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PubMed1986

An evaluation of an intergenerational consultation process to increase personal authority in the family system.

This paper reports an evaluation of an intergenerational consultation process designed to help people change significant relationships in the three-generational family system. The paper first describes the theory behind the consultation process that focuses on increasing personal authority in the family system; this is followed by a description of the consultation process. Clients who participated in the consultation process were compared to clients who participated in systems-oriented psychotherapy. The results indicate that clients who participated in the intergenerational consultation reported significantly more change in intergenerational triangulation and personal authority than did the control group. There were no differences between the groups in reported change in presenting problems, satisfaction with therapy, or helpfulness of therapy. Persons who had their parents in the office for a consultation also reported significantly more change in personal authority and less intergenerational intimidation than did clients who did not have their parents in the office for consultation. Implications of these findings for intergenerational theory and therapy as well as future research are discussed.

Adult↗
PubMed1999

Travel health: perceptions and practices of travel consultants.

BACKGROUND: The global increase in international travel puts travelers at risk of travel-related morbidity and mortality. Prior to travel, most travelers have contact with a travel agency, thereby providing an opportunity for intervention. With this in mind we aimed to determine some of the travel-related health knowledge, practices and needs of travel consultants. METHODS: A cross sectional study was undertaken in which one travel consultant from each of 166 Western Australian travel agencies was asked to complete a self-administered questionnaire. RESULTS: One hundred and forty-five travel agencies (87%) agreed to participate in the study. Fifty-six percent indicated that they "usually" gave broad travel-related health guidelines and recommended their clients consult a medical practitioner. Almost all travel consultants reported discussing travel health insurance; very few provided information on sexually transmissible diseases, the risks associated with drug use, or first aid kits. Over 80% responded correctly to statements eliciting their knowledge on yellow fever, malaria, and food safety; the majority incorrectly answered questions on dengue fever and altitude sickness. Fifty-six percent of respondents thought that there was "not enough" readily accessible travel health information; 52% said they would like to be more involved in providing health information to their clients. CONCLUSIONS: Contact between travelers and travel agents offers an opportunity to promote awareness of travel-related health hazards. While travel consultants' health knowledge on some topics is adequate, in other areas it is inconsistent. Many travel consultants in Western Australia expressed a willingness to be involved in future health promotion activities. This participation may be best nurtured by providing travel consultants with: (1) better health education so they are able to identify high-risk travelers and destinations for medical referral; and, (2) health information in a format they feel comfortable distributing to their clients.

Cross-Sectional Studies↗
PubMedDate not supplied

Selecting a healthcare consultant, Part I: How to get started.

Janet L. Scheuerman and Vaughan A. Smith outline the factors that determine why and when consulting services are appropriate, presenting an overview of the initial steps in consultant selection. The expertise of a consultant is often needed for specialized problems, problems needing immediate assessment, drastic rescue situations, difficulties that defy standard solutions, and changes in the regulatory and competitive environment. Many organizational and planning issues also require outside consulting expertise. Institutions use consultants for specialized information, an independent perspective, as catalysts for change, and for cost-effective service and education. The consulting process consists of five phases; Part I provides a careful analysis of crucial preliminary selection activities. An organizational commitment to the process must be made, and needs, key issues, and expectations defined before selecting a committee and identifying potential consulting sources. Part II will appear in the next issue of the JQA.

Competitive Bidding↗
PubMed1991

Speech patterns and satisfaction in diagnostic and prescriptive stages of general practice consultations.

With a general goal of establishing indicators of the quality of the helping relationship within medical consultations, we recorded and analysed verbal interactions in general practice consultations, in two studies. The diagnostic and prescriptive stages of the consultation were analysed separately, first with doctor satisfaction as the outcome and then, with a second sample of doctors, with both doctor and patient satisfaction as outcomes. Patients and doctors were found to have somewhat different views of what made a highly satisfactory consultation. The most satisfying consultations for doctors were those in which the medical problem and its solution seemed clear; patients felt most satisfied with consultations where they had discussed their own experiences and opinions during the second, prescriptive stage of the consultation.

Consumer Behavior↗
PubMedDate not supplied

Diagnosis and treatment of venous thromboembolism by consultants in Scotland.

A questionnaire was sent to 508 consultants in Scotland likely to encounter deep vein thrombosis and pulmonary embolism to assess their current standard practice in diagnosis and treatment of these disorders. Replies were received from 358 (70.5%). In deep vein thrombosis 47% and in pulmonary embolism 33% of consultants usually depended on clinical observation alone for diagnosis. In deep vein thrombosis 37% used venography to supplement clinical diagnosis and in pulmonary embolism 13% used angiography and 53% used isotopic scanning. Almost all consultants treated deep vein thrombosis (95%) and pulmonary embolism (99%) with anticoagulants. Most consultants (81%) gave heparin by intravenous infusion. Although many consultants gave intravenous heparin for more than three days (49.5% in deep vein thrombosis and 61% in pulmonary embolism), 25% of these consultants did not use any laboratory monitoring of heparin's effect. Large numbers of consultants gave warfarin for more than three months (20% in deep vein thrombosis and 47% in pulmonary embolism). There was a significant tendency to give heparin (p less than 0.01) and warfarin (p less than 0.001) for longer periods in pulmonary embolism than in deep vein thrombosis. This survey shows a widely varying practice and underlines the need for further controlled studies to provide clear guidance in the management of deep vein thrombosis and pulmonary embolism.

Angiography↗
PubMed1987

General practice consultations: is there any point in being positive?

A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were randomly selected for one of four consultations: a consultation conducted in a "positive manner," with and without treatment, and a consultation conducted in a "non-positive manner," called a negative consultation, with and without treatment. Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups. Similarly, 64% of those receiving a positive consultation got better, compared with 39% of those who received a negative consultation (p = 0.001) and 53% of those treated got better compared with 50% of those not treated (p = 0.5).

Attitude of Health Personnel↗
PubMed1999

General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study.

OBJECTIVES: To pilot the use of a range of complementary risk communication tools in simulated general practice consultations; to gauge the responses of general practitioners in training to these new consultation aids. DESIGN: Qualitative study based on focus group discussions. SETTING: General practice vocational training schemes in South Wales. PARTICIPANTS: 39 general practice registrars and eight course organisers attended four sessions; three simulated patients attended each time. METHOD: Registrars consulting with simulated patients used verbal or "qualitative" descriptions of risks, then numerical data, and finally graphical presentations of the same data. Responses of doctors and patients were explored by semistructured discussions that had been audiotaped for transcription and analysis. RESULTS: The process of using risk communication tools in simulated consultations was acceptable to general practitioner registrars. Providing doctors with information about risks and benefits of treatment options was generally well received. Both doctors and patients found it helped communication. There were concerns about the lack of available, unbiased, and applicable evidence and a shortage of time in the consultation to discuss treatment options adequately. Graphical presentation of information was often favoured-an approach that also has the potential to save consultation time. CONCLUSIONS: A range of risk communication "tools" with which to discuss treatment options is likely to be more applicable than a single new strategy. These tools should include both absolute and relative risk information formats, presented in an unbiased way. Using risk communication tools in simulated consultations provides a model for training in risk communication for professional groups.

Attitude of Health Personnel↗
PubMed2004

Medical consultation for gastro-oesophageal reflux symptoms: reasons and associated factors.

OBJECTIVES: To evaluate the frequency of medical consultation for gastro-oesophageal reflux symptoms (GORS) and to ascertain reasons for consultation and associated factors. METHODS: Telephone survey of 2,500 persons using a validated questionnaire. Data were analyzed using multiple logistic regression, in which the dependent variable was consultation for GORS and the independent variables were sociodemographic factors and the clinical characteristics of GORS. RESULTS: Of those reporting GORS, 28% had consulted their physician about them in the last year. Main reasons for seeking medical advice were GORS-induced concern in 48%, and intensity of GORS in 42.6%. Factors independently associated with medical consultation were: housewife (odds ratio (OR) 1.9; 95% CI 1.1-3.4) or retired status (OR 2.3; 95% CI 1.3-4.1), frequent GORS (OR 2.4; 95% CI 1.6-3.5), severe GORS (OR 2.4; 95% CI 1.4-4.2), nocturnal GORS (OR 1.6; 95% CI 1.1-2.3), and association of epigastric pain (OR 1.7; 95% CI 1.0-2.7) or nausea (OR 1.7; 95% CI 1.1-2.8). CONCLUSION: The high frequency of medical consultation for GORS in Spain makes it an important healthcare problem. The fact that half the patients seek medical advice due to concern about the nature of GORS illustrates the benefits of explaining the nature, treatment and prognosis of GORS. The clinical relevance of GORS does not reside in its frequency alone, since severe or nocturnal symptoms, albeit occasional, are also associated with medical consultation.

Adult↗
PubMed1982

Consultation-liaison psychiatry at the crossroads: in search of a definition for the 1980s.

Consultation-liaison psychiatry did not emerge as a prominent psychiatric subspecialty until the remedicalization of the psychiatric profession in the 1970s. The author traces the history of consultation-liaison and discusses the various definitions of the subspecialty. He outlines how consultation-liaison psychiatrists work in general hospitals and medical school departments of psychiatry. The future of consultation-liaison psychiatry, the author says, depends on developments in four areas: psychosomatic research, behavioral medicine, holistic health care, and general hospital psychiatry. To ensure a bright future for the subspecialty, consultation-liaison psychiatrists must meet fiscal, research, and political challenges, make peace with other behavioral scientists, develop close relations with the nursing profession, enjoy the support of medical school departments of psychiatry, and transform the consultation model into a comprehensive consultation-liaison model.

Behavior Therapy↗
PubMed2003

Cultural consultation: a model of mental health service for multicultural societies.

OBJECTIVES: This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. METHODS: We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. RESULTS: Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. CONCLUSION: The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.

Adult↗
PubMed2006

Ethics and lactation consultants: developing knowledge, skills, and tools.

This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.

Breast Feeding↗
PubMed2005

Do older patients feel able to cope with illness following telephone consultations? A multi-practice survey in the UK.

BACKGROUND: Worldwide, patients are offered a telephone consultation as a first point of access to a health care professional. Whilst older patients form a significant proportion of callers, this group has expressed reservation about consultations that preclude a physical examination. OBJECTIVE: This study compares how two groups of patients (< 70 years, > or = 70 years) perceive their ability to cope with illness following a telephone consultation. METHODS: Nine hundred and fifty-six patients from deprived inner city areas receiving telephone consultations with a General Practitioner (GP)/Family doctor or nurse at five practices in South Yorkshire, UK were surveyed within 24 h of the consultation. A 49% response rate was achieved; the mean age of respondents in the respective groups was 78.5 years and 48 years. The questionnaire included the Patient Enablement Instrument (PEI), a self-reported measure of patients' ability to cope with illness measure of patients' ability to cope with illness and supplementary questions on access to GPs in the practice. RESULTS: There was a low response rate from younger patients and males in particular. Ethnic minority groups were hardly represented among the respondents. How ever, scores on the PEI following telephone consultations were no different between older and younger respondents (Mann-Whitney U test, p = 0.56). Regression analysis with PEI scores as the dependent variable and fitting age and differences in responses to the questionnaire as explanatory variables yielded an R(2) of 0.02 suggesting that 'age' per se was a poor predictor of 'enablement'. CONCLUSIONS: These data support an inclusive policy in the provision of telephone access to health care professionals in primary care. We conclude that older patients are not disadvantaged by consulting a primary care professional by telephone.

Adaptation, Psychological↗
PubMed2006

Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists' assessment.

BACKGROUND: In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment. METHODS: Data were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale) in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out. RESULTS: Residents referred to psychiatric consultation at least once were 112 (14.5% of all residents). Reason for referral were: depression (17.2%), delusions and hallucinations (14%), agitation (34.8%), aggressive behaviour (23.5%) and disturbances of sleep (6.8%). Most frequent diagnoses were organic, including symptomatic, mental disorders (33.9%), mood disorders (22.3%) and schizophrenia, schizotypal and delusional syndromes (18.8%). No psychiatric diagnosis was found only in 1.8% of cases, thus confirming high sensibility of referring physicians.A statistically significant correlation was found when comparing referrals for depression or delusions and allucinations or sleep disturbances and diagnostic confirmation of such symptoms by specialistic assessment (respectively 49.8%, 52.7% and 19.6%). Correlation between psychotic symptoms and the consequent prescription of antipsychotic drugs had a significant if somewhat modest value (24%) while correlation between depression symptoms and prescription of antidepressant drugs was more noticeable (66.5%). CONCLUSION: Main reason for referral to psychiatric consultation resulted to be the presence of agitation, a non-specific symptom often difficult to attribute. Data concerning depression confirm tendency to underestimating this diagnosis in the elderly. Furthermore, symptomatic reasons for referral did not always correspond to subsequent diagnostic definitions by psychiatric consultants, therefore demonstrating modest predictive power.

Aged↗
PubMed2000

What do palliative medicine consultants do?

A workload study of consultants in palliative medicine was carried out, in which a task inventory questionnaire was sent to the consultant members of the Association for Palliative Medicine of Great Britain and Ireland. The median number of hours per week worked by a palliative medicine consultant was 49.5 (mean 51.3), excluding time on-call and breaks. The median consultant first on-call roat is 1:3. Palliative medicine consultants work a median of 22.5 direct clinical and 4.5 indirect clinical hours per week. This is very similar to the hours worked by consultants in other specialties who work an average 51.3 h per week, but with a median on-call rota of 1:6. Further studies are planned to monitor the patterns of consultant activity and workload in this specialty.

Consultants↗
PubMed2001

Ward managers' attitudes towards external consultants in Ashworth, a special hospital, 1992-1994.

This case study elaborates the aftermath of the Blom-Cooper Inquiry (1992), which forced the special hospital, Ashworth, into a radical 'culture change'. To this end, two groups of external consultants--a management consultancy and a professional task force--were introduced into the hospital. Newly established ward managers were to spearhead the organizational change by bringing social and clinical order to the wards over which the higher management had lost control. Few studies have mapped out the interaction between segments of an organization and expert outsiders. In this study, the interaction of the ward manager to the newly appointed external management consultancy and task force was analysed. It was clear that ward managers rated poorly the efforts of the management consultancy and task force--it was considered that they were not giving value for money. The task force rated slightly more favourably than the management consultancy. The fact that the management consultancy did not have ward credibility in this closed forensic setting was attributed to low prestige. The management consultancy also failed to fulfill the organizational ambitions of ward managers, who wished to be central to the hospital's major decision-making process.

Attitude of Health Personnel↗
PubMed2004

Variation in activity rates of consultant surgeons and the influence of reward structures in the English NHS.

OBJECTIVES: To explore variation in the National Health Service (NHS) activity rates of consultant surgeons, and examine whether activity is dependent upon the type of contract held and/or bonus payments, after accounting for age and other consultant and hospital characteristics. METHODS: NHS Hospital Episode Statistics (HES) for England were used in combination with workforce data in five surgical specialties in 1998/99 and 1999/2000. Descriptive statistics were used to explore variation in activity rates. A multi-level model was used to analyse the relationship between NHS contract and bonus payments, and activity. RESULTS: There is considerable variation in activity rates of English NHS consultant surgeons, with and without adjustment for casemix. Interquartile variation shows that the top 25% of consultants have activity rates 60 to 85% higher than the bottom 25%. A multi-level model indicates that consultant surgeons with a 'maximum part-time' contract have significantly higher activity rates than those with a full time contract (129 more finished consultant episodes (FCEs) per year, 95% CI 97-160). Consultant surgeons who hold discretionary salary points undertake significantly more activity than those without (95 FCEs, 95% CI 62-128). Those with a distinction award (a type of bonus payment) have a tendency towards higher activity rates, but this does not reach statistical significance (48 FCEs, 95% CI -4 to 103). CONCLUSIONS: 'Maximum part-time contract' status is associated with higher absolute activity rates among NHS surgeons. Rich data sources like HES merit careful exploration and increased use as an essential first step in measuring and managing variations in specialists' performance.

Analysis of Variance↗
PubMed2003

Realtime teleconsultations versus face-to-face consultations in dermatology: immediate and six-month outcome.

We evaluated the outcome of both realtime teleconsultations and face-to-face consultations in dermatology. Forty-six patients were enrolled in an open controlled study. Twenty-nine patients (60%) answered the questionnaire sent to them after six months. Over the six-month follow-up, similar proportions of the two patient groups had visited a general practitioner or a specialist in the consulting hospital. At follow-up, overall patient satisfaction with the consultation, measured on a linear analogue scale (0-10), had fallen only slightly and to the same extent after both types of consultation, that is by 1.2 (SD 3.7) after realtime teleconsultations and by 1.4 (SD 4.5) after face-to-face consultations. The proportions of patients who would prefer the same mode of consultation for their next appointment had decreased from 83% to 50% in the realtime teleconsultation group and from 83% to 62% in the face-to-face consultation group. However, in neither group was the change significant. The study suggests that patient satisfaction with teleconsultation is well preserved after six months.

Adult↗
PubMed1999

Realtime remote consultation in the outpatient clinic--experience at a teaching hospital.

We used an outpatients' telemedicine clinic to evaluate remote consultation in a London hospital practice. Video-images were relayed by ISDN at 384 kbit/s between the main hospital site and the sister hospital. Teleconsultation was evaluated in three different specialties: pain management, orthopaedics and general surgery. Medical personnel involved in the consultation consisted of a resident or senior house officer at the remote site and a senior registrar or consultant at the main hospital. A total of 146 consultations was held over a six-month period in the three clinical specialties involved. Questionnaires were completed by 58% of patients and over 90% of the medical personnel involved. The mean scores (on a five-point Likert scale) for physician satisfaction at the main and distant site were 3.6 and 3.8, respectively. On a scale of 0-10, 92% of patients rated the consultation 8-10 and 90% indicated that they would return for a similar consultation. Seventy-three per cent felt that a similar consultation from their referring doctor would have been appropriate. Confidence in the diagnosis was high among the specialists at the main hospital site.

Computer Systems↗