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PubMed1999

Tonsillectomy: assessment of quality by consultation rate after discharge.

The aim of this prospective study was to establish a measure of short-term quality of treatment after tonsillectomy/adenotonsillectomy. One hundred and thirty-four questionnaires, returned after 14 days, from 41 children and 93 adults were analysed. Forty-seven per cent had one or more consultations with health-care professionals. Eighty-three consultations by telephone and 33 consultations in person were made. Two recent studies reported higher consultation rates in person to doctors compared to this study. The predominant reason for consulting health-care professionals was pain. Maximum pain scores were significantly higher among those with consultations vs. no consultations (p = 0.0001). Additionally, the intensity as well as the duration of maximal pain increased with the number of contacts per patient (p = 0.0001, p = 0.0045). Sixty-four per cent felt relieved after consultation by telephone and 83 per cent felt relieved after consultation in person. The present study suggests consultation rate as a parameter of quality of treatment and quality of information.

Adenoidectomy↗
PubMed2002

Are primary care groups and trusts consulting local communities?

Primary care groups and trusts (PCG/Ts) in the English NHS were established in 1999 and have responsibility for providing and commissioning health-care for around 100 000 people. PCG/Ts are dominated by health professionals, but are responsible for representing the interests of the local community. This paper assesses how they have informed and consulted local communities and the perceived impact of this consultation on decision-making. The paper uses evidence from the National Tracker Survey of PCG/Ts, a longitudinal survey of 72 (15%) of the PCG/Ts in England, using data from telephone interviews with chairs and chief officers, and postal questionnaires to lay board members and representatives of Community Health Councils (CHCs). Eighty-one per cent of PCG/Ts had public involvement working groups. Methods of consulting the community included consulting CHCs (87%), holding public meetings (75%) and consulting local patient groups (67%). Only 31% of chairs felt they were effective at consulting. Ninety-two per cent of CHC representatives attended all board meetings. Most CHC representatives reported that there had been little or no consultation with the CHC in areas such as commissioning, service development or clinical governance. Only 14% of CHC representatives rated PCG/T consultation with the public as effective. Eighty-seven per cent said that local communities were largely unaware of the existence of PCG/Ts, and 70% commented on the weaknesses in PCG/T efforts at public consultation. Public participation is being taken seriously by PCG/Ts, but most are struggling to develop effective ways of involving local communities. Efforts to involve the public may become little more than token gestures. The proposed abolition of CHCs may make it more difficult for PCG/Ts to obtain a lay perspective. Effective consultation requires the development of new methods and adequate resources, but a stronger lay voice in the governance structures of PCG/Ts is needed.

Community Health Planning↗
PubMed2002

Developing a new line of patter: can doctors change their consultations for sore throat?

BACKGROUND AND OBJECTIVES: Doctors report pressure from peers to reduce prescribing of antibiotics for minor respiratory illnesses, and from patients to do the opposite. It has been suggested that doctors adopt a more patient-centred consulting style in order to encourage patient satisfaction and shared decision-making. No evidence exists that such changes are achievable. We developed a new, on-site method for training postgraduates and used this for teaching patient-centred intervention. Here, we examine whether this training method is associated with changes in consulting patterns in consultations for sore throat with children, among doctors from a single group practice. METHODS: Audiotaped consultations (simulated and real) conducted before and after training were analysed and interviews were carried out with participants about the impact of training. SETTING: A general practice in South Wales. PARTICIPANTS: Four general practitioners who consulted with 25 real and simulated patients participated in the study. MAIN OUTCOME MEASURES: Four patient-centred skills used by doctors and 2 patient behaviours measured before and after training were identified. RESULTS: Three out of 4 practitioners produced clear evidence of changes in patient-centred consulting skills. These changes were evident in simulated and real consultations 2 and 4 weeks later, respectively. Prior to training the doctors produced only five examples of patient-centred skills in 10 consultations. After training they produced 39 examples in 15 consultations. CONCLUSIONS: Evidence from both consultations and interviews indicated that the intervention and training were well received and had been put into practice.

Communication↗
PubMed2003

Exploring doctor and patient views about risk communication and shared decision-making in the consultation.

BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice. OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process. DESIGN: Qualitative analysis of semi-structured interview data. SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software. RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study. CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

Adult↗
PubMed2003

Structure and duration of consultations in Estonian family practice.

OBJECTIVE: To study the influence of age, gender and the nature of the patient's problems on length of time of consultation in the practices of newly trained family doctors in a recently reconstructed health care system. DESIGN: Video-recordings of consultations with consecutive patients in family practice were studied for duration of consultation in relation to age, gender and nature of the problem(s). SETTING: Primary health care. SUBJECTS: 405 consecutive consultations were video-taped in the practices of 27 family doctors. MAIN OUTCOME MEASURES: Length of time of consultation and its segments was analysed using the Statistical Package for the Social Sciences. The problems were classified according to the ICPC. RESULTS: The average consultation lasted 9.0 min (+/- 4.9). Physical examination was 2.0 min (+/- 1.9) and was performed in 79% of all consultations. Respiratory and circulatory problems were the most common. More than one reason for the encounter was given in one-fourth of cases. Consultation time was longer for older age groups and for patients with psychological problems. CONCLUSION: Video-recording allows consultations to be evaluated directly and is acceptable to patients. The high participation rate of patients in our study can be explained by the individual approach and by the family doctor system. The period of consultation was dependent on patient age and on the number and nature of the problems, but was not influenced by gender.

Adolescent↗
PubMed2002

Associations of cold temperatures with GP consultations for respiratory and cardiovascular disease amongst the elderly in London.

BACKGROUND: The relationships between cold temperatures and cardio-respiratory mortality in the elderly are well documented. We wished to determine whether similar relationships exist with consultations in the primary care setting and to assess the lag time at which the effects were observed. METHODS: Generalized additive models were used to regress time-series of daily numbers of general practitioner (GP) consultations by the elderly against temperature, after control for possible confounders and adjustment for overdispersion and serial correlation. Consultation data were available from between 38 452 and 42 772 registered patients aged >or=65 years from 45-47 London practices contributing to the General Practice Research Database between January 1992 and September 1995. RESULTS: There was little relationship between consultations for respiratory disease and mean temperature on the same day as the day of consultation. However, a strong association was apparent with temperature levels up to 15 days previously, with an increase in consultations being observed particularly as temperatures drop below 5 degrees C. Every 1 degrees C decrease in mean temperatures below 5 degrees C was associated with a 10.5% (95% CI: 7.6%, 13.4%) increase in all respiratory consultations. No relationship was observed between cold temperatures and GP consultations for cardiovascular disease. CONCLUSIONS: Our study suggests a delayed effect of a drop in temperature on consultations for respiratory disease in the primary care setting. Information such as this could be used to help prepare practices to anticipate increases in respiratory consultation rates associated with low temperatures.

Aged↗
PubMed2000

A population study of factors associated with general practitioner consultation for non-inflammatory musculoskeletal pain.

OBJECTIVE: To investigate factors associated with visiting a general practitioner (GP) for non-inflammatory musculoskeletal pain, and to examine whether these factors were affected by duration (chronic v non-chronic) or location (widespread v regional) of pain. METHODS: From a cross sectional postal survey of 20 000 (response rate 59%) randomly selected adults in two counties of Norway, 6408 subjects who had experienced musculoskeletal pain during the past month were included. Patients who reported inflammatory rheumatic diagnoses made by a doctor were excluded. RESULTS: 2909 (45%) had consulted a GP for their musculoskeletal pain during the past 12 months. The odds of consulting were significantly increased by being a woman, by having a higher age and lower education, and by being a pensioner or on sick leave. Patients with widespread pain were more likely to consult than those with regional pain, as were patients with chronic compared with non-chronic pain. Greater than median pain intensity was the factor most prominently associated with consultation for men (odds ratio (OR)=2.4; 95% confidence interval (95% CI) 2.0 to 2.9) and for women (OR=2.6; 95% CI 2.3 to 2.9). Overall, consultation was significantly associated with mental distress for women but not for men. Subgroup analyses showed that consultation for chronic pain was significantly associated with greater than median mental distress for both women (OR=1.3; 95% CI 1.1 to 1.6) and men (OR=1.2; 95% CI 1. 0 to 1.4), whereas consultation for non-chronic pain was not. CONCLUSION: The results show that about half of the patients with musculoskeletal pain consult a general practitioner (GP) each year, that demographic factors are associated with consulting, and that the role of mental distress for consulting a GP varies with duration of pain.

Absenteeism↗
PubMed2000

Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study.

OBJECTIVE: To explore the relation between work and family life among hospital consultants and their attitude towards the choices and constraints that influence this relation. DESIGN: Qualitative study of consultants' experiences and views based on tape recorded semistructured interviews. SETTING: Former South Thames health region in southeast England. PARTICIPANTS: 202 male and female NHS hospital consultants aged between 40 to 50 years representing all hospital medical specialties. RESULTS: Three types of relation between work and family life (career dominant, segregated, and accommodating) were identified among hospital consultants. Most consultants had a segregated relation, although female consultants were more likely than male consultants to have a career dominant or an accommodating relation. Many male consultants and some female consultants expressed considerable dissatisfaction with the balance between their career and family life. A factor influencing this dissatisfaction was the perceived lack of choice to spend time on their personal or family life, because of the working practices and attitudes within hospital culture, if they wanted a successful career. CONCLUSIONS: Consultants are currently fitting in with the profession rather than the profession adapting to enable doctors to have fulfilling professional and personal lives. Current government policies to increase the medical workforce and promote family friendly policies in the NHS ought to take account of the need for a fundamental change in hospital culture to enable doctors to be more involved in their personal or family life without detriment to their career progress.

Adult↗
PubMed2005

The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants.

BACKGROUND: Given the relatively sudden change from learner to teacher-provider that new consultants experience and the likely clinical and managerial challenges this may pose, there is a relative dearth of research into the problems they may have in relation to their new roles, or how supported they feel by senior colleagues acting in a mentoring role. This research sought to determine new consultants views on the quality and relevance of their training, its relationship to their confidence in clinical and managerial skills and their views on mentorship by senior colleagues. METHODS: Detailed postal questionnaire to new consultants using open and closed questions. Open questionnaire to established consultants to validate new consultant responses. RESULTS: Respondents felt their clinical training was good and were generally confident in most clinical skills although some perceived deficiencies in more complex procedures and specialist areas. Most lacked confidence in many managerial skills. These perceptions were verified by established consultants. Although no relationship was found between total training time or quality of training with confidence, extra training in specific sub-specialities improved confidence in these areas. While most established consultants thought that mentorship would be useful for new consultants, only 52% of them shared this view. CONCLUSION: Training and experience in management should be given greater emphasis. There may be a need for specific, targeted training in complex procedures for doctors who experience lack of confidence in these areas. Mentorship should be offered to new consultants and recognised in the job-plan of the new consultant contract.

Attitude of Health Personnel↗
PubMed2005

[Teleophthalmology as an auxiliary approach for the diagnosis of infectious and inflammatory ocular diseases: evaluation of an asynchronous method of consultation].

PURPOSE: The purpose of this study was to evaluate the efficacy of teleophthalmology as an auxiliary approach for diagnosis of infectious and inflammatory ocular diseases and to study the main problems associated with the conclusion reached by consultation. METHODS: Two hundred and thirty three 35 mm slides (retinography or biomicroscopy photos) were digitalized and stored in a Compact Disc to be later analyzed in a computer monitor by two consultants, specialists in uveitis. The consultants filled out a form and a questionnaire, indicating the diagnosis and probable treatment for the analyzed cases also the main difficulties found to reach a conclusion of the consultation. The Kappa statistic, an assessment of the change-corrected agreement (reproducibility) among consultants, was calculated. Kappa values of > 0.7 indicated excellent agreement; values between 0.4 and 0.7 indicated fair to good agreement and values of < 0.4 indicated poor agreement. RESULTS: Agreement between the consultants and the final diagnosis was of 73.5%. Treatment suggestion or management was not possible in 8% of the cases for consultant A and in 10.4% for consultant B. The higher agreement rate among consultants, relating to the reasons that rendered diagnosis difficult, was found in relation to "lack of clinical data" and "low quality of images". CONCLUSION: Teleophthalmology, through the asynchronous method, was an efficient means for diagnosis of patients with infectious and inflammatory ocular diseases. The main problems affecting the teleophthalmology consultation were lack of detailed clinical data and low quality of the images.

Diagnostic Techniques, Ophthalmological↗
PubMed2000

A question sheet to encourage written consultation questions.

PROBLEM: Interviews with parents and children attending a hospital paediatric neurology clinic indicated they had difficulties in asking questions during consultations. AIM: To set up a process to enable parents and children to get the information they wanted. BACKGROUND AND SETTING: Two paediatric neurology clinics in separate hospitals in Greater Manchester, UK with a similar client group run by one consultant. DESIGN: Various styles of question sheets were evaluated. The one that was chosen asked patients to write down questions and hand these to the doctor at the beginning of the consultation. Question sheets were given to all patients attending one clinic over a 13 week period. STRATEGIES FOR CHANGE: Use of sheets: number of patients taking or refusing a sheet, with reasons for refusal, were recorded. Doctors noted those who handed questions sheets to them Satisfaction with sheets: patients completed a short feedback form after the consultation Effect on consultations: evaluated through interviews with the doctors. EFFECTS OF CHANGE: In total, 66 (41%) of the 162 patients offered the sheet declined: 14 had already prepared questions; eight being seen for the first time felt they did not know what to ask. Seventeen had used the sheet on a previous visit and did not need it again; 19 gave no reason; the rest said they had no questions. Seventy six (47%) patients produced a sheet in the consultation. Of those using the sheet, 64 (84%) liked it and 61 (80%) found it useful. Fifty two (68%) wished to use it at future consultations. The doctors reported that through questions articulated on the sheets many issues, fears, and misunderstandings emerged which otherwise would not have been identified. Concerns about increasing consultation time and clinical disruption did not materialize. In contrast, doctors reported patients to be taking more initiative and control, particularly on subsequent visits. None of these changes was noted in the comparison clinic. LESSONS LEARNT: An attractive, clear question sheet proved a simple but effective intervention in the consultation. Parents felt empowered to take control. The approach may have wider applicability, but implementation requires staff training and support to ensure its continuing use; this ensures medical staff adjust to a new consultation format, and that clinic nurses see the value of the sheets and continue to provide them.

Child↗
PubMed2001

[An individual based analysis of medical expenses of outpatient services for the elderly at one health insurance society in Fukuoka Prefecture. Focus on multiple or redundant consultations].

PURPOSE: To ascertain way to reduce medical expenses of the elderly, we analyzed old outpatients' receipts covered by the Health and Medical Services Law for the Aged at one health insurance society in Fukuoka prefecture. In addition, an attempt was made to find better ways to share medical information and construct a system of receipt analysis. SUBJECTS AND METHODS: We used 312 receipts for 179 old outpatients in July in 1997. The number of prescriptions was internalized into the number of outpatients' receipt. We classified the patients as "multiple" who consulted several clinics a month and as "redundant" who consulted several clinics for the same diseases. RESULTS AND CONCLUSION: 1) The expenses of outpatients accounted for about 1/3 of the total. Average values for patients were 78.3 years old of age, 7.7 diseases, 1.5 pharmacies, 1.7 clinics, 7 consulting days, and the medical expenses of 40,482 yen per month. 2) The rate of multiple including redundant consultations was 49.7% and that for those that were redundant was 9.5%. Redundant consultations increased as the number of consultation clinics increased. 3) Factors considered to increase medical expenses were the number of diseases, the consulting days, and the number of consultation/prescription organizations. Multiple and redundant consultations amounting to half of the whole fulfilled all of these criteria. 4) The average medical expense for non-multiple and non-redundant patients was 28,314 yen, as compared with 52,786 yen for multiple and redundant and 64,306 yen for redundant cases. If there were no multiple consultations, thirty percent of the expenses could be avoided and if there were no redundant consultations, the reduction might be 6%, although more detailed clinical records are necessary for firm conclusions. To reduce excess expenditure, instructions for patients having home doctors and passing through introductions are important. 5) Regarding the expense of medical services, medication was accounted for 39.2% as the greatest outlay. Cautions for suitable use of drugs are required for multiple and redundant patients, because they tend to visit many pharmacies. Considering the rate rise of separation of pharmacy and clinic, fixing of field division of work and the sharing of medical information are inadequate. For example, introduction of an IC card system might be very useful to facilitate the development of community-based medical information system. 6) It is strongly suggested that a computerized information system with a standardized format should be developed on the initiative of a national organization such as the National Federation of Health Insurance Societies.

Aged↗
PubMed1992

Use of medication orders for monitoring prescribing and documenting consultations.

A study of the consultations performed by pharmacists under a documentation system that avoids extra paperwork is described. Pharmacists at a tertiary-care teaching hospital developed a system under which the medication order itself is used to capture the information needed for documenting pharmacist consultations. Orders requiring consultation are flagged, and the consulting pharmacist makes a note on the prescription detailing the problem and the outcome of communication with the prescriber. These orders are collected daily and photocopied. To evaluate the system, data on the consultations and the drug orders they represented were collected from July 1990 through June 1991. The potential of the flagged order, if implemented, to adversely affect patient outcome was used to classify the consultations. During the 12-month period, 1031 clinically significant consultations were documented. The rate of acceptance by prescribers was 83%. Orders with potentially fatal or severe consequences accounted for 18.4% of the consultations. The medical service had the largest percentage of consultations, followed by the psychiatric, surgical, and obstetrics and gynecology services. The data were used to show the positive impact that the pharmacy department has on patient outcomes. A system for documenting pharmacist consultations that avoided the use of forms was simple to use and showed a high rate of acceptance of recommendations.

Clinical Pharmacy Information Systems↗
PubMed2006

Patient expectations from consultation with family physician.

AIM: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. METHOD: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped patients completed a questionnaire about their expectations before and after the consultation. Patient assessment of expected and obtained psychosocial support and biomedical information during the consultation with physician were compared. Two investigators independently assessed patient involvement in the consultation process on the basis of videotaped consultations, using a 5-point scale. RESULTS: Receiving an explanation of biomedical information and discussing psychosocial aspects was assessed as important by 57.4-66.8% and 17.8-36.1% patients, respectively. The physicians did not meet patient expectations in the case of three biomedical aspects of consultation: cause of symptoms, severity of symptoms, and test results. Younger patients evaluated the importance of discussing psychological problems higher than older patients. The involvement of the patients was high in the problem defining process, in the physicians' overall responsiveness to the patients, and in their picking up of the patient's cues. The patients were involved less in the decision making process. CONCLUSION: Discussing biomedical issues was more important for the patients than discussing psychological issues. The patients wanted to hear more about the cause and seriousness of their symptoms and about test results. The family physicians provided more psychosocial care than the patients had expected. Considering high patient involvement in the consultation process and the overall responsiveness of the family physicians to the patients during the consultation, Estonian physicians provide patient-centered consultations.

Adult↗
PubMed1991

Long to short consultation ratio: a proxy measure of quality of care for general practice.

Eighty five general practitioners in the Lothian region recorded information on all surgery consultations on one day in every 15 for a year. On the basis of their mean consultation times with patients the working styles of the general practitioners were described as 'faster' (n = 24), 'intermediate' (n = 40) or 'slower' (n = 21). The 21,707 consultations which they carried out over this period were defined as 'short' (five minutes or less), 'medium' (six to nine minutes) or 'long' (10 minutes or more). Independent of doctor style, 'long' consultations as against 'short' consultations were associated with the doctor: (1) dealing with more of the psychosocial problems which had been recognized and were relevant to the patient's care; (2) dealing with more of the long term health problems which had been recognized as relevant; and (3) carrying out more health promotion in the consultation. Patients also reported greater satisfaction with longer consultations. The ratio of long:short consultations was found to be 0.28:1 for 'faster' doctors as against 2.3:1 for 'slower' doctors. When doctors in either group had more heavily booked surgeries or were running late, the long:short consultation ratio fell, in some cases by over 50%. This paper suggests that the ratio of long to short consultation length for a general practitioner might become the basis of a simply proxy measure of quality of care; and that its use might help monitor the effect of recent and proposed changes in the way in which general practice care is delivered.

Appointments and Schedules↗
PubMed1998

Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices.

BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.

Adolescent↗
PubMed1993

Current models for clinical ethics consultation reimbursement.

The author reviewed the literature on compensation for ethics consultation and undertook an informal telephone survey of 33 nationally prominent clinical ethics consultants in American health care institutions and medical schools in late fall 1992. Twenty-nine (88%) of 33 consultants responded. Most donate their time when asked to consult and are not paid directly for consultation services. Other ethics consultants, however, provide services to colleagues and patients and are compensated by private practice billing, salaried arrangements, and income from ethics training programs. Salaried arrangements through managed-care organizations seem to hold the greatest promise for ethics consultants who wish to be paid, although such arrangements raise ethical issues themselves. To be paid at all, ethics consultants called on by family physicians to see patients may be asked to balance institutional cost-effectiveness with the personal bedside process of ethics consultation.

Cost-Benefit Analysis↗
PubMedDate not supplied

Profile of users of real-time interactive teleconference clinical consultations.

BACKGROUND: Real-time interactive teleconference clinical consultations are envisioned for increasing accessibility to medical care by patients whose demographics restrict care. There are no published studies, however, describing referrals and the referring practitioners, patients, and specialists participating in these consultations. OBJECTIVE: To assess characteristics of participants of interactive teleconference clinical consultations. DESIGN: Descriptive study, February 1, 1996, through April 30, 1999. SETTING: Eastern North Carolina: Brody School of Medicine at East Carolina University and 7 rural hospitals and clinics in its telemedicine network. SUBJECTS: Rural practitioners requesting consultations (n = 76), consulting physicians (n = 40), and patients completing evaluations following consultations (n = 495). MAIN OUTCOME MEASURES: Demographic and descriptive variables for referring providers, patients, and consulting physicians relative to the population in the region and to patients and physicians at the East Carolina University School of Medicine clinics. RESULTS: The largest number of referrals (65.2%) were made to obtain a second opinion or recommend a management plan in dermatology (33.5%), allergy (21.0%), or cardiology (17.8%). Significant patient characteristics were race (56.8% minorities), age (19.6% < or = 10 years old and 26.0% > or = 59.0 years old), sex (59% females), and insurance status (10.7% no insurance, 33.7% Medicaid, 15.4% Medicare). In addition, 38.0% had household incomes below the poverty level. Only 5.2% of the patients would have been treated by the referral practitioner, making travel necessary for consultation. Demographic characteristics of the practitioners were not statistically different. CONCLUSIONS: Participants of interactive teleconference clinical consultations are patients whose access to medical care might otherwise be limited. Use of telemedicine by practitioners is not related to age or sex. Arch Fam Med. 2000;9:1036-1040

Adolescent↗