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PubMed2006

Determinants and impact of generalist-specialist communication about pediatric outpatient referrals.

OBJECTIVE: Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to specialty care. We sought to determine rates of physician-reported communication between primary care physicians and specialists, the clinical impact of communication or its absence, and patient- and practice system-level determinants of communication for a cohort of children referred to specialty care. METHODS: We enrolled 179 patients newly referred from general pediatricians in 30 community practices to 15 pediatric medical specialists in 5 specialties. Primary care physicians and specialists completed questionnaires at the first specialty visit and 6 months later. Questions covered communication received by primary care physicians and specialists, its impact on care provision, system characteristics of practices, and roles of physicians in treatment. We used multivariate logistic regression to determine associations between practice system and patient characteristics and the dependent variable of reported primary care physician-specialist communication. RESULTS: Specialists reported communication from referring primary care physicians for only 50% of initial referrals, whereas primary care physicians reported communication from specialists after 84% of initial consultations. Communication was strongly associated with physicians' reported ability to provide optimal care. System characteristics associated with reported primary care physician-specialist communication were computer access to chart notes and lack of delays in receipt of information. Associated patient characteristics included non-Medicaid insurance, no additional specialists seen, and specialty to which referred. Physicians favored comanagement of referred patients in more than two thirds of the cases. CONCLUSIONS: Although a prerequisite for optimal care, communication from primary care physicians to specialists is frequently absent. Interventions should promote widely accessible clinical information systems and target children with complex needs and public insurance.

Ambulatory Care↗
PubMed2006

An introduced generalist parasite, the sticktight flea (Echidnophaga gallinacea), and its pathology in the threatened Florida scrub-jay (Aphelocoma coerulescens).

The sticktight flea, (Echidnophaga gallinacea), a major pest of the domestic chicken (Gallus gallus) that can cause severe pathology or death if untreated, is rarely recorded in free-living avian species. Sticktight fleas, however, were observed on the federally threatened Florida scrub-jay (Aphelocoma coerulescens) in February 2004, in south central Florida. Of the 81 Florida scrub-jays (FSJs) sampled before the 2004 breeding season, 12 were infested, with from 1 to as many as 57 fleas. Subsequent survivorship and variation in health indices led us to conclude that the sticktight flea caused the death of several jays. Within 4 mo, 46% of sticktight flea-infested (INF) jays died, whereas in the nonflea-infested (NINF) jays, only 5.9% died. Adult INF birds lost body mass in the time since a previous capture compared with NINF jays, and mass gain was slowed in 1-yr-old INF jays. Hematocrit of INF jays was dramatically impacted, as low as 17%, and was negatively correlated with the extent of infestation. Leukocyte counts were highest in INF jays; however, plasma immunoglobulin levels were lowest. Physiological stress levels, measured using plasma corticosterone, increased more rapidly in INF jays than NINF jays and were positively correlated with heterophil/lymphocyte ratios. The impact of the sticktight flea on the federally threatened FSJ negates previous findings that sticktight fleas are benign in wild avian hosts.

Animals↗
PubMed1985

Team approach in mental health services: generalists or specialists?

Psychiatrists, psychologists, and social workers were compared on their assessments of pathology, treatment techniques, and theoretical orientation for a typical hospitalized psychiatric patient. The purpose was to determine the relationship between treatment-team members' professional discipline and their clinical approach to a patient. Clinical discipline was significantly related to assessment, treatment, and theory. Psychiatrists favored medication, hospitalization, support, and brief, infrequent structured treatment focused on the present and external factors with an aim of social adaptation. Social workers were similar, but added types of treatment and longer, more frequent treatment. Psychologists were unique with an emphasis on psychoanalytically oriented psychotherapy aimed at personality change.

Adult↗
PubMed2000

Hepatitis C: a challenge for the generalist.

Most cases of hepatitis C become chronic, and although many of those remain silent for decades, some eventually progress to cirrhosis or other complications. Since almost 2% of the U.S. population is already infected, clinicians are likely to encounter growing numbers of patients with progressive disease. Treatment has been modified; ribavirin can now be added to interferon therapy.

Algorithms↗