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At least 91 records · Page 5Linked to original sources
PubMed2001

Specialists as consultants to GPs. Private sector services as an alternative way of organising consultant services in health care.

OBJECTIVE: To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation. DESIGN: Intervention study with a control group. SETTING AND SUBJECTS: A 34-month experiment in the City of Turku. The experimental group consisted of 10 GPs working in municipal health centres with a list system and serving 23000 residents. As a control group, there were four GPs without a list system serving 10800 residents. OUTCOME MEASURES: GP visits and their referrals to specialists. RESULTS: The number of patient visits was higher among GPs in the experimental group than among those in the control group. During the experiment, the referral rate of GPs in the experimental group increased from 5.7% to 6.8%, but there was no change among the control GPs. Of all referrals to specialists, the share to the private sector increased from 5% to 35%, while at the same time the share to the hospital outpatient clinic decreased. CONCLUSIONS: An enhanced possibility to consult private specialists increases the number of referrals, but there are no consequent changes in the relative shares of the consulted specialties.

Cooperative Behavior↗
PubMed1985

Topic analysis: an objective measure of the consultation and its application to computer assisted consultations.

A simple method has been developed to classify the verbal interaction during medical consultations in terms of the relative proportions of medical and social content and the initiator of conversational topics discussed. The method has been applied to video tape recordings of three doctors' consultations with and without a computer present to classify and compare the items discussed. Actual computer use has been shown to have a medical effect on the consultations (p less than 0.05) and to increase the proportion of topics initiated by the doctor (p less than 0.001). Although this was largely accounted for by the massive increase in doctor initiated medical items resulting directly from computer use, there was evidence that, for two of the doctors, these topics were replacing some of the normal social and patient initiated medical exchanges.

Diagnosis, Computer-Assisted↗
PubMed2006

[Management of diabetes during the last days of life: attitudes of consultant diabetologists and consultant palliative care physicians in the UK.

Diabetes is an increasingly common condition and hence, managing dying patients with diabetes as a co-morbidity will become a frequent challenge. It is uncertain whether there is net beneficence in preventing hyperglycaemia in diabetic patients during the terminal phase or whether the distress involved in administering therapy and blood glucose monitoring may outweigh this ordeal. Since there is no available evidence upon which to base clinical decisions, a semi-structured questionnaire based around three clinical vignettes was sent to consultants in diabetes and palliative care in the UK. There was consensus of opinion from both groups of consultants that treatment and monitoring should be stopped in patients with type 2 diabetes, once in the terminal phase. There was less consensus regarding management of type 1 diabetes. Practical issues were raised by both groups of consultants and clinical guidelines are suggested.

Attitude of Health Personnel↗
PubMed2003

Clinical pharmacology consultations: consultation requests may be misleading -- an organized approach to drug-induced hepatitis.

The present case report describes a consultation with the Clinical Pharmacology Consultation Service at the Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, for drug-induced hepatitis in a patient with multiple drug exposures. The original question to be addressed was whether dalteparin was responsible for an acute rise in liver transaminases. The approach involved establishing a best possible diagnosis of the adverse event, obtaining a comprehensive history of drug exposure and evaluating the possible contributory role of alternate etiologies supported by a literature search. On balance, based on temporal relationships and previous case reports, ranitidine was considered to be the most likely causal agent. The initial consultation request was to investigate the likelihood that daltaperin caused hepatitis; however, a systematic and comprehensive approach led to the conclusion that it was more likely to be ranitidine-induced hepatitis.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Successful consulting relationships: the nurse executive and the consultant.

As hospitals today are faced with numerous health care reform challenges, many are seeking the expertise of consulting organizations to help them achieve institutional objectives. The successful relationship between the nurse executive and the consultant is essential to the organization's ability to achieve defined institutional goals. The nurse executive and the consultant have specific roles to play and also share some common roles.

Consultants↗
PubMed1997

[Medical consultation about Pakistani immigrants. The pattern of consultations and diagnosis at a health center in Oslo].

The purpose of this study was both to ascertain the extent to which Pakistanis, compared with Norwegians, consult a doctor and to discover possible differences in the type of diagnosis received by the two groups, 6867 consultations where the patient was either Pakistani or Norwegian were registered over a period of one year at Stovner Health Centre. The frequency of the consultations differed more between men and women than between Pakistanis and Norwegians. On the whole the Pakistani patients received more symptom diagnoses and fewer diagnoses of illness than the Norwegians did, but here too there was a greater difference between the sexes than between the nationalities-women received most symptom diagnoses. Women practitioners gave symptom diagnoses more often than their male colleagues, did. Our study has shown that differences between the sexes are greater than differences between the races. This may help to break down barriers between "US" and "them".

Adult↗
PubMedDate not supplied

Funding for consultation-liaison services in public sector-managed care plans. The experience of the Consultation-Liaison Association of Philadelphia.

Recently, the Commonwealth of Pennsylvania initiated plans to implement a mandated behavioral health carve-out program for Medicaid-eligible persons. The Consultation-Liaison Association of Philadelphia (CLAP) discovered that there was no provision for the coverage of psychiatric services for patients with concomitant medical illness. As a result, the authors responded by initiating a series of actions aimed at ensuring inclusion of such services as part of mental health services to be delivered. CLAP developed a brief position paper that includes a description of the need for such services, the types of services typically delivered, the impact of psychiatric input in the medical setting on costs and other outcomes, and a specific set of recommendations. These efforts have lead to the inclusion of consultation-liaison services in the new plan. A description of recent changes in Medicaid, including expansion of managed care plans, the status of mental health carve outs, and the possibility for inclusion of psychiatric consultations for the medically ill within these plans, is detailed.

Behavior Therapy↗
PubMed2004

The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure.

BACKGROUND: Empathy is a key aspect of the clinical encounter but there is a lack of patient-assessed measures suitable for general clinical settings. OBJECTIVES: Our aim was to develop a consultation process measure based on a broad definition of empathy, which is meaningful to patients irrespective of their socio-economic background. METHODS: Qualitative and quantitative approaches were used to develop and validate the new measure, which we have called the consultation and relational empathy (CARE) measure. Concurrent validity was assessed by correlational analysis against other validated measures in a series of three pilot studies in general practice (in areas of high or low socio-economic deprivation). Face and content validity was investigated by 43 interviews with patients from both types of areas, and by feedback from GPs and expert researchers in the field. RESULTS: The initial version of the new measure (pilot 1; high deprivation practice) correlated strongly (r = 0.85) with the Reynolds empathy measure (RES) and the Barrett-Lennard empathy subscale (BLESS) (r = 0.63), but had a highly skewed distribution (skew -1.879, kurtosis 3.563). Statistical analysis, and feedback from the 20 patients interviewed, the GPs and the expert researchers, led to a number of modifications. The revised, second version of the CARE measure, tested in an area of low deprivation (pilot 2) also correlated strongly with the established empathy measures (r = 0.84 versus RES and r = 0.77 versus BLESS) but had a less skewed distribution (skew -0.634, kurtosis -0.067). Internal reliability of the revised version was high (Cronbach's alpha 0.92). Patient feedback at interview (n = 13) led to only minor modification. The final version of the CARE measure, tested in pilot 3 (high deprivation practice) confirmed the validation with the other empathy measures (r = 0.85 versus RES and r = 0.84 versus BLESS) and the face validity (feedback from 10 patients). CONCLUSIONS: These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.

Adult↗
PubMed1993

Psychiatric consultation in the eastern Canadian Arctic: I. Development and evolution of the Baffin Psychiatric Consultation Service.

The Baffin Consultation Service of the Clarke Institute of Psychiatry has been providing psychiatric consultation services to the Baffin Island region of the Eastern Canadian Arctic since 1971. This report describes the background history, development and evolution of the service. Attention is focused on aspects of the consultation visits, educational activities of the project and the development of a mental health network. It is suggested that this is a useful model for the provision of psychiatric services to remote areas with limited resources.

Arctic Regions↗
PubMed1998

Parenthood as talked about in Swedish ante- and postnatal midwifery consultations. A qualitative study of 58 video-recorded consultations.

In order to explore the manner in which parenthood was discussed in midwifery consultations, 58 video-recorded consultations were analysed. A content analysis revealed a variety of topics concerning conversation on parenthood--topics of an intimate nature and discussions from a societal perspective. Parenthood was not of primary importance in visits, which were mostly directed by the midwives. A phenomenological hermeneutic analysis of the meaning of being a mother revealed a complex and difficult situation of being both needed and dependent. The meaning of being a father revealed a struggle between distancing from and closeness to the child. The mate relationship was indicated as important and under strain. The metaphor of the 'spiders web', where the mother is the spider with the child mostly on her back, the father entering the web on her terms, summarizes the understanding. The results from this study could provide a basis for reflection on the status of the topic of parenthood, on the meaning of being a mother and a father disclosed in the consultations, and ultimately on the organization of ante- and postnatal midwifery care.

Adult↗
PubMed1998

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup.

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.

Adult↗
PubMed1997

[German and American consultant psychiatrists evaluate their function. A contribution to quality improvement in consultation psychiatry].

There is an increasing interest in scientific and practical aspects of C/L psychiatry in Germany. The every day C/L work in Germany still differs substantially from the American one. In contrast to Germany and other European countries, C/L psychiatry in the USA has developed into a subspecialty with multiple activities in research and patient care during the last 3 decades. This study was conducted in Germany and the USA in order to evaluate and compare the training and patient care in C/L psychiatry, as assessed by consultants doing the every day C/L work. 227 C/L psychiatrists participated in the study in both countries. There are significant differences in theoretical and practical C/L psychiatry is obviously more comprehensive. American C/L psychiatrists take more time for consultations, do more follow-ups, and more frequently organize psychiatric or psychotherapeutic outpatient after-care. These results are suited to support activities to improve quality in Germany C/L psychiatry.

Cross-Cultural Comparison↗
PubMed2004

Predictive factors for 1-year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone.

OBJECTIVES: To examine the relative influences of sociodemographic and episode-specific factors on change in low back pain intensity and self-rated disability. METHODS: Of 204 patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group and 102 to a consultation-alone group. These groups were each divided into 2 clusters based on change in both pain intensity and self-rated disability at 1 year. The first cluster included patients whose symptoms clearly decreased, and the second those whose trouble persisted. Association between sociodemographic and episode-specific factors and poor recovery from low back pain and disability were evaluated by univariate and multivariate analysis. RESULTS: Severe affective distress (OR 3.81; 95% CI 1.3-10.8) predicted poor response to the manipulative treatment. Over a 25-day sick leave during previous year (19.64; 3.8-102.5), poor life control (9.40; 1.9-47.0), and generalized somatic symptoms (3.18; 0.9-11.6) were the risk factors for not benefiting from the informative approach. CONCLUSIONS: Psychosocial differences seem to be important determinants for treatment outcomes, and should be the focus of future studies.

Adult↗
PubMed1989

[Psychiatric consultations in a general hospital (III): Positions of the consultant].

Various clinical situations are described to illustrate the specific psychological assumptions toward which the psychiatric consultant is drawn in the course of daily liaison work in the general hospital. The purpose is to stress the usefulness and relevance of hitherto known models of consultation and models of patient-doctor relationships.

Aged↗
PubMedDate not supplied

Consulting with the anxious patient, Part I: Complexities of the consultation process and problems of referral.

At least 20% of medical patients have anxiety disorders and are in need of treatment, but work with anxious patients is complicated by their distortions and often negative attitudes toward physicians and hospitals. Consultation is complicated by inconsistent referral patterns. Most anxious medical patients accept psychiatric consultation: only 15% to 20% have negative attitudes toward psychiatry. Guidelines for referral are presented.

Adult↗
PubMed1992

Cultivating ethics consultation: commentary on "The development of a clinical ethics consultation service in a community hospital.

CONCLUSION: Simpson's article [in this issue, p. 124-130] provides us with needed data about the development and utilization of an ethics consultation service in a community hospital. It makes clear, however, how much further we have to go in developing guiding standards for practitioners and institutions. We need to learn much more about the effectiveness of ethics consultation in meeting well-defined goals and producing desired processes and outcomes before standards for credentials and accountability have a sound empirical basis.

Conflict of Interest↗
PubMed2005

Audit of an inpatient neurology consultation service in a tertiary referral centre: value of the consulting neurologist.

The Mater Misericordiae Hospital is a 575-bed tertiary referral centre with busy medical and surgical subspecialty services (including the national cardiac, cardiothoracic, spinal cord injury and pulmonary hypertension units). An audit of in-patient referrals to a neurology service was carried out over the twelve-month period of January to December 2002 inclusively. Five hundred and seventy seven inpatients were evaluated and managed in conjunction with the referring services. Consultation by the neurological service led to a significant contribution in the management of clinical cases in one of three ways: establishing a de novo diagnosis in patients admitted with active neurological symptoms where no working diagnosis exists (40.7% of referrals), significant alteration in diagnosis where the referring service have already established a specific working diagnosis (11.1% of referrals), or offering advice in the ongoing management of active neurological symptoms when the diagnosis is historically established and secure (48.2% of referrals). In order of frequency the most common reason for referral was stroke (131 cases (22.7%)), seizures unrelated to alcohol (59 cases (10.2%)), alcohol-related neurological problems (55 cases (9.5%)), movement disorders (41 cases (7.1%)), neuromuscular (40 cases (6.9%)), coma (35 cases (6%)), disorders of cognition (31 cases (5.3%)), acute headache (28 case (4.8%)) and functional neurological syndromes (26 cases (4.5%)). This audit highlights the value of a consulting neurology service in a multidisciplinary tertiary referral setting.

Adult↗
PubMedDate not supplied

Ethics consultation in Portland. Providence Health's Oregon Region has created an ethics consult service.

In response to the need for a more structured approach toward the enhancement of and preparation for case consultation, the Portland Service Area (PSA) of the Providence Health System Oregon Region implemented a "special team" system. These teams--an extension of the ethics committees already in place--underwent training in areas such as an overview of ethics, patient decision making, professionalism, organizational ethics, and palliative and end-of-life care. Moving ethics consultation away from the purview of ethics committees generally, and into the realm of these trained special teams, has improved PSA's ability to respond to ethics needs in the region.

Ethics Consultation↗