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The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

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HEALTH POLICY AND PLANNING 1998年第3期13卷 323-331页

作者： Bojalil, R Guiscafré, H Espinosa, P Martínez, H Palafox, M Romero, G Gutiérrez, G Cerro Macuiltepec 404 Col Campestre Churubusco Mexico City 04200 DF Mexico

In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care;in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under Five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.

关键词：儿童保健服务/标准腹泻/死亡率腹泻/治疗家庭医学/标准家庭医学/统计学和数值数据墨西哥/流行病学私人开业/标准私人开业/统计学和数值数据公共卫生管理/标准公共卫生管理/统计学和数值数据卫生保健质量/统计学和数值数据呼吸道感染/死亡率呼吸道感染/治疗儿童儿童学龄前人类婴儿婴儿新生

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Private health care provision in developing countries: a preliminary analysis of levels and composition

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HEALTH POLICY AND PLANNING 1998年第3期13卷 195-211页

作者： Hanson, K Berman, P Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Harvard Univ Sch Publ Hlth Dept Populat & Int Hlth Boston MA 02115 USA

While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.

关键词：发展中国家卫生保健调查卫生经费支出/统计学和数值数据卫生资源卫生服务研究收入/统计学和数值数据私人开业/统计学和数值数据私营部门/经济学私营部门/统计学和数值数据社会经济因素

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How and why public sector doctors engage in private practice in Portuguese-speaking African countries

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HEALTH POLICY AND PLANNING 1998年第3期13卷 332-338页

作者： Ferrinho, P Van Lerberghe, W Julien, MR Fresta, E Gomes, A Dias, F Gonçalves, A Bäckström, B Univ Nova Lisboa Dept Saude Publ Inst Higiene & Med Trop Unidade Sistemas Saude P-1300 Lisbon Portugal Univ Nova Lisboa Inst Higiene & Med Trop Ctr Malaria & Outras Doencas Tropicais P-1300 Lisbon Portugal Inst Trop Med Prince Leopold Dept Publ Hlth B-2000 Antwerp Belgium Univ Eduardo Mondlane Fac Med Maputo Mozambique Minist de Saude Luanda Angola Minist da Saude Ctr Reg Desenvolvimento Sanitario Maputo Mozambique Minist Saude Lab Saude Publ Bissau Guinea Bissau

Objective: To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service. Design: cross-sectional qualitative survey. Subjects: In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tome and Principe answered a self-administered questionnaire. Results: All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues.

关键词：非洲非洲西部安哥拉几内亚比绍卫生保健调查卫生服务研究收入/统计学和数值数据莫桑比克私人开业/经济学私人开业/统计学和数值数据公共卫生管理/人力公共卫生管理/统计学和数值数据问卷调查薪金和附加福利/统计学和数值数据

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The Development of a State‐level Health Manpower Database Using an Employer‐based Survey: A Pilot Project

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The Journal of Rural Health 1994年第3期10卷 199-207页

作者： Bamberg, Richard Malvey, Donna Wainright, Major Charles Fottler, Myron D. Joiner, Charles L. University of Alabama-Birmingham Birmingham Alabama United States Administration-Health Services University of Alabama-Birmingham Birmingham Alabama United States Administration-Health Services School of Health Related Professions University of Alabama-Birmingham Birmingham Alabama United States School of Health University of Alabama-Birmingham Birmingham Alabama United States Board for Alabama's Health Professiosn Eduction Employment Council Niversity of Alabama-Birmingham Birmingham Alabama United States

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database–a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：亚拉巴马数据收集数据库事实型就业/统计学和数值数据卫生人力/统计学和数值数据卫生服务研究/方法院内诊疗/统计学和数值数据私人开业/统计学和数值数据专业业务/统计学和数值数据专业场所/统计学和数值数据农村卫生州卫生计划美国

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100 total laparoscopic hysterectomies in private practice in Brazil

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JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999年第2期6卷 169-171页

作者： Jaenisch, JB Junior, WA Mae de Deus Hosp Porto Alegre RS Brazil

Study Objective. To evaluate of 100 total laparoscopic hysterectomies performed in a private practice. Design. Prospective observational study (Canadian Task Force classification II-2). Setting. Private hospital. Patients. One hundred women. Interventions. Total laparoscopic hysterectomy (TLH). Measurements and Main Results. The most common indications for TLH were chronic menorrhagia (uterine myomas), pelvic pain (severe endometriosis), and uterine enlargement. Four of our first 20 procedures were converted to laparotomy in which bipolar was used exclusively. In the others cases the Endo cia stapler was used in the first step of the procedure (section of broad ligaments) in combination with bipolar coagulation. Mean operating time was 90 minutes (range 45-150 min) and hospital stay was 36 hours (range 18 hrs-2 days). The two intraoperative complications were hemorrhage requiring blood transfusion and a rectal injury;the lour postoperative complications were two cases of vesicovaginal fistula, and one each of colonic vaginal fistula and vaginal cuff infection (total complication rate 5%). Ninety-six women returned to work in 2 weeks. Conclusion. Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained and experienced in managing complications. We believe that it will become standard treatment for benign uterine disease.

关键词：巴西评价研究随访研究子宫切除术/方法子宫切除术/统计学和数值数据腹腔镜检查/方法腹腔镜检查/统计学和数值数据住院时间私人开业/统计学和数值数据前瞻性研究治疗结果子宫疾病/诊断子宫疾病/外科学成年人老年人女(雌)性人类中年人

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Predictors of episiotomy use at first spontaneous vaginal delivery

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OBSTETRICS AND GYNECOLOGY 2000年第2期96卷 214-218页

作者： Robinson, JN Norwitz, ER Cohen, AP Lieberman, E Harvard Univ Brigham & Womens Hosp Sch MedDiv Maternal Fetal Med Dept Obstet & Gynecol Boston MA 02115 USA

Objective: To identify factors associated with the use of episiotomy at spontaneous vaginal delivery. Methods: We studied 1576 consecutive term, singleton, spontaneous vaginal deliveries in nulliparas at Brigham & Women's Hospital between December 1, 1994 and July 31, 1995. The association of demographic variables and obstetric factors with the rate of episiotomy use were examined. Adjusted odds ratios (OR) and confidence intervals (CI) were estimated from multiple logistic regression analysis. Results: The overall rate of episiotomy was 40.6% (640 of 1576). Midwives performed episiotomies at a lower rate (21.4%) than faculty (33.3%) and private providers (55.6%) (P = .001). After controlling for confounding factors with logistic regression, private practice provider was the strongest predictor of episiotomy use (OR, 4.1;95% CI, 3.1, 5.4) followed by faculty provider (OR, 1.7;95% CI, 1.1, 2.5), prolonged second stage of labor (OR, 1.8;95% CI, 1.2, 2.7), fetal macrosomia (OR, 1.6;95% CI, 1.1, 2.5), and epidural analgesia (OR 1.4, 95% CI, 1.1, 1.8). Conclusion: The strongest factor associated with episiotomy at delivery was the category of obstetric provider. Obstetric and demographic factors evaluated did not readily explain this association. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：镇痛硬膜外波士顿/流行病学置信区间会阴切开术/统计学和数值数据全体教工医学院校/统计学和数值数据巨大胎儿/外科学 Logistic模型病案助产学/统计学和数值数据分娩并发症/外科学产科学比值比私人开业/统计学和数值数据回顾性研究成年人女(雌)性人类妊娠

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