Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CONSULTATIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed1978

The consultation readiness scale: an attempt to improve consultation practice.

The Consultation Readiness Scale is designed to facilitate mental health and other forms of human services consultation. The scale is based on the assumption that consultee-consultant relationships vary in their "readiness" for consultation. A basic task for consultants is to assess the current readiness level and help move the relationship to a higher level. The Consultation Readiness Scale facilitates this process by specifying six levels of readiness and indicating the general intervention strategies appropriate for each. Initial, descriptive data based on five consultants and 366 consulteees are presented. Most consultation relationships were not as high levels of readiness; readiness varied with the amount of time consultants had worked in the consultees' setting and did not vary by more than one level over a 6-month period.

Community Mental Health Services↗
PubMed2001

Inside the routine general practice consultation: an observational study of consultations for sore throats.

OBJECTIVES: The aims of this study were to examine how GPs manage the consultation for upper resiratory tract infections (URTIs) and the prescribing of antibiotics, to understand what skills and strategies are used in managing URTIs without antibiotics, and to note evidence of pressure on doctors to prescribe and whether there are signs of overt disagreement about prescribing in the consultation. METHODS: A qualitative analysis of audiotaped consultations was carried out. The setting was a general practice in South Wales and the subjects were five GPs and 29 parents presenting children with URTIs over a 2-week period. The main outcome measures were skills and strategies identified from audiotapes of consultations. RESULTS: This group of GPs used a set of readily identifiable consulting skills for managing the consultation without prescribing. Their consultations had a highly routinized quality. There was little evidence of either conflict or overt pressure from parents to prescribe. The word 'antibiotics' was seldom mentioned. Clinicians did not elicit patient expectations for receiving antibiotics. CONCLUSIONS: Doctors use a set of readily identifiable skills in managing the URTI consultation. Avoiding the prescribing of antibiotics is not necessarily a simple and straightforward matter. Since patients apparently want antibiotics less than anticipated, eliciting expectations might be a way of reducing prescribing and broadening the approach to meeting patient needs. Whether doctors can adjust their routinized consulting patterns in the time-limited context of general practice remains an open question.

Anti-Bacterial Agents↗
PubMed1983

Consultation-Liaison outcome evaluation system. I. Consultant-consultee interaction.

The Consultation-Liaison Outcome Evaluation System characterizes the effectiveness of consultative activities. The initial phase of the system identifies consultees' responses to psychiatric consultants' recommendations and diagnoses and the variables critical to concordance with the use of quantitative measures. The observed incidence and concordance rates of the consultant-consultee interaction were integrated (1) to establish a concordance hierarchy clarifying consultees' priorities in seeking psychiatric consultation, (2) to provide reference points to guide psychiatric consultants' clinical actions, (3) to establish tentative standards with which to evaluate the effectiveness of psychiatric consultation, and (4) to signal the need for further outcome studies and the development of data-based consultation practices.

Clinical Competence↗
PubMed1990

The Psychiatric Consultation Checklist: a structured form to improve the clarity of psychiatric consultation requests.

Medical specialty consultation is requested to obtain expert review of a patient's condition. The specialist usually receives a case synopsis with pertinent positives and negatives and a specific request for assistance. In contrast, the psychiatrist often gets a statement of diagnostic speculation (e.g., "depressed") with a request to "please evaluate." Classically, the psychiatric consultant begins with open-ended empathic questioning in an attempt to redefine the written consultation question. However, given the difficulty consultees have in forming questions, and increasing time limitations, a more structured approach to obtaining data might assist both the consultee (M.D. requesting assistance) and the consultant (psychiatrist). The Psychiatric Consultation Checklist (PCC) was devised to function as a paper "expert" questioning system to provide such assistance. In a pilot study, 10 administrations of the PCC took an average of 3.6 minutes. In comparison to consultations using standard forms, more data were supplied in several categories when the PCC was used, particularly regarding patient stressors, patient behaviors of concern, and consultee speculation on psychiatric diagnostic formulation. The PCC may be used in consultation research, for assessment and education of physicians in training (regarding psychiatric issues in the medical/surgical setting), and for general clinical consultation purposes.

Humans↗
PubMed1992

What can doctors do to achieve a successful consultation? Videotaped interviews analysed by the 'consultation map' method.

Positive consultations, where both the GP and the patient had a positive impression, were compared with negative consultations, where both the GP and the patient had a negative impression. The consultations were compared with respect to tasks listed by Pendelton et al. in their 'consultation map', constituting satisfying and efficient consultation. The determining points in the positive consultations were that the GP and the patient were in agreement about the reason for the consultation and that the GP asked about the patients' ideas and concerns or health beliefs. In consequence, the GP used more time to achieve a share understanding with the patient and involved the patient in the management. This last point seemed to be the most discriminating between the positive and the negative consultations.

Adult↗
PubMed1993

Factors associated with consultation length and characteristics of short and long consultations.

Consultation length illustrates how general practitioners balance contradictory concerns such as productivity and quality, listening to patients, and handling their own stress. Important factors for consultation length are list size, characteristics of doctors and patients, and character of the problem. The purpose of this study of 463 consultations was to describe factors that are associated with short and long consultations and to examine the relative influence on the consultation length of patients' age and sex, character of the problem, continuity, and the 'doctor's speed'. A questionnaire was used for both doctors and patients. Short consultations were often made by younger male patients about physical problems, while long consultations often were made by older patients about problems with both psychological and physical dimensions. The 'doctor's speed' explained 22.5%, character of the problem 11.6%, and patient's age 2.9% of the variation in consultation length.

Adolescent↗
PubMed1996

Consulting--Part 1. Why consultations fail.

The first article in this series describes a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the consultation process and the failure to clearly establish and maintain consensual goals. Part 2 of this series will explore the consultation process from a different perspective, examining the issues that often trigger requests for consultation services and the dynamics that can foreshadow success or failure before consultants are even engaged.

Attitude of Health Personnel↗
PubMed1996

Consulting--Part 2. The art and science of using consultants.

Part I of this series described a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a clear picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the process and the failure to clearly establish and maintain consensual goals. In Part 2, the consultation process is explored from a very different perspective. What are the issues that often trigger requests for consultation services, as well as the dynamics that can foreshadow success or failure before consultants are even engaged? What are the pitfalls and pointers for the successful use of consultation services?

Consultants↗
PubMed1996

The role of oak pollen in hay fever consultations in general practice and the factors influencing patients' decisions to consult.

BACKGROUND: Patients often consult for hay fever before significant counts of grass pollen are recorded, and this has prompted the question, 'Are symptoms already present or are patients consulting to obtain medication in anticipation?' AIM: The study is concerned with the relationship between hay fever symptoms and pollens, and also with the impact of the media on patient consulting behaviour. METHOD: Symptom questionnaires were presented to patients consulting with hay fever for the first time that year in 1994 in four Birmingham practices. The questionnaire concerned the nature and duration of symptoms and the influence of the media on their decision to consult. Incidence data collected over the spring and summer periods (1989-1995) in the Weekly Returns Service (WRS) were examined in relation to pollen counts reported by the Midlands Asthma and Allergy Research Association at Derby. Data are presented for oak, birch and grass pollen, but other pollen data including rape, nettle and other trees were also examined. RESULTS: Questionnaire data from 1994 were analysed in two periods starting from 4 April: early (day 1-60) and late (day 61-124). Out of the 364 subjects, 38% consulted in the early period and 62% in the late period. Altogether, 41% developed symptoms before the start of the grass pollen season. Overall, 91% of patients first consulting in the early period had already experienced symptoms compared with 99% late period and were not simply collecting prescriptions in anticipation. The influence of the media on consultation behaviour was very small, except in children, 23% of whom (or their parents) were reported to be influenced. The new episode data from the WRS examined over 7 years showed an early peak that was coterminous with oak pollen, and a later and higher peak with grass pollen. CONCLUSION: The consistency of the relationship between oak pollen and the early peak of hay fever over the years examined suggests that oak pollen is a major cause of hay fever symptoms.

Adolescent↗
PubMedDate not supplied

[Patient-medical staff-consultant triad: conditions for satisfaction in psychosomatic consultation service].

In a large 1000 bed University Medical Center the psychosomatic consultation service (PCS) was evaluated by a two step investigation. 1. Housemen (interns) and senior staff members were asked by questionnaires about their previous experiences with psychological medicine and particularly about their satisfaction with the PCS and how they would estimate the need for additional psychosomatic treatment for the patients on their ward. A striking disproportion was found between actual requests (1.8%) for PCS and the estimated need (18%) for additional psychosomatic advice or treatment. 2. Questionnaires dealing with satisfaction were given to the consultant, the patient and the consultee. The satisfaction of the consulte was mainly determined by the promptness in answering his request and formal aspects of the exchange, the patient satisfaction was mainly determined by the way they viewed the help, the sense of importance of the consultation and by the feeling of being understood by the consultant. This seems to influence the future compliance. Surprisingly, a correlation between the patient satisfaction with the consultation and the quantitative and qualitative aspects of exchange between consultant and consultee was less clearly demonstrated. This could be seen as a hint of communication problems between the consultee and his patient, the improvement of which is one of the main concerns of psychosomatic consultation.

Adult↗
PubMed1996

The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

Diagnosis, Differential↗
PubMed2001

Support and consultation for general practitioners concerning euthanasia: the SCEA project. Support and Consultation in Euthanasia in Amsterdam.

UNLABELLED: In the project 'Support and consultation in Euthanasia in Amsterdam' (SCEA) general practitioners can turn to 20 especially trained physicians for advice or consultation concerning euthanasia or physician-assisted suicide. In this study the implementation was evaluated and it was investigated whether the goals of SCEA, supporting physicians and improving the quality of consultation, the quality of decision-making and the willingness to report, were met. Methods used were a questionnaire send to all general practitioners registered in Amsterdam (n=398), registration forms SCEA physicians filled in for every time SCEA was contacted and records of the public prosecutor. After the study period of 14 months, of the general practitioners who had performed euthanasia during this period, 53% had contacted SCEA at least once. The vast majority of general practitioners felt supported by SCEA. The quality of consultation was (even) higher in cases of euthanasia in which a SCEA physician acted as consultant than in cases with another consultant. We found no relation between use of SCEA and the last two goals of SCEA. CONCLUSIONS: Whether the lack of relation found between SCEA and it's last two goals is real or due to the studies limitations remains unclear. The results of this study do suggest that SCEA, by further improving the quality of consultation, has contributed to the safeguarding of euthanasia and assisted suicide. Therefore, similar networks are being developed throughout the Netherlands.

Attitude of Health Personnel↗
PubMed2001

Whither infectious diseases consultations? Analysis of 14,005 consultations from a 5-year period.

During a 5-year period, data from all infectious disease (ID) consultations were recorded in a computerized database, which included 9068 new and 4937 additional consultations. The purpose of these 14,005 consultations was therapy (for 58%), diagnosis (for 13%), both (for 24%), and prophylaxis (for 4%); 51% were performed at the bedside, and the remainder were by discussion (19%) or telephone (30%). Recommendations included the following: initiation, change, or discontinuation of antibiotics (in 46%); performance of diagnostic tests (in 20%) or surgical procedures (in 1%); prophylaxis (in 3%); or no change (in 29%). Analysis of new versus additional consultations revealed significant differences. A new ID consultation was given at a rate of 6.0 consultations per 100 hospitalized patients; the rate per department correlated with the expenditure on antimicrobials per patient admission. During the study period, expenditure on antimicrobials per admission steadily decreased, from $44 in 1995 to $30 in 1999, a 35% reduction. In conclusion, analysis of data from ID consultations enables the ID service to evaluate its activity and to direct efforts to departments with high rates of nosocomial infections, antimicrobial resistance, and/or antimicrobial use.

Anti-Infective Agents↗
PubMedDate not supplied

Seeking medical consultation: perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia.

OBJECTIVE: Subjects with functional dyspepsia (FD) in most previous studies have been confined to those who sought medical consultation. The generalizability of results from these studies to individuals with FD who do not seek medical consultation is limited. This study examined 1) differences in perceptual and behavioral characteristics between "nonconsulters" and "consulters" with FD and 2) the influence of these characteristics on dyspeptic and psychological symptoms. METHODS: A matched case-control design was used to compare differences among 43 nonconsulters with FD, 43 consulters with FD, and 43 healthy individuals. Subjects' monitoring perceptual style, confrontative coping behaviors, dyspeptic symptoms, anxiety, and depression were assessed by using well-validated questionnaires. RESULTS: FD consulters exhibited higher levels of monitoring, confrontative coping, anxiety, and depression than FD nonconsulters and healthy subjects (p values < .01). Results from discriminant analysis revealed that all these variables reliably predicted the membership of the three groups. Significant Monitoring by Confrontative Coping interaction effects were also found, indicating the conjoint influences of these variables on dyspeptic and psychological symptoms. CONCLUSIONS: These results show that FD nonconsulters are distinguishable from FD consulters by their perceptual style, coping behaviors, and psychological symptoms. Both monitoring perceptual style and confrontative coping behaviors may magnify dyspeptic and psychological symptoms in individuals with FD, especially those who seek medical consultation.

Adaptation, Psychological↗
PubMed2005

Cost-effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2-year follow-up.

STUDY DESIGN: A prospective, randomized controlled trial. OBJECTIVE: To examine long-term effects and costs of combined manipulative treatment, stabilizing exercises, and physician consultation compared with physician consultation alone for chronic low back pain (cLBP). SUMMARY OF BACKGROUND DATA: An obvious gap exists in knowledge concerning long-term efficacy and cost-effectiveness of manipulative treatment methods. METHODS: Of 204 patients with cLBP whose Oswestry Disability Index (ODI) was at least 16%, 102 were randomized into a combined manipulative treatment, exercise, and physician consultation group (i.e., a combination group), and 102 to a consultation alone group. All patients were clinically examined, informed about their back pain, and encouraged to stay active and exercise according to specific instructions based on clinical evaluation. Treatment included 4 sessions of manual therapy and stabilizing exercises aimed at correcting the lumbopelvic rhythm. Questionnaires inquired about pain (visual analog scale (VAS)), disability (ODI), health-related quality of life (15D Quality of Life Instrument), satisfaction with care, and costs. RESULTS: Significant improvement occurred in both groups on every self-rated outcome measurement. Within 2 years, the combination group showed only a slightly more significant reduction in VAS (P = 0.01, analysis of variance) but clearly higher patient satisfaction (P = 0.001, Pearson chi2) as compared to the consultation group. Incremental analysis showed that for combined group compared to consultation group, a one-point change in VAS scale cost $512. CONCLUSIONS: Physician consultation alone was more cost-effective for both health care use and work absenteeism, and led to equal improvement in disability and health-related quality of life. It seems obvious that encouraging information and advice are major elements for the treatment of patients with cLBP.

Adult↗
PubMed1994

Evaluation of consultative skills in respiratory medicine using a structured medical consultation.

An essential component of competency in respiratory medicine is the acquisition of consultative skills. The American Board of Internal Medicine (ABIM) and other certification bodies have recommended a greater emphasis on the evaluation of clinical skills by direct observation. In this study, consultative abilities are assessed using the format of an objective structured clinical examination (OSCE). A six-case, 160-min-long, examination was administered to three groups of physicians: faculty members, respiratory residents, and junior residents in internal medicine. The overall quality of the consultations was significantly better for the attending physicians when compared with the junior residents, and there was a systematic trend for the quality to improve with increased training. The educational value of the consultation improved significantly with the level of training. There was a tendency for physicians with greater experience to report less of the findings from the history and physical on their consultations. Patient satisfaction, as measured by the standardized patients using an ABIM patient satisfaction questionnaire, did not differ between groups of examinees. The test reliability for the overall quality of consultation score was 0.65. The reliability of a 14-station exam was estimated to be 0.81. This exam proved to be a useful, valid, and moderately reliable tool for assessing the consultative skills of physicians and could prove to be of benefit to clinical training programs.

Clinical Competence↗
PubMed2005

Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients/family: a descriptive study.

BACKGROUND: Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. METHODS: An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. RESULTS: 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. CONCLUSION: Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

Aged↗
PubMed2002

Consultation planning to help breast cancer patients prepare for medical consultations: effect on communication and satisfaction for patients and physicians.

PURPOSE: To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. PATIENTS AND METHODS: We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients' and physicians' satisfaction with the consultation. RESULTS: Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. CONCLUSION: Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient's agenda, were more satisfying to patients and physicians than the Productive Listening sessions.

Adaptation, Psychological↗