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 613 records · Page 34Linked to original sources
PubMed1999

Consultation length and chronic illness care in general practice: a qualitative study.

OBJECTIVE: To study the relationship between duration and content of general practice consultations for patients with chronic conditions. DESIGN: A qualitative analysis of transcripts of consultations. The major themes and concepts of psychosocial support were identified and coded using the Ethnograph computer package. SETTING: A mix of rural and urban general practices in two States of Australia in 1993-1994. PARTICIPANTS: 14 selected general practitioners and 50 of their patients with complex chronic conditions. RESULTS: Transcriptions of 106 consultations were analysed. General practitioners (GPs) led most consultation dialogue and emphasised disease management. The major themes were provision of information by the GP, review of treatment by the GP, review of illness by the GP, and description and explanations of their illness by patients (patient narrative). The first three themes predominated in consultations of all lengths. Longer consultations (20 minutes and over) contained more dialogue initiated by patients and more patient narrative about living with their illness. CONCLUSIONS: Patients with complex chronic conditions may require longer consultations to allow adequate time for review of their illness and treatment as well as an opportunity to raise issues and concerns about their illness, its impact on their lives and their personal management strategies. Longer consultations may thus provide the mechanism for what has been described as patient "enablement".

Aged↗
PubMed1989

A computer-assisted medical diagnostic consultation service. Implementation and prospective evaluation of a prototype.

STUDY OBJECTIVE: To evaluate the accuracy of a computer-aided consultation service using academic general internists and the Quick Medical Reference (QMR) diagnostic program: and to study the impact of the consultation on the diagnostic behavior of physicians caring for patients. DESIGN: Prospective study of the diagnostic accuracy of computer-aided consultation in 31 cases, as well as a prospective study of ward team diagnoses and opinions before and after consultation. SETTING: General medicine wards of two tertiary care centers. PARTICIPANTS: Thirty-one patients identified as posing a diagnostic challenge and meeting eligibility criteria, as well as the housestaff caring for these patients. MEASUREMENTS AND MAIN RESULTS: After 6 months follow-up, diagnoses were established in 20 of 31 cases. The diagnostic sensitivity of the computer-assisted diagnoses, 85% (95% CI, 56% to 97%), was similar to that of the consult service physicians, 80% (95% CI, 55% to 94%), but better than that of the ward teams, 60% (95% CI, 33% to 81%; P = 0.03 using the binomial test). The consultation influenced the postconsultation differential diagnoses of the ward teams in 26 of the 31 cases (95% CI, 92% to 95%). House officers rated the consultation service as being educationally helpful in 25 of the 31 cases (95% CI, 62% to 94%). CONCLUSIONS: Computer-aided diagnostic consultation, when provided by physicians familiar with the limitations of the system and capable of overriding inappropriate suggestions, was both accurate and educationally helpful in most cases. The system provided reasonable diagnostic suggestions not previously considered by the ward teams and these suggestions were valued sufficiently to cause alteration of the original differential diagnoses.

Diagnosis, Computer-Assisted↗
PubMed2000

[Moroccans' opinions about general practitioners: analyzing reasons for consultation].

OBJECTIVE: To determine whether there is a difference in the extent to which the GP succeeds in establishing the reasons for consultation of Moroccans and those of the Dutch; and whether the opinion of Moroccans about the GP's consultation differs from that of the Dutch. DESIGN: Analysis of patient interviews and GP's consultations. METHOD: In 11 general practices in Amsterdam and The Hague in May 1997, 50 Moroccan adults and 50 Dutch individuals were asked for their reasons to attend before the consultation and in the mother language; a distinction was made between the actual complaint and the expectations with regard to the consultation. The GPs recorded these data after every consultation. The complaints were coded by organ system and by nature of complaint, following which agreement of the assessments was scored on a scale ranging from 0 to 100. RESULTS: Both groups comprised 20 men and 30 women. The mean age of the Moroccans was 38.6 years (SD: 13.8), that of the Dutch 56.4 years (SD: 16.7). The GPs established complaints of Moroccan patients not as well as those of Dutch patients (score: 73.9 versus 87.3); the difference was more pronounced where patients with only elementary education were concerned (67.0 as against 86.1). The GPs were able to establish the expectations with regard to the consultation nearly as often for the Moroccan as for the Dutch patients (58.5 versus 55.9). Moreover, the Moroccans were as positive about the course of the consultation as the Dutch. Except for communication problems among the lower educated, none of the problems indicated appeared to be experienced more often by the Moroccans than by the Dutch. CONCLUSION: A large part of the complaints presented by lower educated Moroccan patients were interpreted differently by the GP. For Moroccans with a higher education, the care was comparable with that among the Dutch.

Adult↗
PubMed2001

[The influence of the presence of students on the consultation--attitudes of tutors in family medicine clinics].

BACKGROUND: The consultation is the pivot of clinical teaching in ambulatory care. It is therefore essential that students observe the consultation. The students' presence itself influences the consultation and also requires the patients' consent. Moreover the introduction in Israel of the "Patients' Rights Act" in 1996 has made us more acutely aware of the place of the patient in teaching especially with regard to the consent to be part of the teaching process. AIM: This study was undertaken in order to investigate how tutors in family medicine perceive changes in the consultation caused by the presence of students. METHODS: An anonymous physician questionnaire was distributed on the first day of the 6th year clinical clerkship in family medicine. The questions pertained to perceived influence on length and content of the consultation. In addition physician and patient background information was gathered; and the physicians were asked to estimate the patients' willingness to be part of the teaching process. RESULTS: 46 tutors in family medicine participated, 70% of whom were female. Sixty four percent of the doctors thought that the student's presence had an influence on the consultation. Ninety one percent thought that it increased consultation length, especially of the physical part (93%). More than half thought that the student's presence might interfere with asking intimate questions. The majority held the opinion that the patient's gender and socioeconomic background were inconsequential. Ninety two percent of physicians estimated that 5% or less of the patients would refuse the presence of a student. IN CONCLUSION: Tutors in family medicine think that the presence of a student affects the consultation. Those involved in and responsible for teaching should take this into account. Further research of these changes with objective measurements is needed.

Adult↗
PubMed2002

Why women consult with increased vaginal bleeding: a case-control study.

BACKGROUND: Many women with heavy periods and irregular bleeding do not consult about them. It has been suggested that some of these symptoms are associated with psychological distress and that this influences consultation behaviour which may account for why some women present with a menstrual disturbance and others with apparently the same problem do not. AIM: To explore the relationship between symptom severity, psychological distress, and the seeking of medical help in primary care among women aged 54 years or less with increased vaginal bleeding. DESIGN OF STUDY: Case control. SETTING: An urban four-partner general practice of 10,000 patients. METHOD: Questionnaires were sent to women who were consulting with new episodes of 'increased vaginal bleeding' and two groups of controls: consulting controls with 'acute respiratory tract infection' (RTI) or 'other illness' as identified by weekly computerised searches, and community controls, selected from the practice age-sex register. RESULTS: Nine hundred and forty-three questionnaires were sent out to 108 cases and 835 controls with an 80% response rate. Of these, 60.9% of the cases, 47.0% of the consulting controls, and 39.7% of the community controls were subjects with probable psychological distress on the General Health Questionnaire (chi2 test, P = 0.002). Cases were more likely than community controls to have heavy periods (odds ratio [OR] = 2.86, 95% confidence interval [CI] = 1.53-5.35) and heavy periods interfering with life (OR = 3.69, 95% CI = 2.02-6.75). After controlling for heaviness of periods, cases were still more likely to have psychological distress (OR = 1.80, 95% CI = 1.00-3.24). The same relationships prevailed when comparing cases and consulting controls. CONCLUSION: Interference in life caused by heaviness of periods appears to be a powerful initiator of consultation with increased vaginal bleeding. Perceived heavy periods and psychological disturbance are weaker predictors. Women presenting to primary care with increased vaginal bleeding are more likey to have a psychological disturbance than women from the community or those consulting with another illness.

Adult↗
PubMed2003

The decline in bulk-billing and increase in out-of-pocket costs for general practice consultations in rural areas of Australia, 1995-2001.

OBJECTIVE: To describe the changes in bulk-billing and out-of-pocket costs for Australian general practice consultations over the period 1995-2001. DESIGN: Retrospective analysis of 1996-2001 survey data from the Australian Longitudinal Study on Women's Health (ALSWH), linked with Medicare and Department of Veterans' Affairs (DVA) data on general practice consultations from 1995 to 2001. PARTICIPANTS: 22 633 women who gave consent to linkage of their ALSWH data with Medicare/DVA records. In 1996, women in the "young" cohort (n = 6219) were aged 18-23 years, those in the "mid-age" cohort (n = 8883) were aged 45-50 years, and those in the "older" cohort (n = 7531) were aged 70-75 years. OUTCOME MEASURES: Out-of-pocket costs paid by patients for general practice consultations, by calendar year, urban/rural area of residence, age, frequency of attendance, self-rated health, and education level. RESULTS: For each age group and year studied, the use of bulk-billing was lower in rural areas than in urban areas. For example, in 2000, the percentage of women in rural and urban areas, respectively, who had all their general practice consultations bulk-billed was 31% v 52% (young women), 24% v 45% (mid-age women) and 58% v 79% (older women). There has been a steady decline in bulk-billing for general practice consultations in rural areas since 1995. The average out-of-pocket cost per consultation for women in rural areas was higher than the cost for women living in urban areas. After adjusting for age, health and socioeconomic factors, women living in urban areas were more than twice as likely to have all their consultations bulk-billed as women living in rural areas: odds ratio (OR), 2.4 (95% CI, 2.1-2.7) (young women); OR, 2.5 (95% CI, 2.3-2.8) (mid-age women); OR, 2.6 (95% CI, 2.3-2.9) (older women). CONCLUSIONS: In Australia, the geographic differential in the cost of general practice consultations is widening. Policy changes are required to enable women in rural and remote areas to have access to affordable healthcare services.

Adult↗
PubMed1990

Does awareness of being video recorded affect doctors' consultation behaviour?

Four general practitioners, two of whom had no previous experience of video recording in the consultation, took part in a study to assess the effect of awareness of video recording on their consultation behaviour. A video camera was sited unobtrusively in each consulting room for a month during which five randomly selected surgeries were recorded with the doctors being informed at the time, and five without their being informed. The video recorded consultations were analysed using TIMER, a tool designed to measure objectively behaviour in terms of physical, verbal and secondary activities in consultations. The proportions of time spent on the 27 consultation parameters were compared when doctors were aware and unaware of the recording, using analysis of variance. This demonstrated only one significant difference, in the low frequency parameter of the doctor's exploration of the patients' concepts (P less than 0.05). In a secondary analysis of the first four consultations in each surgery, where any effect of the presence of the video camera would be expected to be most marked, there was again only one significant difference in the 27 parameters (in patient preparation; P = 0.01). No significant difference owing to awareness of video recording was found in consultation length, the number of problems dealt with, or previous inexperience of video recording. When surgeries at the start of the month were compared with those at the end, four significant differences (P less than 0.05) out of 108 areas were demonstrated both when the doctor was aware and unaware of video recording, and there was no consistency in the direction of the differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness↗
PubMed1994

Consultation patterns in a community survey of men with benign prostatic hyperplasia.

BACKGROUND: The Stirling benign prostatic hyperplasia natural history group have previously reported a prevalence of this condition of 255 per 1000 in a community study of 1610 men aged 40-79 years. AIM: It was decided to examine the consultation patterns of men with benign prostatic hyperplasia in greater detail. METHOD: All participating men were invited to complete a previously validated lifestyle questionnaire including questions on consultations with their general practitioner during the previous year and previous history of prostatic problems. The men who had a urinary symptom score greater than 11, or who had a urinary flow rate of less than 15 ml per second were examined by transurethral ultrasonography for prostate size. RESULTS: Of 364 men with benign prostatic hyperplasia, 89% had not consulted their doctor about urinary symptoms in the year prior to the study. Men with moderate to severe urinary symptoms were six times more likely to have consulted their doctor than those with mild symptoms. Moderate to severe symptoms and greater interference with daily living activities were both associated with a greater likelihood of consultation, independent of age. Of all the men in the study referred to the specialist clinic for assessment of prostate size by transurethral ultrasonography, two thirds were referred because of low urinary flow rate and one third because of high urinary symptom scores. The reported consultation data showed a reverse ratio of one third of those consulting having a low urinary flow rate and approximately two thirds having urinary symptoms. CONCLUSION: While mass screening is unjustified, there is a need for patient education about benign prostatic hyperplasia in general and the recognition of declining strength of urinary flow as a symptom of benign prostatic hyperplasia and not of ageing alone. Furthermore, evaluation of primary care use of urinary flowmeters and the development of local protocols are suggested as elements of a case finding strategy for benign prostatic hyperplasia based on patient led consultation.

Adult↗
PubMed1995

Practice nurses' workload and consultation patterns.

BACKGROUND: There are calls for the role of the practice nurse to be developed and extended. Before areas for further training and education can be identified, baseline data are needed on practice nurses' current activity and workload. AIM: A study was undertaken to analyse the activity of practice nurses in two large inner city general practices and to assess the skills mix of the nursing staff required to meet the needs of the practices. METHOD: The study practices had a combined list of 26,000 patients, 80% of patients attracting a deprivation allowance. Each practice employed three practice nurses. A nurse activity index with 45 codes was constructed to describe patient-nurse consultations. Activity codes were categorized into traditional treatment tasks, extended role tasks or diagnosis and management tasks. For eight months, practice nurses in practices Y and Z recorded activity index codes for each patient consultation. Practice Y also recorded the source of referral and the age and sex of the patient. RESULTS: There were 13,898 practice nurse consultations during the study period, equivalent to an annual nurse consultation rate of 0.8 per patient. Compared with the practice population as a whole, the patients attending the practice nurses in practice Y were older (mean age 43 years versus 37 years, P < 0.001). Those attending the practice nurses in practice Y were also more likely to be female (61% of consultations were with female patients compared with 50% of the practice population as a whole, P < 0.001). In practice Y, patients referred themselves to the practice nurse in 42% of consultations, 32% were follow-up consultations and in 25% of cases the patient had been referred by a doctor. The most common reasons for nurse consultation were blood tests (15% of procedures in practice Y and 18% in practice Z) and dressings (13% in both practices). Most procedures in practices Y and Z were in the traditional treatment category (61%), 26% were in the extended role category and 9% in the diagnosis and management category (3% coded 'other', 1% uncoded). Between practices, the greatest difference in recorded procedures was for asthma check ups (7% of procedures in practice Y compared with 2% in practice Z). CONCLUSION: This study describes the workload of practice nurses in two inner city practices over eight months. Other practices could use the activity index to make comparisons over time and between practices. Up to 60% of nurses' work in the study practices could be done by a nurse without extended training and up to 30% could be done by a health care assistant, but with some loss of quality. It is suggested that half the nursing hours available to a practice should be offered by a nurse with extended training in order to undertake and develop extended role tasks and diagnosis and management tasks.

Adolescent↗
PubMed1995

Examination of the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation.

BACKGROUND: A patient's satisfaction with a consultation may be influenced by many factors relating to both patient and doctor. AIM: This study set out to examine the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation. METHOD: A prospective study involving 893 adult patients attending 12 general practitioners in Glasgow was carried out. Questionnaires were completed by general practitioners after consecutive surgery consultations. Patients completed forms assessing mental state and satisfaction with inter-personal aspects of the consultation. RESULTS: Patients reporting frank psychological disturbance tended to express more dissatisfaction with the inter-personal aspects of the consultation. This effect was alleviated in the majority by recognition of the disturbance by the general practitioner. General practitioners differed markedly in their assessment of the psychological component of consultations. Fewer dissatisfied patients were found in the surgeries of doctors who tended to rate the psychological component of consultations more highly. In contrast, the general practitioner's overall accuracy of diagnosis of psychological distress was a poor predictor of the proportion of dissatisfied patients. CONCLUSION: This preliminary study suggests that a tendency among doctors to assign importance to the psychological component of consultations may enhance elements of patient satisfaction. It is not clear whether this [psychological-mindedness' is an attribute which can be learnt. To resolve this uncertainty, studies are needed of the effects on patients of educational interventions designed to increase general practitioners' sensitivity to psychological distress.

Adult↗
PubMedDate not supplied

[Economic-health care indicators in 2 health areas: the cost of the "consultation product" of primary health teams].

OBJECTIVE: To describe the main economic-healthcare indicators of Aragon Areas 2 and 5 in 1992. To quantify in economic terms the value of the medical and nursing consultations carried out by Primary Care teams. DESIGN: Cost-analysis type study (total costs). The criteria for attributing indirect costs were established by consensus. The data correspond to 1992 (real spending by each centre). The cost of the consultations was calculated in function of the overall activity undertaken and in line with the type of consultation. SETTING: Areas 2 and 5, Aragon. Calculation of the cost per consultation only for Primary Care teams (PCT). RESULTS: Spending per inhabitant and per year, both overall and broken down into care and pharmacy costs was 20,140 for PCT's (8,805 pesetas + 11,355 pes) and 23,153 pes for the traditional model (7,677 + 15,476 pes). Costs per consultation were: 1,031 pes for General Medicine plus 2,537 on Pharmacy; 1,765 pes for Paediatrics plus 716 on Pharmacy; 972 on nursing. Costs per consultation were also offered in function of the duration of each type of consultation and the health-care delivered. CONCLUSIONS: Overall, PCT's generated less expense per each insured person than the traditionally-based Consulting rooms. This situation is mainly due to Pharmacy costs, where the difference is over 4,000 pesetas. The evaluation of service costs in function of attendance supposes that, between two teams of equal composition and the same volume of spending, the more efficient will be that which produces the greater amount of services.

Costs and Cost Analysis↗
PubMed1997

[Demand for consultations at the Emergency Service of the "Dr. José Horwitz B" Psychiatric Institute in Santiago, Chile: comparison between 1988 and 1994].

BACKGROUND: In the last decade, there have been changes in the prevalence of specific psychiatric disorders. AIM: To study the diagnoses and demographic features of patients consulting the emergency wards of a public psychiatric hospital in Santiago during 1994 as compared with those of patients consulting in 1988. MATERIALS AND METHODS: A random sample of 439 patients charts, corresponding to 3% of all consultations during 1994, were analyzed. The results were compared with consultations during 1988, analyzed in a previous study. RESULTS: During 1994, patients were older, came alone to the emergency wards and consulted during the night with greater frequency than during 1988. In both years psychosis were the main cause of consultation. Compared to 1988, during 1994 there was an increase in the frequency of affective disorders (16 and 12% of all consultations respectively) and substance abuse (15 and 3% respectively). CONCLUSIONS: The increase in consultations due to affective disorders and substance abuse in 1994 is in accordance with changes in the epidemiological profile of psychiatric disorders in Santiago.

Adolescent↗
PubMed2002

Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients.

OBJECTIVE: To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means. DESIGN: Questionnaire. SETTING: Conducted by email and surface mail as appropriate in August 2000. SUBJECTS: All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society. OUTCOME: An 86 per cent response was obtained from the 231 consultants. RESULTS: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source. CONCLUSIONS: A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients.

Adult↗
PubMed1998

Role of the consultant obstetrician in the delivery suite.

The role of consultant obstetricians is under considerable debate. This has particularly focused on the role of consultants in intrapartum care. The article explores the role of the consultant in delivery suite from the view point of a consultant, a clinical director, a training programme director and a chief executive. These viewpoints determine a range of common themes which mean the duties of consultants over their career lifecycle need to be addressed; the need to expand consultant posts; and the tensions which inevitably occur. The authors believe these need to be addressed because of the need to ensure consultant roles in delivery suite are developed as a key part of seeing quality improvement.

Attitude of Health Personnel↗
PubMed1991

Ethics consultation: skills, roles, and training.

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

Certification↗
PubMed1988

An ethics consultation service in a teaching hospital. Utilization and evaluation.

A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31%. Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.

Adult↗
PubMed1982

Factors related to an effective referral and consultation process.

A study of 141 consecutive referrals from family physicians in four clinic sites was undertaken to obtain descriptive characteristics of the referral-consultation process and to identify factors associated with effective outcomes. Consultation reports were returned to referring physicians in 88 percent, 75 percent, and 43 percent of referrals from consultants in community practice, university faculty practice, and university outpatient clinics, respectively. The quality of the consultation reports, as determined by the referring physician's opinion, increased directly with the amount of referral information originally sent to the consultant. The referral-consultation process appears to be functioning well in this site. The data suggest that this process might function even better if referring physicians would personally contact and send letters to consultants.

Communication↗
PubMed1980

Consultees' concordance with consultants' psychotropic drug recommendations. Related variables.

In an attempt to identify variables critical to consultees' concordance with the recommendations of psychiatric consultants for the use of psychotropic medications in a general hospital, the medical records from 394 psychiatric consultations were reviewed. Using quantitative concordance criteria, consultee response was examined as a function of 29 variables. These characterized the patient, the consultee, the consultant, and the consultation. Seven variables were found to be significantly related to concordance. Among these were the patient's history of exposure to psychotropic medications, the presence of multiple recommendations, specification of starting dosage, the category of psychotropic drug recommendation, and the timing of the consultation. The latter two variables emerged as most noteworthy. This work extends the investigation of consultees' responses to consultants' recommendations and anticipates the development of specific consultation strategies derived from quantitative outcome studies.

Attitude of Health Personnel↗