Health care for Kentucky's uninsured indigents: the perspective of providers in the Kentucky Physicians Care program.

The pressing issue of providing care for the uninsured indigent has been addressed in Kentucky by a unique private sector program that depends on physician donation of services. The Kentucky Physicians Care (KPC) program which provides health care to uninsured indigent patients in Kentucky was evaluated from the perspective of the participating physicians through in-depth interviews with 22 randomly selected physicians. The results of the interviews suggested that the KPC program is generally viewed by participating providers as a successful and personally rewarding enterprise. Suggestions for improving services included strategies to increase awareness of the program for both patients and providers. As state and federal policy continues to focus on the uninsured as a vulnerable population, integration of this private sector program into a partnership with the public sector may be a worthwhile strategy.

Patterns of antibiotic-resistant Streptococcus pneumoniae in children in a day-care setting.

BACKGROUND: Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of antibiotic-resistant S pneumoniae is increasing. The purpose of this study was to investigate the prevalence of antibiotic-resistant S pneumoniae in a sample of children in day-care facilities in a region that includes both rural and urban communities. METHODS: Nasopharyngeal cultures were obtained from 104 children in eight day-care centers located in rural and urban central Kentucky in April and May, 1997. Thirty-five of the children produced isolates positive for S pneumoniae. Each isolate was tested for susceptibility to penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, vancomycin, and cefotaxime. RESULTS: Of the children with S pneumoniae isolates, 54% had isolates that were resistant to penicillin and 40% that were resistant to trimethoprim-sulfamethoxazole. Twenty-one (60%) of the isolates had resistance to at least one of the six tested antimicrobials, with 15 (43%) having resistance to more than one of the antimicrobials. The mean age of children with isolates resistant to penicillin was significantly less (2.7 + 1.6) than those with penicillin-susceptible isolates (3.7 + 1.1, P = .02). There was no relation between resistance and rural or urban day-care location. CONCLUSIONS: A substantial proportion of S pneumoniae isolates in young children are resistant to antibiotics. Limiting the effect of S pneumoniae drug resistance may require a reexamination of outpatient treatment strategies for childhood respiratory tract infections.