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Biomedical subjects

L R Barker

Publications and source records attributed to L R Barker.

At least 19 recordsLinked to original sources

When should learning about hospitalized patients end? Providing housestaff with post-discharge follow-up information.

PURPOSE: As hospital stays grow shorter, many patients are discharged to follow up with their primary care physicians before their diagnoses and responses to treatment are clear. The authors studied the value and feasibility of providing housestaff with follow-up information about their former inpatients. METHOD: Patients included in the study (1) had been admitted to the housestaff service during the study period (January to March 1997), (2) had received follow-up care from a primary care physician in the Johns Hopkins Bayview Physicians' Professional Association, and (3) had been hospitalized for at least three days. The primary care physician completed a single-page follow-up form four to six weeks after the patient's discharge from the hospital; that form was given to the house officers who had cared for that patient. RESULTS: Responses to a preintervention questionnaire completed by 28 of 39 house officers (72%) showed that 92% felt it to be important or extremely important to get follow-up information about inpatients; 86% indicated that they rarely or never receive such information. During the study period, house officers were sent follow-up information for 65 of 76 eligible patients (85%). In their responses to a post-intervention questionnaire (response rate 73%), the house officers most valued learning about the accuracy of the discharge diagnosis, the results of additional diagnostic tests, and information about the patient's quality of life since discharge. Housestaff's satisfaction with the follow-up information received about inpatients improved (p = .001). CONCLUSIONS: Providing follow-up information was a feasible intervention that was valued by housestaff.

Adult↗

Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial.

BACKGROUND: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters. OBJECTIVE: To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress. METHODS: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits. RESULTS: Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months. CONCLUSIONS: Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.

Adult↗

Hypertension: spectrum of problems and guidelines for management.

Hypertensive patients may present to the emergency department with one of three general problems: high blood pressure due to labile hypertension, chronic hypertension, accelerated hypertension, or a hypertensive emergency; side effects from antihypertensive drugs; or acute medical or surgical illness whose management may be affected by hypertension or by drugs taken for hypertension. We describe these problems and recommend an approach to each that is appropriate in the emergency department.

Antihypertensive Agents↗

Recent trans-European initiatives in general practice.

Recently, several initiatives have addressed the situation of general practice in Europe. These trans-European developments in medicine have paralleled the continuing emergence of geopolitical Europe. Most of these initiatives have emanated from 2 events in that occurred in 1995: the mandatory implementation of the European Union's directive governing the duration of postgraduate training in general practice and the founding of the European Society of General Practice/Family Practice.

Education, Medical, Graduate↗