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 469 records · Page 26Linked to original sources
PubMed1995

General practice consultations in central and northern Finland.

OBJECTIVE: To examine general practice consultations in health centres in central and northern parts of Finland. DESIGN: A questionnaire concerning all general practice consultations during one week. SETTING: Central and northern parts of Finland in a region comprising 72% of the area of the country and one-third of its population. PARTICIPANTS: 851 health centre doctors. OUTCOME MEASURES: Consultation rates by age and sex of the patients and by characteristics of doctors and their practices. RESULTS: The average consultation rate per 1,000 female inhabitants was 43 and per 1,000 male inhabitants 34 per week. For total contacts, a J-shaped association with increasing age was demonstrated for both sexes. The average number of consultations per doctor in a week was 72. Consultation rates were lowest among physicians over 45 years of age. A low consultation rate was also found among general practitioners not participating in the personal doctor programme and among those who worked in municipalities with over 30,000 inhabitants. CONCLUSION: In Finland, consultation rates per 1,000 inhabitants, as well as per general practitioner, are remarkably lower than in most European countries. The personal doctor programme with defined lists of patients seems to be associated with high consultation rates.

Adolescent↗
PubMed2004

What are entrepreneurial dietitians charging? The Consulting Dietitians Network National Fee Survey.

To respond to a need to develop a national fee guideline, the Consulting Dietitians Network conducted a membership fee survey. A questionnaire requesting fee information for various nutrition consulting services was distributed to members as an insert with the Consulting Dietitians Network quarterly newsletter and by electronic mail. The response rate was 38.4% (98 respondents) and most respondents (74.5%) had urban practices. The most frequently charged fees (mode) for individual counselling ($75/hour), industry and commercial firm consultations ($150/hour), group facilitation ($150/hour), and media consultations ($150/article) were highest in the region of Ontario, Quebec, and the Atlantic provinces. The most frequently charged fees (mode) for home visits ($100/hour), writing for newspapers ($250/hour), and menu reviews ($60/hour) were highest in the region of Saskatchewan and Manitoba. The minimum and maximum fees were significantly different for the three regions (Ontario, Quebec, and the Atlantic provinces; Manitoba and Saskatchewan; and Alberta, British Columbia, and Yukon Territory) studied for initial client consultations, industry and commercial firm consultations, and menu reviews (p<0.05). For home visits, teaching in an institution, seminar presentations, group facilitation, media consultations, and writing media articles, the differences in the minimum and maximum fees charged were highly significant (p<0.001). Entrepreneurial dietitians may use these data as a reference to establish and negotiate consultation fees.

Canada↗
PubMed1991

Pharmacokinetic consultation service workload measurement study.

A study was conducted to collect work measurement data for pharmacokinetic drug consultation services. A stopwatch was used to measure the time required to perform pharmacokinetic consultations in the Ottawa General Hospital, a 530-bed tertiary care teaching hospital. Ten pharmacists provided 166 drug consults primarily for phenytoin, aminoglycosides, digoxin, and theophylline. The time required to obtain drug level measurements averaged 1.10 minutes. Consults required an average of 8.28 (SD = 4.72) minutes. Initial consults took 10.35 (SD = 5.07) minutes, while repeat consults took 6.62 (SD = 3.67) minutes. The difference was significant (t = 5.48, df = 164, P less than 0.001). No significant differences were found among consults for different drugs nor between primary and secondary patient coverage areas. There was a significant difference in the time required to perform a consult among pharmacists. Consult times were considerably less than those reported by the Canadian Hospital Pharmacy Workload Measurement Study.

Analysis of Variance↗
PubMed2001

The psychologically vulnerable witness: an emerging forensic consulting role.

The role of witness consultant is emerging as forensic psychiatrists and psychologists provide valuable input as participants in witness development teams. Anecdotally, retained experts also have undertaken a witness consultant role when asked or pressured to do so by the retaining attorney. Forensic psychiatrists and psychologists with extensive treatment and testimony experience may be of assistance to attorneys in preparing psychologically vulnerable clients and nonparty witnesses to tell their stories effectively at trial. In addition to litigation, other venues of witness consultation include administrative, congressional, and state legislative proceedings. In litigation, the witness consultant works directly with the attorney in support of the attorney's counselor role with the client. As an agent of the attorney, the identity of the witness consultant is shielded by the attorney-client privilege. The witness consultant does not meet face to face with the witness unless otherwise indicated. Collateral sources of information are used in providing witness consultation. The witness consultant can identify and provide management techniques for the psychological issues that threaten to impair a witness's ability to testify effectively. The consultant also may be able to assist the attorney who is experiencing difficulty in his or her relationship with a client or a nonparty witness.

Adolescent↗
PubMed2001

An evaluation of telehealth in the provision of rheumatologic consults to a remote area.

OBJECTIVE: To evaluate the feasibility and acceptability of providing telehealth consultations in rheumatology. METHODS: A prospective review of new consults from a rural area assessed by a rheumatologist in an urban area using telehealth. Patient demographics were recorded along with a self-administered questionnaire reporting assessment of the acceptability of the process. Referring physician and consultant provided open ended feedback as to relative strengths and weaknesses of telehealth versus traditional consult. A simple cost and time benefit analysis was undertaken. RESULTS: The spectrum of patients with rheumatic disease assessed was similar to a traditional consultation clinic. Patients found the overall process to be acceptable and effective. Apart from accessibility to specialist consultation, the greatest benefit was improved communication among patient, referring physician, and consultant. The process was determined to be efficient in both time and cost savings. CONCLUSION: Telehealth rheumatology consultations are feasible, acceptable, and cost/time effective and are therefore advocated for those geographic areas where traditional consultations are not readily available.

Adolescent↗
PubMed2001

Consultant outreach, 1991 to 1998. An update and extension on its distribution in Scotland.

OBJECTIVE: To assess the extent and distribution of consultant outreach in Scotland between 1991 and 1998. DESIGN: The paper has three parts. First a description of the trends in consultants and consultant activity provides the background. This is followed by the results of an update of the 1991 survey of all health centres in Scotland and its extension to all GP premises considered suitable to hold consultant clinics. Finally, binary regression analysis of outreach is used to test the importance of total list size, distance to alternative provision and deprivation. Fourteen of the most common consultant specialties are studied. SETTING AND SUBJECTS: Scotland-wide data on consultants and consultant activity using annual data over the 1990s; and a Scotland-wide survey of 231 health centres and 312 GP premises over the period July to December 1998. RESULTS AND CONCLUSIONS: Consultant full time equivalents (ftes) increased and, with minor exceptions, consultant activity did so too. In respect of outreach, the increase was largely at GP premises and for psychiatry. For only two specialties of the fourteen studied, obstetrics and general psychiatry, could outreach be considered important. Such outreach provision as was made went where the total list size was largest and alternative provision farthest distant. The evidence that deprivation had an influence on outreach varies with specialty and is qualified.

Ambulatory Care Facilities↗
PubMedDate not supplied

[A descriptive study of intrahospital neurology service consultations].

INTRODUCTION: Neurology consultations requested by other services are a part of hospital attention that has not been studied or valued enough. However, it is a health care activity that is carried out on a daily basis and which consumes considerable amounts of time and resources. AIMS. The aim of this study is to assess intrahospital consultations (IHC) requested from a Neurology service. PATIENTS AND METHODS: We conducted a retrospective study of the requests for consultations received in the Neurology Service at the Hospital Universitario San Cecilio in Granada throughout the year 2001. The following variables were analysed: number of consultations, specialities involved, urgency of the request, syndromic diagnosis, complementary tests requested, final resolution and referral of patients. RESULTS: The number of consultations amounted to 270. The most frequent syndromic diagnoses were stroke (24.3%), epilepsy (13.7%) and dementia (11.7%). Internal Medicine, Cardiology, Vascular surgery and Oncology were the specialities that requested most consultations from the Neurology service. The most common complementary test was a computerised axial tomography of the head. 38.74% of the consultations were referred to Neurology outpatients for follow up. 40.5% of the consultations received were lacking in the information needed to understand the actual problem the patient was suffering from. CONCLUSIONS: This study attempts to highlight the importance of IHC as part of the day to day activity within a Neurology service, with respect to the number of consultations, knowledge of the most prevalent neurological pathologies in other services and the resources used in this type of assistance. More studies are needed on this subject, since there are few references in the literature to reports that analyse this type of attention.

Hospital Departments↗
PubMedDate not supplied

Some predictors of psychiatric consultation in nursing home residents.

OBJECTIVE: Despite the high rate of psychiatric disorders in nursing homes, research indicates that psychiatric consultation is requested infrequently. The authors sought to determine the rate of psychiatric consultation in a nursing home population and to assess what factors were related to a consultation request. METHODS: Subjects were recruited from a stratified random sample of 59 nursing homes across Maryland. All new admissions age 65 years and older from September 1992 through March 1995 were eligible for the study. A total of 2,285 subjects were included in the study. Variables examined were factor scores from the Cornell Scale for Depression in Dementia and the Psychogeriatric Dependency Rating Scale (Behavioral Subscale), nursing home characteristics, and whether the resident had a psychiatric consultation within 90 days of admission. RESULTS: Twenty percent of the residents (N=404) had a psychiatric consultation. There was no significant association with demographic variables. Behaviors that triggered a psychiatric consultation included agitation, physical/verbal abuse, wandering, and manic/destructive acts. A psychiatric consultation was also requested when residents displayed anxiety. Surprisingly, depression in retarded and psychotic residents did not trigger a psychiatric consult. CONCLUSION: As expected, behavioral problems and agitation are common reasons for a psychiatric consultation. However, the resident who is depressed, particularly the quiet or retarded depressed resident, may be overlooked. In this context, it is important for the nursing staff to recognize that lethargy and social withdrawal may be signs of depression, and a referral to a psychiatrist may be in order.

Aged↗
PubMed2005

Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000.

BACKGROUND: Antibiotic prescribing by GPs in the UK has declined since 1995. AIM: We investigated whether general practices that issue fewer antibiotic prescriptions to patients presenting with acute respiratory infections had lower consultation rates for these conditions. DESIGN OF STUDY: Retrospective data analysis. SETTING: UK general practice. METHOD: We analysed data from the General Practice Research Database, including all registered patients from 108 practices between 1995 and 2000. For each practice, numbers of consultations for acute respiratory tract infections and the proportion of consultations resulting in an antibiotic prescription were obtained. An age- and sex-standardised consultation ratio (SCR) and standardised prescription ratio (SPR) were calculated for each practice. We evaluated whether SPR and SCR values were associated. RESULTS: For the mid-year data (1997), the crude consultation rate for all acute respiratory infections ranged from 125-1,110 per 1,000 registered patients at different practices; the proportion of consultations with antibiotics prescribed ranged from 45-98%. After standardising for varying age and sex structure of practice populations, practices with lower SPR values had lower SCR values (r = 0.41; P<0.001). This association was observed in each study year. Moreover, practices that demonstrated reductions in SPR between 1995 and 2000 also showed reductions in SCR (r = 0.27; P = 0.005). CONCLUSION: Practices that prescribe antibiotics to a smaller proportion of patients presenting with acute respiratory infections have lower consultation rates for these conditions. Practices that succeed, over time, in reducing antibiotic prescribing also experience reductions in consultation rates for these conditions. Although our methodology cannot prove that these two findings are causally related, they imply that patients alter their illness behaviour and that this may be a response to previous consultation experience. In consequence, respiratory illness in the community may be undergoing a process of de-medicalisation.

Acute Disease↗
PubMed2005

The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review.

BACKGROUND: In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care. AIM: To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction. DESIGN OF STUDY: We looked at randomised controlled trials, controlled studies, controlled before/after studies, and interrupted time series of telephone consultation or triage in a general healthcare setting. SETTING: All healthcare settings were included but the majority of studies were in primary care. METHOD: We searched the Cochrane Central Register of Controlled Trials, EPOC specialised register, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register and checked reference lists of identified studies and review articles. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. RESULTS: Nine studies met our inclusion criteria: five randomised controlled trials; one controlled trial; and three interrupted time series. Six studies compared telephone consultation with normal care; four by a doctor, one by a nurse, and one by a clinic clerk. Three of five studies found a significant decrease in visits to GPs but two found an increase in return consultations. In general at least 50% (range = 25.5-72.2%) of calls were handled by telephone consultation alone. Of seven studies reporting accident and emergency department visits, six showed no difference between the groups and one--of nurse telephone consultation--found an increase. Two studies reported deaths and found no difference between nurse telephone consultation and normal care. CONCLUSIONS: Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction.

Controlled Clinical Trials as Topic↗
PubMed1976

Nursing consultation: a clinical specialty.

In summary, the Mental Health Nurse Consultant is committed to the belief that nursing staff are competent to implement appropriate mental health care. Because of this the consultant utilizes both resource and process consultation to assist staff in determining care plans and to support a realistic method for delivery. The Mental Health Nurse Consultant interviews clients in order to assess dynamics of behavior and uses this information for care plan development. The direct interview also enables the consultant to investigate client perceptions of Psychiatric Mental Health Intervention and support the utilization of direct involvement by a member of the Consultation and Liaison Team. The Mental Health Nurse Consultant acts as a facilitator for ongoing utilization of existing resources through resource and process consultation to members of the Department of Nursing. Thus, consultation as a clinical specialty offers an additional opportunity for nurses to utilize individual skills and refocus the tasks of nursing within the general hospital.

Hospitals, General↗
PubMed1991

Image and role of the consultant dietitian in long-term care: results from a survey of three Midwestern States.

Consultant dietitians and other health care professionals in three states were surveyed to determine the image and role of consultant dietitians in long-term care. Data were derived from telephone interviews with nursing home personnel in Illinois, Indiana, and Ohio. Chi 2 Analysis was used to determine whether health professionals' perceived image and job functions of consultant dietitians were significantly different from the perceptions of consultant dietitians. Overall, respondents held positive views of consultant dietitians. More than half of the respondents said the image of consultant dietitians had improved over the past 5 years. More than half of nursing directors, dietitians, dietary managers, and medical directors responded that consultant dietitians spent adequate time in facilities to do their jobs. Results of the study indicate that consultant dietitians believe that they are viewed by other health professionals as they actually are: competent, knowledgeable, well-respected, and involved in direct patient care functions. The next challenge is for more consultant dietitians to build on this base and become proactive, developing strong franchises and more opportunities for the profession.

Attitude of Health Personnel↗
PubMed1987

Consultant utilization by family physicians in a university hospital practice.

All inpatient consultations obtained by family physicians at a university hospital were monitored for 2 1/2 years to determine the number and types of consultations obtained. Overall, 1,017 consultations were obtained on 2,155 patients (0.47 consultations per patient). The consultation rate, however, gradually decreased from 0.56 consultations per patient at the beginning of the study to 0.36 consultations per patient at the end of the study, probably corresponding to cost-containment pressures placed on physicians by increasing involvement with prepaid health care plans. The specialties most frequently consulted were cardiology, gastroenterology, neurology, and pulmonary medicine, which together accounted for more than one third of all consultations obtained.

Arizona↗
PubMed1983

The preoperative consultation. Response to internists' recommendations.

Preoperative consultations are frequently performed; however, little is known about the way requesters respond to the recommendations offered. For this reason, 90 consecutive preoperative consultations, performed by a general medical unit, were reviewed and compared with 66 consecutive nonpreoperative consultations, performed by the same unit during the same period. Analysis disclosed that recommendations made during preoperative consultation were often not followed and were less likely to be followed than were those made during nonpreoperative consultation (53.9% v 68.9%). Controlling for the type of consultative advice offered and for the type of surgical service requesting the consultation did not alter this relationship. These results highlight the particular importance of consultant follow-up for recommendations made during preoperative consultations.

Consultants↗
PubMed1995

The effect of interinstitution anatomic pathology consultation on patient care.

OBJECTIVE: To determine the effect of routine interinstitution anatomic pathology consultation on patient evaluation and treatment. DESIGN: All interinstitution anatomic pathology consultation diagnoses made during a 1-year period were compared with the original pathologic diagnoses. Patients with discrepant diagnoses were evaluated after an interval of 1 year to determine the correct clinical diagnosis. The relevance of the pathologic consultation to furthering medical evaluation and treatment was determined from a review of the medical record and when necessary from consultation with the patient's physician. SETTING: Patients referred to a university hospital. MAIN OUTCOME MEASURES: We determined the number of patients with discrepant pathologic diagnoses and whether these diagnoses changed the planned surgical procedure, chemotherapy, radiation therapy, or medical evaluation. RESULTS: Seventy-one (9.1%) discrepant diagnoses were identified among the 777 patients. Of these 71 patients, 45 (63%) demonstrated a change in therapy or clinical evaluation as a result of the interinstitution anatomic pathology consultation. In five of these patients the consultation diagnosis was in error. There was a significantly greater percentage of discordant diagnoses among the cytology and fine-needle aspiration biopsies (21%) as compared with the surgical pathology specimens (7.8%; P < .001). CONCLUSIONS: Routine interinstitution anatomic pathology consultation resulted in a change in patient evaluation or treatment in 45 (5.8%) of the 777 cases reviewed. Our interinstitution anatomic pathology consultation policy appears to provide useful diagnostic information, which should contribute to improved patient care. However, when a discrepancy is identified, additional consultation or evaluation should be considered.

Biopsy↗
PubMed1994

Consultation competence in general practice: testing the reliability of the Leicester assessment package.

BACKGROUND: An acceptable assessment must be both valid and reliable; the face validity of the Leicester assessment package has already been established. AIM: This study set out to test the reliability of the Leicester assessment package, and the factors influencing it, when used by multiple assessors to assess performance in general practice consultations. METHOD: Six randomly selected course organizer assessors simultaneously used the package to conduct independent assessments of the performance of five doctors of widely varying abilities in consultation with six simulated patients. The scores allocated were subjected to generalizability analysis. RESULTS: The mean scores allocated for consultation performance of individual doctors ranged from 51% to 70%, with the lower scores being allocated to the less experienced doctors. Scores of each assessor across the cases were examined for internal consistency and five of the six assessors consistently scored the doctors with an alpha coefficient of the minimum accepted level of 0.80 or greater. The other assessor had a consistency of only 0.22. Measurements of consistency within cases between markers indicated that the first case produced unreliable results (alpha coefficient 0.25) but all other cases were scored consistently. Two independent assessors scoring eight consultations are the requisite numbers to achieve acceptable levels of reliability in a formal assessment process; seven consultations produce the minimum acceptable generalizability coefficient of 0.80 plus the first 'non-counting' consultation. CONCLUSION: Required levels of reliability can be achieved when the package is used by multiple markers assessing the same consultations over a wide range of consultation performance. To achieve reliability only two hours of assessment time are required using the Leicester package compared with the previously regarded minimum of 32 hours. Although assessors can produce reliable scores with minimal training, intra-assessor reliability cannot be taken for granted and all assessors should be trained and calibrated before being sanctioned to conduct assessments, particularly for regulatory purposes. The Leicester assessment package has now been shown to be valid, reliable, feasible and easy to use in practice. It can, therefore, be recommended for use in both formative and summative assessment of consultation competence in general practice.

Communication↗
PubMed1993

Calculating the GP consultation fee in Singapore: towards a rational costing approach.

PURPOSES: The General Practitioner (GP) consultation fee in Singapore, unlike that of his specialist colleague, has been left very much undefined over the years. There is a need for an objective way of calculating the GP consultation fee. METHOD: A proposed method of calculating the GP consultation fee based on the model of estimating the total cost of producing the service plus the doctor's remuneration is described. Known prevailing costs were used in the computation. This model allows us to work out the cost to the patient by dividing the total cost of producing the service by the number of patients (referred to as patient encounter load) seen by each duration of consultation--4, 6, 10, 15 and 30 minutes. Different monthly remuneration levels for the doctor were used to compute the different consultation fees that would result for each of the duration of consultations. RESULTS: Using this method of calculation, for a doctor with a desired monthly remuneration of $7000, and seeing a patient every 6 minutes over a 150-hour month, the consultation fee is $13.00. This drops to $11.00 if the doctor receives a remuneration of $4000 per month. Using the same parameters, a 15 minute consultation will cost the patient $30.00 and $25.00 respectively. CONCLUSION: This method can be used to derive a consultation fee for services requiring different durations and varying remuneration brackets for the doctor.

Capital Financing↗
PubMed1994

Consultation competence in general practice: establishing the face validity of prioritized criteria in the Leicester assessment package.

AIM: This study set out to test the face validity of prioritized criteria of consultation competence in general practice as contained in the Leicester assessment package. METHOD: A questionnaire was sent to a geographically stratified random sample of 100 members of the United Kingdom Association of Course Organisers to seek their views on the categories, components and weightings contained in the Leicester assessment package and to determine the proportion of respondents who rejected or suggested a new category, component or weighting or reallocated components to other categories or amended weightings. Their views were sought on a six-point scale (strongly approve, approve, tend to approve, tend to disapprove, disapprove and strongly disapprove). RESULTS: There was a 73% response rate. Of the respondents 99% either strongly approved or approved of the overall set of categories of consultation competence. Only two respondents (3%) expressed any disapproval of individual categories. Thirty five of the 39 suggested components of consultation competence were supported by more than 80% of respondents. There was minimal support for excluding any categories or components of consultation competence, for moving any components to different categories or for the inclusion of new categories or components. Eighty eight per cent of respondents were in favour of the need to identify priorities between any agreed categories of consultation competence and 79% expressed approval of the suggested weightings. Although 42% of respondents indicated a wish for some alteration in weightings, the mean values for all consultation categories suggested by all respondents were almost identical to the original weightings in the Leicester package. CONCLUSION: The face validity of the categories and components of consultation competence contained in the Leicester assessment package has been established, and the suggested weightings of consultation categories have been validated. Consequently, the criteria contained in the Leicester package can be adopted with confidence as measures against which performance can be judged in formative or summative assessment of consultation performance in general practice.

Clinical Competence↗