely painful eyes having a seasonal restriction and an apparent response to topical indomethacin, is described. From patients seen in a rural private practice, the clinical picture of this acute syndrome and the use of indomethacin drops is described. A favourable response to topical indomethacin in 21 patients is documented. Topical indomethacin is worthy of further trial and investigation in the management of the Albury-Wodonga syndrome, harvester's eye, Christmas eye or seasonal corneal ulcer.

Patient perceptions of family practice residents in rural private practice settings.

Patient perceptions of family practice residents in rural private practice settings.

Of Mugs and Marketing: The Robin Hood Solution

To the Editor. —I've recently moved from a rural private practice to academia, and Dr Goldstein's Commentary 1 on the largess of pharmaceutical companies has helped me to understand better a phenomenon I've found perplexing. While in practice, my partner and I refused to let drug company representatives in the door. We saw the ethical downside as being too great, and although we knew that we couldn't truly purify ourselves, we felt compelled to attempt integrity. We were sorely tempted by the appeal of free samples for our many poor patients but realized that accepting them would put us at the top of a slippery slope. Therefore, we prescribed inexpensive antibiotics and older, generic medications for chronic illnesses whenever possible. There were times, I must admit, when quality care demanded our prescribing an expensive new medicine—when we regretted not having a full sample closet—but we got by. My new job,

The Airplane

As a rural private practice in occupational therapy expanded to meet the service requests in a large, sparsely populated area, the need for fast, efficient transportation became obvious. A private pilot's license was acquired and then an airplane was purchased to meet that transportation need. The private practice, geographical area and the intervention methods are reviewed. The efficiency, cost, safety and practicality of flying, and its effect on the success of the private practice are then described.

Consultation psychiatry in a rural private practice

The author reviews the psychiatric consultations of 50 patients admitted to two rural community hospitals to see how such service differs from that of university medical school hospitals. Thirty-eight of the patients had a psychiatric diagnosis or significant situational reaction. The appropriateness of referrals is attributed to the education the author provided to the hospital staff, which emphasized differential diagnosis. Psychiatric training should be modified to take into consideration the special circumstances of rural private practice, such as short hospital stays and the reluctance of patients to pursue follow-up treatment.