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PubMedDate not supplied

The consultant family physician.

Family physicians frequently consult and refer to other specialists, both generalist and subspecialist. Less commonly has the family physician been used as a consultant. A randomized questionnaire survey of family physicians in five midwestern states was used to consider the frequency and reasons for other specialists collaborating with the family physician as a consultant. Fifty percent of the respondents consult and refer to as well as receive consultations/referrals from other family physicians. Thirty-five percent of the respondents receive consultations and referrals from other generalist specialists, and 28 percent receive theirs from subspecialists. Most often these occur because the patient has no family physician, but family physicians are also used for their procedural skills and coordination of patient evaluation and management, including preoperative evaluation of patients. This study confirms that the consultant family physician is an important part of the health care team.

Consultants↗
PubMed2005

Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation.

BACKGROUND: Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers. OBJECTIVE: To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings. DESIGN: Prospective trial. SETTING: Twenty-two military treatment facilities in the Pacific. PARTICIPANTS: Primary care providers, pediatric consultants, and 5 reviewers. MAIN OUTCOME MEASURES: Consult response time, physician panel review, and evacuation cost avoidance. RESULTS: There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408. CONCLUSIONS: The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.

Adolescent↗
PubMed2005

Family physician consultation patterns indicate high risk for early-onset anorexia nervosa.

OBJECTIVE: There is often a delay in the recognition of early-onset anorexia nervosa. The current study aimed to determine whether there are specific patterns in the frequency and content of family physician consultations that might predict its onset. METHOD: Lifetime number and type of family physician consultations were recorded for three groups: (a) an index group comprising 19 girls with anorexia nervosa, onset under 14; (b) a clinical control group comprising 19 girls with an emotional disorder; and (c) a nonclinical group comprising 19 girls with no history of mental health problems. RESULTS: Both clinical groups had an elevated number of consultations, particularly in the 5 years before diagnosis. The index group had a significantly higher number of eating, weight, and shape consultations (especially in the year before diagnosis), whereas the clinical control group had a greater number of psychological consultations. CONCLUSION: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.

Adolescent↗
PubMed2004

Consultation and interprofessional collaboration: modeling for the future.

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Cooperative Behavior↗
PubMed2003

Providing letters and audiotapes to supplement a prenatal diagnostic consultation: effects on later distress and recall.

OBJECTIVES: Information provided at a mid-trimester fetal scan aims to improve patients' knowledge and minimize anxiety. This randomized controlled trial conducted at the Fetal Medicine Centre at Birmingham Women's Hospital aimed to assess the relative value of providing 1.standard information: a consultation and computer-generated ultrasound report (n = 29); 2.standard information plus a post scan written non-technical letter (n = 29); 3.standard information plus audiotapes of the consultation (n = 29); 4.standard information plus both non-technical letters and audiotapes (n = 30). It also aimed at exploring whether severity of diagnosis (none; mild; moderate-severe) interacted with the type of information provided to affect subsequent anxiety, depression and recall of information. PARTICIPANTS: Women (n = 550) referred with suspected fetal anomalies (without a previous history of anomaly or known psychiatric illness) were sent information regarding this study. One hundred and seventeen women consented and were randomly assigned to one of four information groups. The groups were similar with regard to age, education and marital status. MAIN OUTCOME MEASURES: State anxiety and depression were evaluated with the self-report State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) prior to consultation and two weeks post-scan. A structured telephone interview assessed recall of information approximately two weeks later. RESULTS: Two weeks after the initial consultation, women who received an audiotaped recording of the consultation reported significantly less anxiety than the control group (mean STAI 41.44 [95% CI 35.63-47.26] versus 44.92 [39.32-50.52]; difference = 10.70 [3.56-17.83], p < 0.01). Women who received a non-technical letter also reported less anxiety than the control group, an effect that approached significance (mean STAI 39.08 [95% CI 32.85-45.30]; difference = 6.48 [0.21-13.16], p = 0.058). There were no differences between the information groups on depression scores or recall of information. Women with a more severe abnormality reported higher anxiety and depression two weeks post-consultation, and had greater free recall but less cued recall of information. CONCLUSIONS: Provision of additional material (particularly an audiotape) following a prenatal scan appears to minimise anxiety compared with standard practice. Provision of audiotapes and non-technical letters do not appear to affect patient recall.

Adult↗
PubMed2007

Impact of providing audiotapes of primary treatment consultations to men with prostate cancer: a multi-site, randomized, controlled trial.

BACKGROUND: The purpose of this investigation was to systematically examine the efficacy of providing men with prostate cancer with an audiotape of their primary treatment consultation. METHOD: Participants included 425 men newly diagnosed with prostate cancer and 15 radiation oncologists from 4 cancer centers in Canada. Patients were block randomized to one of four consultation groups: 1. Standard care control--not audio-taped; 2. Audio-taped--no audiotape given; 3. Audio-taped--patient given audiotape; and 4. Audio-taped--patient offered choice of receiving audiotape or not (4 patients declined; 94 accepted). Patient outcomes were measured at 12 weeks post-consultation: perceived degree of information provision; audiotape satisfaction and use; communication satisfaction with oncologist; mood state; and cancer-specific quality of life. RESULTS: Patients receiving the consultation audiotape reported having been provided with significantly more disease and treatment information in general (p=0.04), and more information about treatment alternatives (p=0.04) and treatment side effects (p=0.01) in particular, than patients who did not receive the audiotape. Audiotape benefit was not significantly related to patient satisfaction with communication, mood state or quality of life at 12 weeks post-consultation, and was not significantly affected by choice of receiving the audiotape. Patients rated the audiotape intervention positively, with an average score of 83.0 out of 100. CONCLUSION: Consultation audiotapes are rated highly by men with prostate cancer, and these audiotapes help to enhance their perception of having been provided with critical disease- and treatment-related information.

Adaptation, Psychological↗
PubMed1993

[The effect of information and communication in the orthodontic consultation. 1. The imparting of the information].

The initial consultation has a crucial impact on the patient's decision whether or not to undergo orthodontic treatment. The consultation is the occasion for providing information regarding the nature of the malocclusion and its possible treatment. The consultation has a threefold objective: first, the ethical, i.e. assisting the patient in making an informed and responsible decision; second, the legal, i.e. facilitation of an informed consent; and third, the psychological, i.e. motivation to treatment and enhanced health behavior. The basic prerequisites to a successful consultation are the patient's accurate comprehension and retention of the given information. In the course of an ongoing quasi-experimental study the Wuerzburg orthodontic department has made video recordings of initial consultations. All information was coded according to a standardized schematic. After ten days the patients were interviewed about the consultation. With help of the schematic, retention and comprehension of the information given were assessed quantitatively by comparing the number of information units actually given with those recalled, understood, or forgotten. In addition, the recordings were analyzed for provider interaction patterns.

Communication↗
PubMed2000

How to effectively use consultants.

Apart from a few pioneering medical centers, most medical organizations lack the internal knowledge and technical expertise to develop a comprehensive digital imaging business plan, create medical imaging architectures, select vendor(s), and implement picture archiving and communication systems (PACS) and other information systems. Many of these processes are only done once (eg, vendor selection and initial implementation) and developing such one-time expertise in-house is wasteful and inefficient. It is highly unlikely that an inexperienced hospital-based group undertaking their first and only PACS project will be able to match the experience and depth of a well-organized consulting group with prior experience. Organizations therefore are looking to consulting groups to fill their internal resource gaps. This report presents the benefits of engaging consultants, guidelines for selecting a consulting group, and insight on effectively using the consultants. The presentation is based on actual experiences using consultants for planning, selecting, and implementing a PACS at Children's Hospital Medical Center, Cincinnati.

Consultants↗
PubMed2007

[Accelerating consult letter time in inpatient psychiatric and psychotherapeutic care].

Consult letters are the main way of relaying information between attending physicians involved in patient treatment at different levels of care and should therefore reach continuing care physicians with minimal delay. The quality assurance project described here was intended to reduce dispatch times for inpatient consult letters at our department of psychiatry and psychotherapy. To accomplish this, different measures were put to work at two levels of intervention. These included standardizing work flow, centralizing and optimizing work distribution in the secretaries' office, enabling faster access to typewritten consult letters by way of central data storage on the clinic's server, sending email notifications to all persons involved, using a central office for signing letters, and prompt monitoring and reporting of consult letter delays. These interventions helped reduce the average delay of dispatching consult letters from 29 days to 11. All in all, the project led to a high degree of workplace satisfaction for all persons involved and should be adaptable to other departments and units without difficulty. In our own department, ward-specific consult letter efficiency has become an important quality indicator.

Delivery of Health Care↗
PubMed2000

[Psychiatric consultation services for the elderly. Changes in utilization due to the new German legislation concerning guardianship and restructuring of health care providers].

In the discussion of increasing costs of health care in Germany, the frequent and long hospital stays of elderly patients are often pointed out. Since these patients very frequently suffer from psychiatric disorders, psychiatric consultation is often required. This study was aimed at investigating whether new German laws concerning guardianship and the structure of health care providers change conditions for psychiatric consultation services. For this purpose, the documentation of all consultations in the years 1991 to 1995 was retrospectively evaluated. In about 3% of all patients aged over 65 referred to the General University Hospital of Lübeck, psychiatric consultation was ordered. The most frequent diagnosis was senile dementia. Comparison of the requests and psychiatric recommendations show a significant increase in wishes and recommendations for guardianship. Moreover, there is evidence of the increasing need of consultation in elderly patients. Possibly due to the new law concerning the structure of health care providers and the number of requests and recommendations to transfer patients to psychiatric wards, these results show that the new laws do affect psychiatric consultation.

Aged↗
PubMed2006

Telephone consultation in palliative care for cancer patients: 5 years of experience in The Netherlands.

GOALS OF WORK: To analyze cancer patient-related consultations of a telephone helpdesk (TH) for palliative care over a period of 5 years in the region of Utrecht, The Netherlands. MATERIALS AND METHODS: A descriptive analysis was performed of consultations over a period of 5 years (2001-2006). The discipline and location of requesting professionals, patient characteristics, reasons for calling, symptoms, palliative care problems and needs for support were registered. MAIN RESULTS: A total of 1,794 consultations were analyzed. There was an increasing number of consultations during the study period. Of the patients, 51% were male and their median age was 65 years (range 0-104). Eighty-four percent were treated at home by their general practitioner. Two thirds of the patients had a life expectancy <4 weeks. Most questions referred to pain (49%), delirium (20%), nausea and vomiting (16%) and dyspnea (12%). The median number of symptoms was 1 (0-6). Of the questions, 54% were related to pharmacological problems, 19% to psychological problems and 21% to the organization of care. Of the requesting professionals, 17% asked for support for themselves. Of the consultations, 14% were related to end-of-life issues: palliative sedation (11%) and euthanasia (3%). CONCLUSION: After more than 5 years, the 24-h telephone consultation service fulfills a need for general practitioners dealing with daily dilemmas in palliative care treatment for cancer patients at home during the last period of their life.

Adolescent↗
PubMed1983

Developing strategies for improving the diagnostic and management efficacy of medical consultations.

To determine the clinical effects of internists' consultations to surgeons and other non-internists, we studied a random sample of 250 consultations provided by the Yale Medical Service to patients admitted on non-medical services during 1978-1979. We found that consultations changed or confirmed a diagnosis in 82% (205), and changed or confirmed a management plan in 69% (172). We also found that the diagnostic or management effects could be enhanced by several features of the way the consultation is performed: rapid response to the request for consultation; frequent follow-up notes by the consulting medical team; and detailed specifications of dosage and duration in recommendations for pharmacologic therapy.

Diagnosis↗
PubMed1993

Use of remote video microscopy (telepathology) as an adjunct to neurosurgical frozen section consultation.

We investigated the use of remote video microscopy (telepathology) to assist in the diagnosis of 52 neurosurgical frozen section cases. The TelMed system (Discovery Medical Systems, Overland Park, KS), in which the referring pathologist selects appropriate fields for transmission to the consultant, was used for the study. There was a high degree of concordance between the diagnosis rendered on the basis of transmitted video images and that rendered on the basis of direct evaluation of frozen sections; however, in seven cases there was substantial disagreement. Remote evaluation was associated with a more rapid consultation from the standpoint of the consultant, who spent approximately 2 minutes less per case when using remote microscopy; this was achieved at the expense of considerably greater effort on the part of the referring pathologist, who spent approximately 16 minutes per case selecting an average of 4.5 images for transmission to the consultant. The use of remote video microscopy for pathology consultation is associated with a complex series of tradeoffs involving cost, information loss, and timeliness of consultation.

Frozen Sections↗
PubMed1991

Northwick Park Infection Consultation Service. Part II. Contribution of the service to patient management: an analysis of results between September 1987 and July 1990.

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93% of patients, essential investigations needed to confirm or refute the diagnosis performed in 92%, and side-room isolation correctly instituted in 81% of patients requiring it. However, 41% of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P less than 0.05). Advice was given following consultation in 893 of 1038 patients (86%) and related to treatment (66%), investigation (41%), diagnosis (30%) and patient isolation (4%). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in III (13%), and went unheeded in 25 (3%). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30% of consultations and in a further 47 patients (5%), the diagnosis was proposed by the ICS on initial consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

Psychiatric consultation among hospitalized arthritis patients.

Fifty consecutive psychiatric consultations on 48 patients over an 18-month period in an arthritis hospital are analyzed. The range of psychiatric disorders and their relationship to characteristics of the patient population, such as age, sex, and medical diagnosis, are described. Approximately 2% of patients admitted to the hospital during this period elicited psychiatric consultation. This rate is one-third of the consultation rate of an acute medical and surgical hospital serviced by the same consultants. The relative distribution of psychiatric diagnoses--depression 59%, personality disorders and drug abuse 15%, psychosis 10%, conversion reaction 10%, and "other" 6%--was similar to that encountered in an acute general hospital setting. Although depression was the most prevalent psychiatric problem, it was severe enough to elicit consultation only in 1% of the total hospitalized population; its severity did not correlate directly with the severity of rheumatoid arthritis, the most common medical diagnosis encountered. Neither a particular medical illness nor sex accounted for a disproportionate share of the psychiatric consultations.

Adolescent↗
PubMed1980

Psychiatric consultation-liaison service: patients, requests, and functions.

Prospective data were gathered from 388 psychiatric consultations performed in a general hospital setting. Data included demographic, medical, psychiatric, and illness behavior characteristics of the patients seen, as well as consultant functions and recommendations. Results indicate that consulted patients suffer from a wide variety of medical problems, are frequently taking psychoactive medications before the consultation, and experience a spectrum of psychosocial problems in coping with their disease. Primary physicians infrequently provided any psychiatric data or reasons for referral other than for depression. Consultants determined what they felt were the motivating reasons for referral and besides patient psychopathology found a significant amount of maladaptive illness behavior and staff/patient conflict. Comparison with other studies supports the high incidence of primary (21%) and secondary (18%) depression in this population and the active involvement in its treatment by consultation-liaison psychiatrists. Research, training, and clinical issues generated by the findings are discussed.

Adaptation, Psychological↗
PubMed1987

Assessment of patient-staff and intrastaff problems in psychiatric consultations.

In a study of 249 consecutive inpatient consultations, the occurrence of patient--staff or intrastaff problems as determined by the psychiatric consultation team was compared with questionnaire answers, provided by the consultant following each consultation, and interpreted as indications for such staff problems. According to the consultation team, staff problems played a role in 33% of the consultations. In the questionnaires, of the nine criteria statistically significantly related to the occurrence of staff problems, the following were the most relevant: 1) emotional tone or wording of request; 2) abnormal timing of referral; 3) request unclear; 4) unjustified urgency of referral; and 5) existence of hidden questions. If none or only one of these criteria were positive, then there was little chance that staff problems were present. If three or four criteria were positive, then the probability of staff problems was much higher. If the first three criteria were negative, then staff problems were hardly ever encountered.

Hospital Bed Capacity, 500 and over↗
PubMed1991

Psychiatric consultations for psychoactive substance disorders in the general hospital.

A series of 511 consultations to a psychiatric consultation-liaison service was studied. Patients diagnosed with substance abuse disorders were found more likely to be younger, male, and nonwhite. Payer status was not significantly different. Psychiatric consultants' recommendations for substance abuse patients more often consisted of aftercare referral, with less utilization of nonmedical consultations, environmental manipulations, social support, and psychological testing. Further, nonsubstance abusers received more and longer follow-up visits. Overall length of stay was shorter for substance-abuse cases, and for nonabusing cases earlier consultation was associated with briefer hospital stay. The authors discuss factors that may explain these findings, and urge psychiatric consultants to rethink their approach to these patients. A thorough, thoughtful diagnostic evaluation and consideration of a variety of interventions is always indicated.

Adult↗