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PubMed1996

The reliability and validity of work measurement in Australian general practice consultations.

OBJECTIVES: To examine the reliability of relative work value assessment in general practice consultations and to determine whether different methods of assessing work produce consistent rankings. DESIGN: Cross-sectional observational assessment of general practice consulations. SETTING: General practices in Victoria between October 1991 and October 1992. PARTICIPANTS: 686 patients attending one of 58 general practitioners (GPs) drawn from a random, stratified sample. METHODS: Each participating GP had one day of consultations videotaped. They rated the work value of each consultation by using a magnitude estimation scale relative to a reference vignette. Three GP observers independently applied the same scale to the videotaped consultations. After three months, the observers applied a second measurement of work value, a compensation scale (also relative to the reference vignette), to the videotaped consultations. Duration of consultation was the third rating method. MAIN OUTCOME MEASURES: The reliability of work value assessment for each scale. Consultation rank order correlation coefficients among all rating methods. RESULTS: Observer reliability was high for both scales. Practising GPs showed lower levels of reliability in assessing the work value of their consultations. Strong positive correlations were found for consultation rankings among the observer scales and duration of the consultation. The duration of the consultation emerged as an important predictor of consultation work value. CONCLUSIONS: Scaling methods appear to be of little value to the practising GP in reliably assessing the relative work value of their consultations; training in the use of these scales may improve their reliability. However, the duration of consultation may be a reasonable proxy for relative work value assessment in general practice consultations.

Australia↗
PubMed2001

[Motives for consultation and demographic characteristics of a community of "undocumented" immigrants in the district of Usera-Villaverde (Madrid)].

OBJECTIVE: The objectives of the present study are to describe to the social particularizations, reasons for consultation and diagnoses conducted in the adult immigrants without regularizing that they went to this doctor's office in the district of Villaverde-Usera (Madrid), excluding the data from obstetrics-gynecology and pediatric. DESIGN: One is a descriptive observational study, based on the registry of the daily activity of the consultation from 1996 to 1999. SETTING: Primary level of attention in the area of influence of the municipal districts of Villaverde-Usera. PARTICIPANTS: 1496 consultations to immigrants without regularizing adults, taken care of in our consultation are described in the mentioned period. MEASUREMENTS AND RESULTS: By means of the registry of daily activity social and demographic variables took shelter, of reason and type of consultation, as well as of the main diagnosis that brought to them to the consultation, en 1496 consultations of illegal immigrants (533 people). 31% of the consultations were new and a 14% of absences to the citation were registered. 67% of the consultations made women, the average age was of 34.9 years and in a 76% it referred like South America origin. The diseases that more consultations generated were acute respiratory infection 18%, depressives disorders 11% and the backache with also a 11%. The 48% the reasons for the consultation were acute and 60% took place to free demand. CONCLUSIONS: The group of consultations taken care of responds to the profile of a young South American woman, that fundamentally consults by acute respiratory infections, and very in proximity by depressive-anxious upheavals and lumbar affections, problems very in relation to his situation of immigrant. The irregularity adds to a risk when making difficult the access, most of the consultations are precise, failing in elevated occasions to the programmed consultation.

Adult↗
PubMedDate not supplied

Outpatient consultation: interaction between the general internist and the specialist.

To define the process of outpatient consultation, the authors conducted a prospective study of 716 consecutive outpatient consultations in a university-based primary care internal medicine practice. The overall consultation rate was 11.9 per 100 patient visits, with 78% of the referrals to other physicians and 22% to non-physician specialists. Consultation rates and patterns of referral varied little between physicians with different levels of experience. Eighteen per cent of the consultations resulted in a no-show by the patient to the consultant. Referring physicians received communications from the consultants 80.5% of the time when appointments were kept. By multivariate regression two variables were shown to be most important in determining the internist's overall satisfaction: 1) how well the consultant aided the internist in his ongoing management of the patient's problem, and 2) how well specific questions were addressed by the specialist. Other statistically significant variables were the clarity and promptness of the consultant's reply, the educational value of the consultation, and specific management recommendations made by the consultant. To improve the consultation process no-shows must be minimized, communication from the consultant maximized, and the interaction between the internist and the consultant bolstered.

Ambulatory Care↗
PubMedDate not supplied

Preoperative medical consultations: impact on perioperative management and surgical outcome.

PURPOSE: This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome. METHODS: The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded. RESULTS: 138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was "preoperative evaluation." In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not. CONCLUSION: A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery.

Age Factors↗
PubMed2000

The value of peri-operative consultation on a general surgical ward by the internist.

BACKGROUND: Medical peri-operative consultation plays an important role in the practice of the internist. It represents 13-33% of the total consultation done by the internist. The value of preoperative consultation by the internist is still unclear and the place of the consultations is under discussion. METHODS: Consecutive medical consultations--by internist-intensivists from the surgical ICU--of 408 patients in the department of Surgery of the University Hospital Groningen were retrospectively analyzed, with specific attention to the consultation request, the consultation report and the outcome of the consultation. RESULTS: The main problems were cardiac (34%) or pulmonary (20%). In 78% well defined questions about the patients were asked and in 29% of the preoperative requests, the requesting surgeon asked specific advice about diagnosis and management. In 49% the requesting physician asked for an 'evaluation' of the patients. Of all consultations 271 (67%) were preoperative consultations. In 12% the findings of the preoperative consultation had a significant impact on the course of the patient, whereas in 7% of the preoperative requests the operation was postponed. The consulting internist recommended in 2% to cancel the operation for this admission, which was shared by the surgeon and anesthesiologist. In 10% of all cases new diseases or processes were diagnosed, or were found not to be treated adequately before consultation, so the diagnosis or management was changed. CONCLUSIONS: Our data show that (semi-) elective consultations by internists at the department of Surgery, on indication of the surgeon, changes the course of a significant percentage of patients. (See Editorials p. 1 and p. 4).

Adolescent↗
PubMed1999

Consultation for asthma: results of a generalist survey.

BACKGROUND: There are few studies that examine referral patterns for asthma and few studies that examine the referring physicians' reasons for consultation. OBJECTIVE: The purpose of this study was to survey generalist physicians on their referral patterns for adult patients with asthma. METHODS: We mailed a questionnaire to all the staff (faculty) in the Department of Family Medicine and the Division of Community Internal Medicine at the Mayo Clinic in Rochester, Minnesota. There were 37 completed questionnaires (18 family medicine and 19 internal medicine) out of a total of 58 for a response rate of 64%. The survey asked what were reasons for consultation, whether allergists or pulmonologists were preferred, and the characteristics of a good consultation. RESULTS: We asked respondents to indicate "how often you consult a specialist for an adult asthma patient" for a variety of clinical indications. The percentage responding "always" (for the top five indications) were if the patient requests one (46%), for allergen immunotherapy (38%), for single life-threatening attack (27%), for allergy testing (14%), and for steroid-dependent asthma or poorly controlled asthma (11%). Twenty-seven percent of respondents generally consulted allergists only, 22% generally consulted pulmonologists only, 3% indicated both, while 46% had no preference. Respondents did express a preference for a pulmonologist when the reported reason for the consultation was diagnosis of asthma uncertain, chronic cough, asthma in smoker, exercise training, or for an allergist when the reported reason for consultation was allergy evaluation or immunotherapy. The respondents indicated that the top six characteristics of a good consultation were the following: clear recommendations, clinically appropriate recommendations, high patient satisfaction, including recommendations for future management scenarios, including educational content in the consultation, and calling the referring physician before requesting a secondary consultation. CONCLUSIONS: These results suggest that while consultation occurs often for severe or uncontrolled asthma, some asthma patients who may benefit from consultation may not be seeing the specialist. There were no systematic preferences for consultations with allergists versus pulmonologists for asthma although for some clinical indications pulmonologists or allergists were favored. Referring physicians value clear, clinically appropriate recommendations.

Adult↗
PubMed2000

Agricultural consultancy--a career choice for veterinarians.

OBJECTIVE: To document the personal, educational and professional skills that characterise veterinarians pursuing careers as agricultural consultants and to determine the future direction for veterinary-related advisory services to agriculture in Australia. DESIGN: Thirty-six veterinarians practising as consultants in agriculture throughout Australia were sent a postal survey in 1994. PROCEDURE: A descriptive analysis was chosen because of the relatively small population available to sample. Comparisons were made on a percentage basis where appropriate. RESULTS: Twenty-four useable responses to the questionnaire were received. Consultants were mostly men with an agricultural background, aged 31 to 40 years. They considered their undergraduate veterinary studies to be a stepping stone into further education and practical experience and ultimately consultancy. Consultants predicted an increased reliance for their work on corporate farms, private agribusiness, research and development and sub-contracted work, rather than on family-owned farms. Consultants disagreed on the wisdom of combining consultancy activities with alternative businesses (for instance mixed veterinary practice). Only 13 consultants derived greater than 76% of their income from consultancy and 14 combined another business with consulting. The need for continuing education was considered important. Consultants predicted various future prospects for the industry. Many predicted that there would not be enough veterinarians to fulfill the demand for this type of work. IMPLICATIONS FOR THE VETERINARY PROFESSION: Results from this survey suggest that veterinary consulting will extend into finance, agronomy and marketing in addition to current skills in animal nutrition, parasite control and animal reproduction. As clients demand specialised skills and knowledge, the formation of co-operatives or companies of specialists may be beneficial to both client and consultant in the future. The consultant's role can be characterised as one of extending relevant information to clients in a useful form. Excellent communication skills are necessary, as is an understanding of rural issues and animal industries.

Adult↗
PubMed1988

Domiciliary consultations: some facts and questions.

The domiciliary consultation scheme introduced at the start of the NHS enables joint consultation between a consultant and general practitioner in a patient's home when the patient cannot attend hospital on medical grounds. Consultants claim a fee from the NHS, general practitioners do not. Data from the Department of Health and Social Security on domiciliary consultations in England and Wales during 1981-6 were analysed. The number of domiciliary consultations fell during 1981-6 from 429,759 in 1981 to 387,394 in 1986, a fall of 10%, whereas the numbers of consultants and general practitioners increased by 1404 (12%) and 2400 (10%), respectively. The yearly rate of domiciliary consultation per consultant fell by 19% from 36 in 1981 to 29 in 1986 and that per general practitioner by 18% from 18 to 15. In 1986 geriatric medicine had the highest rate of domiciliary consultation per consultant (187) followed by psychiatry (89), general medicine (52), dermatology (49), rheumatology (42), general surgery (36), gastroenterology (35), thoracic medicine (34), and orthopaedics (30). In 1986 all specialties apart from clinical pharmacology and therapeutics and clinical genetics showed a decrease in the yearly rate of domiciliary consultation when compared with the rate for 1981. Domiciliary consultation seems to have become a domiciliary visit by the consultant alone. At an estimated cost of about 20m pounds for 1988 the scheme needs critical evaluation.

Aged↗
PubMed2001

A protocol for consultation of another physician in cases of euthanasia and assisted suicide.

OBJECTIVE: Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. PARTICIPANTS: Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the general practitioners who were going to use the protocol. EVIDENCE: There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. CONSENSUS: An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. CONCLUSIONS: The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere.

Clinical Protocols↗
PubMed2002

[Interruptions during consultations--harmful to both patients and physicians].

UNLABELLED: The physician-patient consultation is a confidential meeting that necessitates uninterrupted privacy. During consultations, physicians are asked to give their undivided attention to the patient. The purpose of this study was to document interrupted consultations and to address the related opinion of both physicians and patients. METHODS: The study was divided into two parts: 1. A record was kept of all interruptions that occurred during one working day in the offices of four family physicians and four pediatricians in a large urban clinic in Israel. 2. Documentation from interviews and questionnaires that were submitted to both physicians and patients from the clinic and neighboring clinics regarding interruptions during consultations with patients. RESULTS: There were 218 interruptions recorded during 110 pediatric consultations. Four hundred and twenty-six interruptions were recorded during 116 consultations with family physicians. A total of 83% of the pediatrics consultations and 95% of the family physician consultations were interrupted. The most common reasons for interruption were: 1) disturbance by other patients (23% pediatric visits and 44% family medicine visits) and 2) telephone calls, 22% for all physicians. Eighteen percent of the pediatricians time and 31% of the family physicians time was involved with dealing with problems other than those of the patient. Fifty-one physicians from the study clinic and neighboring clinics completed a questionnaire. Eighty-four percent of the physicians expressed the opinion that interruptions during consultations are harmful and disruptive and 92% felt that this had a negative influence on patient-doctor relationships. Sixty patients were interviewed and asked to express their opinion about interruptions during consultations. Only 40% of the patients felt that their physician had given them undivided attention. Seventy percent of the patients were aware of the interruptions during their consultations and subconsciously annoyed. CONCLUSIONS: Interruptions during consultations are frequent and harmful to both patients and physicians. Consultation interruption should be regarding as a major threat to the quality of the patient-physician relationship. The nursing and clerical staff of the clinics should be briefed and cautioned to limit interruptions during consultation hours to a minimum.

Child↗
PubMed1992

Variability in consultation rates and practitioner level of diagnostic certainty.

BACKGROUND: This study was designed to determine the variability in the consultation practices of family physicians and family nurse practitioners in an urban group practice, and to examine the relation between the referring practitioner's diagnostic certainty at the time of the consultation request, the specificity of the request to the consultant, and the frequency with which the practitioner ordered consultations in that specialty. METHODS: This study examined consultations requested by six family physicians and two family nurse practitioners that were directed to nine medical and surgical specialties in connection with 35,218 family practice visits made over a 19-month period in an urban family practice. Requests for consultation were scored based on the level of certainty of the referring practitioner's diagnosis at the time of consultation and the specificity of the consultation request. RESULTS: There was nearly a fivefold variation in the overall specialty consultation rates among providers, with even greater variation in each individual specialty area studied. Referral rate correlated positively with certainty of diagnosis (r = .40). There was no consistent relation between request specificity and referral rate. CONCLUSIONS: Consultation rates vary widely, even among family physicians and nurse practitioners within the same practice. The rate at which a practitioner orders consultations in a specialty area increases in relation to the practitioner's certainty of the diagnosis at the time the consultation was requested. Diagnostic certainty is discussed as a possible indicator of a referring practitioner's knowledge in a specialty area, implying that the greater a practitioner's knowledge in a specialty area, the more he or she consults with specialists in the field. Financial incentives that attempt to decrease specialty consultation should be reexamined in light of these findings.

Diagnosis↗
PubMed1995

Telephone consultations in general practice: an additional or alternative service?

BACKGROUND: There is conflicting evidence about whether telephone consultations in general practice represent additional or alternative contacts with the general practitioner. AIM: A study set out to assess the characteristics of patients using the telephone to consult the general practitioner and whether telephone consultations were used as an additional or an alternative service to surgery consultations during surgery hours. METHOD: The study took place in one practice that has run a 'phone-in clinic' for five years. A questionnaire on perceptions of and attitudes towards telephone consultations was sent to 259 patients who consulted the general practitioner by telephone and to an age-sex matched group of patients whose medical records indicated that they had never consulted the general practitioner by telephone. For both groups, numbers of repeat prescriptions and consultations in the preceding year were determined from medical records. RESULTS: Those who consulted the doctor by telephone were significantly more likely to be aware of the phone-in clinic, to have a telephone at home, to have children aged under five years at home and to be receiving repeat prescriptions and repeat prescriptions for psychotropic drugs compared with those who had never consulted by telephone. Eleven of 226 patients who consulted be telephone (5%) indicated that they would definitely not have made a surgery appointment or home visit request (that is, they represented additional general practitioner workload) while 120 (53%) used the telephone consultation as an alternative to making a surgery appointment and 22 (10%) used the telephone consultation as an alternative to requesting a home visit. CONCLUSION: It appears that the telephone service was being used largely as an alternative access point to the doctor. General practitioners should not be apprehensive about the possible increase in workload generated by introducing telephone consultations, for example in phone-in clinics.

Attitude to Health↗
PubMed2004

An investigation in primary care of the relationship between consultation behaviour, increased vaginal bleeding and mental disorder.

Studies have shown an association between consultation for increased vaginal bleeding and the presence of psychological disturbance. However, many of the studies have failed to control the known link between psychological distress and propensity to consult in general. The aim of this case-control study was to determine whether psychological distress in women consulting with increased vaginal bleeding is associated with the illness or with the propensity to consult. Women consulting as cases of 'increased vaginal bleeding' were compared with three sets of control women: two sets of consulting controls ('acute respiratory tract infection' or a physical 'other illness') and one set of community controls. Predictor measures were consultations and prescriptions in the previous 5 years. There was no difference in overall consultation rates (P = 0.19), proportion consulting for a mental disorder (P = 0.39), frequency of consultation for a mental disorder (P = 0.46) or having a prescribed hypnotic or anxiolytic (P = 0.29) between the three consulting groups. However, the consulting groups had higher rates of consulting both overall and specifically for a mental disorder than the community controls. The association between increased vaginal bleeding and mental disorder or use of psychotropic medication appeared to be explained by consultation behaviour.

Adolescent↗
PubMed1993

A descriptive study of healthcare ethics consultants in Canada: results of a national survey.

As part of a project to examine health care ethics consultation in Canada, we surveyed individuals who were considered by themselves or others to play a significant role in health care ethics consultation. Since one goal of the project was to examine the education and abilities necessary for consultants, we sought to determine the qualifications and skills currently possessed by persons considered to be ethics consultants. For the purposes of the questionnaire, 'health care ethics consultation' was defined broadly to include consultation on ethical issues in clinical care or in clinical research, ethics consultation to Clinical Ethics Committees, Research Ethics Committees, and policy formulation committees in health care institutions; 'clinical ethics work' was defined more broadly still to include, in addition to the above, ethics education, administration, research and writing on bioethics other than the above, and public speaking. Three hundred and fifty questionnaires were sent to individuals and institutions across Canada that were thought to have some involvement in health care ethics consultation. Two hundred and fifty-three questionnaires were returned for a response rate of 72%. This report presents initial findings of the study and attempts to provide a comprehensive overview of the current state of ethics consultation within Canada. The survey examines demographics, educational background, time spent on ethics, institutional affiliations, approaches to the role of consultation, research related issues, and attitudes toward certification. Of the 253 questionnaires returned, 162 were completed by individuals who indicated that they provided some kind of ethics consultation. Of these, 43 indicated that they spent 30% or more of their time in clinical ethics work. These individuals are quite heterogeneous in background, training and activities, and while the great majority of them are based in an academic setting (university or teaching hospital), many act as resources to community hospitals, long-term care facilities and other organizations. Finally, the survey found that respondents' views on the advisability of certification for those offering ethics consultation were split evenly between those in favour of and those against certification. This report serves, then, as a reference point for studying the roles, responsibilities, training and accreditation of ethics consultants in health care.

Canada↗
PubMedDate not supplied

Mail consultations in ophthalmology. The Tenth Richard E. Hoover Lecture.

BACKGROUND: Although a number of diagnostic and therapeutic methods are available to assist the ophthalmologist, relatively little attention has been given to mail consultations. By this method, a clinical summary and photographs, fluorescein angiograms, ultrasonograms, and/or other relevant materials are mailed to a consultant who then renders an opinion by telephone and/or return mail. MATERIALS AND METHODS: The records of all mail consultations that were sent to the senior author and his colleagues during a 20 year period were reviewed to determine the total number of mail consultations, the reasons for the consultations, and the diagnoses and therapeutic recommendations that were made by the consultant. RESULTS: A total of 1357 mail consultations were received during the 20 year period, with a progressively increasing number of consultations each year. Consultations were received from 757 physicians representing all 50 states in the United States and 32 other countries. Because of the authors' subspecialty in ocular oncology and medical retinal diseases, the majority of the consultations received were related to those topics. In many cases, the initial diagnosis and treatment plan were altered based on our opinion through mail consultation. Based on the material received, the recommendations that we made included observation in 635 cases, enucleation in 152, surgical excision of a lesion in 120, plaque radiotherapy in 102, laser photocoagulation in 81, systemic evaluation in 40, external beam irradiation in 36, fine needle aspiration biopsy in 33, orbital exenteration in 25, chemotherapy in 21, and cryotherapy in 14. CONCLUSION: Although not as ideal as direct patient examination, mail consultation can be an effective method of making or confirming a diagnosis and obtaining a therapeutic opinion. Although the authors have received mail consultations related to ocular oncology, this method may be applicable to other subspecialties in ophthalmology and to general medicine.

Adult↗
PubMed2007

Frequency, nature and determinants of pharmaceutical consultations provided in private by Dutch community pharmacists.

OBJECTIVE: According to a report published by the federation of Dutch patients' associations, patients would like to see a pharmacist, who acts more as a personal adviser. This raised the question, how often Dutch community pharmacists have personal consultations with their patients in daily practice, on which factors this depends, and what kind of topics are discussed during these meetings. SETTING: Community pharmacies in the Netherlands. METHOD: A questionnaire was distributed among 800 randomly selected pharmacies. Questions were restricted to consultations characterized by one-to-one contact, drug therapy related content, and adequate privacy. These consultations were labelled as pharmaceutical consultations in private to distinguish them from other contacts between pharmacists and patients. MAIN OUTCOME MEASURE: Number, content, and character of consultations. RESULTS: 198 (24.8%) community pharmacies responded. The pharmacists provide an average of roughly 1.2 consultations in private per working day. The vast majority of respondents provided face-to-face and telephone consultations (94.4 and 91.9%, respectively), only a minority gave consultations by e-mail (30.8%). These consultations primarily dealt with topics related to medication safety. The mean overall time spent was 290 min per month. A relatively high frequency of personal consultations was significantly associated with the absolute number of full-time equivalent pharmacists in the pharmacy. CONCLUSION: The frequency of pharmaceutical consultations in private is low, but may be improved by reorganisation of the pharmacist's activities. The possibility of personal consultations by e-mail is not yet well-developed. Further research is needed to assess the patient's view of pharmaceutical consultations in private.

Adult↗
PubMed2001

Predictors of health-care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia.

AIM: To look at the predictors of health-care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia. METHODS: Recurrent abdominal pain was defined as at least three episodes of abdominal pain, severe enough to affect a child's activities over a period longer than 3 months. A health-care consulter was defined as a child who had been brought to see a doctor regarding recurrent abdominal pain at least once in the past year. Children aged between 9 and 15 years were randomly chosen from schools in the city of Petaling Jaya, given questionnaires to fill in and interviewed to determine whether they fulfilled the above criteria for having symptoms of recurrent abdominal pain and for being a consulter. Bivariate analysis and multiple logistic regression analysis were performed on the data obtained. RESULTS: One hundred and forty-three (9.61%) children fulfilled the criteria for recurrent abdominal pain out of a total of 1488 schoolchildren interviewed. There were 65 (45.5%) consulters and 78 (54.5%) non-consulters. Among the consulters, the male to female ratio was 1:1.4, while among the non-consulters, the ratio was 1:1.1. On bivariate analysis, the Chinese had a significantly lower likelihood to consult a doctor (P = 0.02), while the other two races did not show any increase in consultation (Malays, P = 0.08; Indians, P = 0.21). Among those with severe pain, there was a significantly higher prevalence of consulters (P < 0.01). Furthermore, those whose sleep was interrupted by abdominal pain were more likely to consult (P < 0.01). Children who had consulted a doctor were more likely to be missing school because of abdominal pain (P < 0.01). Following multiple logistic regression analysis, ethnicity was no longer a significant predictor. CONCLUSIONS: Approximately 45.5% of schoolchildren with recurrent abdominal pain in an urban setting were brought to see a doctor. Predictors of recent health-care consultation were school absence, pain severity and interruption of sleep caused by abdominal pain.

Abdominal Pain↗
PubMed2002

Determinants of consultation rate in patients with anxiety and depressive disorders in primary care.

BACKGROUND: Although it is recognized that anxiety and depression are associated with frequent attendance in primary care, not all patients with these disorders attend frequently. The factors associated with general practice consultation in the important group of patients with anxiety and depressive disorders are not clear. OBJECTIVES: Our aim was to determine prospectively the factors which predict consultation rate in a cohort of patients with anxiety and depressive disorders in primary care. METHODS: A total of 148 adult patients with a depressive, anxiety or panic disorder (DSM-III criteria) were studied prospectively for 6 months to determine the factors which predicted consultation rate during this time. Measures at baseline included: the Psychiatric Assessment Schedule, Hamilton Depression Rating Scale, Life Events and Difficulties Schedule, Clinical Anxiety Scale, details of substance misuse and demographic data. The principal outcome measure was the number of consultations recorded in the GP records over the following 6 months. The variables associated with consultation rate were assessed by multiple regression analysis, with number of consultations as the dependent variable. RESULTS: The median consultation rate during the 6 months of the study was five (range: 1-22). Thirty per cent of the sample consulted seven or more times during the 6 months and 10% consulted 12 or more times. The regression analysis demonstrated that the following variables contributed to the best model: prior consultation rate, past psychiatric history, ongoing social difficulties, current level of alcohol consumption, total psychiatric symptom score and total anxiety score. These variables together accounted for 41% of the variance in consultation rate. CONCLUSION: The detection and rigorous treatment of psychiatric disorder, the provision of social support and interventions for alcohol dependence may help to reduce the frequency of consultation of anxious and depressed patients in primary care. Future research to identify additional variables which explain the major part of the variance in consultation rate may pave the way for novel treatment approaches to the phenomenon of frequent attendance.

Adolescent↗