Doctor Shopping Behaviour and Its Predisposing Factors amongst Dermatology Patients / Jurnal Sains Kesihatan Malaysia

@#Doctor shopping increases health economic burden and morbidities. Its prevalence and predisposing factors have to beidentified in order to formulate preventive measures. We aimed to determine the prevalence of doctor shopping, its reasonsand predisposing factors by conducting a cross sectional study of new patients at the Dermatology Clinic, UniversitiKebangsaan Malaysia Medical Centre (UKMMC). Doctor shopping was defined as having consultation with ≥3 healthcareproviders without a referral for the same illness prior to the patients’ visit to UKMMC. Reasons and contributing factorswere classified as disease, healthcare provider, logistic and cost related. Data was collected by a face to face interview.Dermatology Life Quality Index (DLQI) questionnaire determined disease impact on the patients. A total of 58 (55.8%)female and 46 (44.2%) male patients participated. Referral was patient-initiated in 51.9% while 40.4% were doctorshopping. Age, gender, ethnicity, income, occupation and type of health finance provider were not associated with thisbehaviour. About 95% doctor shopped due to disease factors: searching for a cure (95.2%), lack of improvement (88.1%),worsening disease (50.0%), dissatisfaction with treatment (31.0%), seeking other opinions (26.2%) and exploringtreatment options (26.2%). Impaired DLQI (OR 1.17; 95% CI 1.08,1.38), p 0.04, and disease related factors (OR 6.57; 95%CI 1.52, 7.72), p 0.041 were significant independent risk factors. Doctor shopping is very common among our patients.Reasons and predisposing factors are predominantly disease related. Patient education and counselling is important inmanagement of dermatological diseases to prevent doctor shopping.

Conflictos de intereses en nefrología / Conflicts of interest in nephrology

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation­ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

Effect of referral for dental service on dental-service utilization by primary school children aged 8 to 11 years in Enugu, Nigeria

Aim: To determine how one dental education session and referral of study participants aged 8-11 years would affect utilization of oral-health care services. Methods: This descriptive prospective study recruited 1,406 pupils aged 8-11 years from randomly selected primary schools in Enugu metropolis. All pupils received one oral-health education and referral letters for treatment. Data were collected on the pupils' socio-demographic profile, family structure, and history of oral-health care utilization in the 12 months preceding the study and within 12 months of receipt of referral letter. The effect of these factors as predictors of past and recent dental service utilization was determined using logistic regression. Results: Only 4.3% of the study participants had ever used oral-health services in the 12 months prior to the study. Within 12 months of issuing the referral letters, 9.0% of pupils used the oral-health services. Children from middle (AOR: 0.46; CI: 0.29-0.73; p=0.001) and low socioeconomic strata (AOR: 0.21; CI: 0.11-0.39; p<0.001) and those living with relatives/guardians (AOR: 0.08, CI: 0.01-0.56; p=0.01) were still less likely to have utilized oral-health services. Conclusions: Referral of children for oral-health care increased the number of children who utilized oral health care services (Au)

Factors Contributing Patients' 'Self Requested Referral' in University Hospital Family Medicine Clinic / 가정의학회지

BACKGROUND: After the referral system had been established, a tendency of patients who prefer to consult themselves to a specialist with 'self requested referral' is increasing in university hospital family medicine clinics. This study was conducted to know which factors of patients who for the first time visited university hospital family medicine clinic to require medical request for 'self requested referral' to a specialist influence 'self requested referral' tendency. METHODS: Among 905 patients, 647 agreed to the questionnaire were included in this study. We divided the patients in two, the 'self requested referral' group and the 'general patients' group that does not. Patients completed a four-item, self-administered questionnaire. RESULTS: 'Self requested referral' group tended to have no experience in family medicine and tended to be negative about the need for family medicine (P < 0.001) The factors that have effect on 'self requested referral' are age, occupation, education, experience of family medicine, and recognition degree of necessity of family medicine. Patients in 20-39 of age, who were white colored, higher education had higher tendency of 'self requested referral' and patients who had no experience in family medicine and lower degree of recognition about the necessity of family medicine had higher tendency of 'self-referral'. CONCLUSION: It is necessary to find ways to increase satisfaction of patients who have factors that have effect on their 'self requested referral' tendency such as age, occupation, education, experience of family medicine, and degree of recognition about the necessity of family medicine.