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PubMed2001

Off-the-cuff cellular phone consultations in a family practice.

In Israel the public tends to make use of informal medicine alongside organized health services, and cellular phones now allow contact with physicians at almost any time or place. For three months in 1999 a family physician documented all consultations on medical subjects conducted by cellular phone, the phone being available 24 hours a day. There were 94 cellular phone medical consultations, of mean duration 5.8 min (range 2-18). Only 11 took place over the weekend, and 63 took place while the clinic was open. The most common reasons for consultation were advice on treatment (29%) and a second opinion (28%). In 48 cases the consultation was for a close relative rather than the caller. In 42 cases the request for consultation came while the physician was busy with other patients. The results of this small personal study confirm that the practice of informal consultations now extends to the cellular phone. Technologies of this sort demand new rules of conduct, if we are to avoid the various hazards of off-the-cuff medicine.

Family Practice↗
PubMed1988

Psychiatric consultation in a general hospital.

The psychiatrist's role in the therapeutic management of a wide range of hospitalized persons is now recognized. This study investigated the extent and the pattern of consultations among the medical specialties (medicine, surgery, obstetrics/gynecology, family practice, pediatrics and psychiatry) in a large teaching hospital over a one year period. Among the specialties consultations were requested most often from within the same specialty; for example, medicine sought 64.4% consults from medicine. The proportion of patients with an associated psychiatric diagnosis in each of the specialties ranged from 2 to 21%. Psychiatric consultations on these patients ranged from 5 to 13 per hundred (medicine = 12, surgery = 8.9, family practice = 13.2 and pediatrics = 5). Consultations rates reported in previous studies were also reviewed. Factors that may contribute to the generally low rate of psychiatric consultation and the implications for providing better care are then discussed.

Alberta↗
PubMedDate not supplied

HIV care: continuing medical education and consultation needs of nurses, physicians, and pharmacists.

This article explores the impact of provider characteristics on their HIV-related continuing medical education (CE) attendance, consultation needs, satisfaction with skills, and willingness to provide care. A total of 731 users (52% physicians, 26% nurses, 11% pharmacists, and 10% nurse practitioners and physician assistants) of an HIV consultation were surveyed by mail (76% response). Significant differences in provider variables were found to be related to HIV experience and profession. Experienced providers reported more CE, more satisfaction with skills, lower consultation needs, more consultations sought, and more willingness to take new patients than other providers. "Unwillingness" was commonly explained by concerns over quality of care or staying up-to-date. Relative to physicians, nurses had more CE hours, were more dissatisfied with their skills, and had greater consultation needs. Although all providers had high consultation or CE needs in some areas, accessibility to such programs is particularly important for low-volume providers.

Analysis of Variance↗
PubMed1975

Evaluating the impact of program consultation in health services.

This article describes a methodology developed to be useful to both consultant and consultee in evaluating their mutual efforts to improve agency health service programs. Reporting forms and instruction manuals based upon the concept of mutuality in consultation were used by 19 consultants in 29 consultations. Two-thirds of the respondents reported some increase in problem-solving ability. The implications of evaluating program consultation are discussed, as are certain issues in consultation: definition, implementation, process, utilization, impact delays, interpersonal interactions, hidden agendas, organizational learning, and outcome measurements.

Evaluation Studies as Topic↗
PubMed2004

Cancer consultation preparation package: changing patients but not physicians is not enough.

PURPOSE: This study evaluated a cancer consultation preparation package (CCPP) designed to facilitate patient involvement in the oncology consultation. PATIENTS AND METHODS: A total of 164 cancer patients (67% response rate) were randomly assigned to receive the CCPP or a control booklet at least 48 hours before their first oncology appointment. The CCPP included a question prompt sheet, booklets on clinical decision making and patient rights, and an introduction to the clinic. The control booklet contained only the introduction to the clinic. Physicians were blinded to which intervention patients received. Patients completed questionnaires immediately after the consultation and 1 month later. Consultations were audiotaped, transcribed verbatim, and coded. RESULTS: All but one patient read the information. Before the consultation, intervention patients were significantly more anxious than were controls (mean, 42 v 38; P = .04); however anxiety was equivalent at follow-up. The CCPP was reported as being significantly more useful to family members than the control booklet (P = .004). Patients receiving the intervention asked significantly more questions (11 v seven questions; P = .005), tended to interrupt the physician more (1.01 v 0.71 interruptions; P = .08), and challenged information significantly more often (twice v once; P = .05). Patients receiving the CCPP were less likely to achieve their preferred decision making style (22%) than were controls (35%; P = .06). CONCLUSION: This CCPP influences patients' consultation behavior and does not increase anxiety in the long-term. However, this intervention, without physician endorsement, reduced the percentage of patients whose preferred involvement in decision making was achieved.

Chi-Square Distribution↗
PubMed1998

Patient reactions to specialist telemedicine consultations--a sociological approach.

A sociological study was made of patient experiences of telemedical specialist consultations in northern Norway. The study made use of a qualitative methodological approach. The data were collected through unstructured in-depth interviews of patients or the parents of very young patients. The patients were referred for a telemedical otolaryngology consultation in a randomly selected period of three months. Of a total of 35 patients, 15 refused to participate in the study. Of the 20 remaining, three were excluded for practical and financial reasons. The telemedicine consultation consisted of a general practitioner examining patients endoscopically and realtime transmission of the examination to a specialist by means of a videoconferencing system. Video-communication seemed to restrict personal contact with the specialist. In spite of that, it was not the video-communication itself but the social situation that mattered to the patients. Compared with an ordinary medical consultation, a telemedical consultation represented a wider interaction system, with more channels for access, inspection and information, which gave the patients different options for participation in the consultation.

Adolescent↗
PubMed2001

Consultations of children living near open-cast coal mines.

Because of local concerns, general practitioner consultation rates in children living in communities close to and away from open-cast mines were compared. Information on consultations was collected on 2,442 children 1-11 years of age living in five socioeconomically matched pairs of open-cast and control communities in northern England. The data collection periods were 6 weeks each during 1996-1997 and the 52-week periods preceding these weeks. Consultations were categorized as respiratory, skin and eye conditions (possibly exacerbated by particulate matter), or other conditions. Over the 6-week periods, children in 4/5 pairs of open-cast and control communities had similar consultation rates for all conditions combined [2.7 vs. 2.4 per person-year; odds ratio (OR) = 1.1; 95% confidence interval (CI), 0.96-1.3). Consultations were higher in the open-cast communities for respiratory, skin, and eye conditions (2.1 vs. 1.5 per person-year; OR = 1.4; 95% CI, 1.2-1.7), and respiratory conditions alone (1.5 vs. 1.1 per person-year; OR = 1.5; 95% CI, 1.2-1.8). However, increases in consultation rates in open-cast communities were generally not seen over the portions of the 52-week periods when the open-cast sites were either active or inactive.

Air Pollution↗
PubMed1999

The evaluation of a consultation service for delivery of substance abuse services in a hospital setting.

OBJECTIVE: This study evaluated the institutional impact of a substance abuse consultation service in a hospital setting. METHOD: Treatment and matched comparison groups were compared on five outcome variables: length of stay, total cost, reimbursement, readmission, and appropriateness of care. The treatment group consisted of patients with discharge diagnoses falling into targeted Diagnostic Resource Groups (DRGs) and who received a substance abuse consultation. The comparison group consisted of patients with the same targeted DRGs, a coexisting substance abuse diagnosis, and who did not receive a substance abuse consultation. RESULTS: No statistically significant differences were found for the five outcome variables. Findings closely approached statistical significance for rate of readmission with treatment patients being less likely to be readmitted during the 12 months following the consultation. CONCLUSIONS: Although cost savings were not found during the hospitalization when the substance abuse consultation was provided, the data suggests that the consultation may reduce the need for readmission during the year following discharge.

Adolescent↗
PubMed2005

A guide to defining the competence required of a consultant in clinical chemistry and laboratory medicine.

A definition has been agreed for the most senior professional (consultant) in clinical chemistry and laboratory medicine. A model job description for a consultant has been determined, which is intended to act as a toolkit to assist employing authorities and professional bodies to define the role of individual consultant posts. A total of 86 competences for a consultant have been designated and expressed in the form of simple generic proficiency standards. These competences have been allocated to six broad areas: clinical [13]; scientific [15]; technical [12]; communication [12]; management and leadership [20]; professional autonomy and accountability [14]. The competences are intended to be illustrative rather than definitive and to enable the duties of any consultant post to be defined. Assessment of competence is likely to entail consideration of qualifications, registration status, continuing professional development and performance review. The project is intended as a guide to European societies of clinical chemistry and laboratory medicine. The guide should be capable of local interpretation to encourage a greater degree of commonality in the role of the consultant whilst protecting national identity. The guide should stimulate international understanding and collaboration and contribute to an overall improvement in the quality of practice.

Chemistry, Clinical↗
PubMed2003

Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service.

CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do C ncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated patients, who deserved special attention throughout the psychiatric interventions.

Adolescent↗
PubMed2005

Concerning women: questionnaire survey of consultations, embarrassment, and views on confidentiality in general practice among women in their teens, thirties and fifties.

BACKGROUND: Concern exists that women, and in particular teenagers, do not consult in general practice, particularly for contraception because of embarrassment and concern over confidentiality. The aim of this study was to compare reported consultation rates, embarrassment when consulting, and views on confidentiality of women in three age groups. METHODS: A postal questionnaire was used to survey women aged 16-19, 36-39 and 56-59 years attending a semi-rural practice in East Devon, UK in December 1999. RESULTS: Response rates of 57% (teenagers), 79% (women in their thirties) and 89% (women in their fifties) were achieved. In each group over half the respondents had seen a general practitioner (GP) in the previous 3 months. Embarrassment at attending a GP decreased from 38% of teenagers to only 16% of women in their fifties. There was a similar pattern with 78% of teens and 42% of women in their fifties preferring to see a woman doctor for a women's problem and 31% of teens and 18% of women in their fifties expressing a preference for a woman doctor for any problem. Some 97% of women in their thirties and fifties thought a consultation with a GP would be confidential compared with 88% of the teenagers. Only 9% of the teenage group thought the GP might tell their parents about the consultation. CONCLUSIONS: This study found that teenagers were just as likely as older women to have seen a GP in the preceding 3 months. Embarrassment at attending decreased with age, as did the preference to see a female doctor for both women's and any problems. The majority of women in each age group believed a consultation with a GP, or practice nurse, was confidential.

Adolescent↗
PubMed1996

Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.

OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations. RESULTS: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent. CONCLUSION: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.

Family Practice↗
PubMedDate not supplied

Evaluation of medical-psychiatric consultation.

This report describes four approaches to the evaluation of hospital psychiatric consultation. These are: 1) a survey of actual consultation use; 2) a house staff attitudinal survey; 3) a patient chart review; and 4) a patient questionnaire. The findings of this project and those previously reported are: 1) The psychiatric consultation is under-utilized and a large number of house staff find it not useful. 2) The psychiatric and non-psychiatric house staff view the functions of consultation in markedly different ways. 3) A high percentage of written consultation reports are too vague to determine if the needs of the referring physician were met. 4) Patients usually respond positively to psychiatric consultation. The implications of these findings are discussed in this report.

Attitude of Health Personnel↗
PubMedDate not supplied

Are psychiatric consultants' recommendations followed?

The extent of adherence to psychiatric consultants' recommendations was calculated through a review of charts. All charts of patients seen in Psychiatric consultation from May 1976 to April 1977 were reviewed and a total of 273 charts contained scoreable consultant recommendations. Recommendations were scored as either actively followed, passively followed or not followed. Results are reported for the extent of adherence 1) between different types of recommendations (medications, disposition, etc.), 2) between medical, surgical and obstetrical-gynecological services and 3) between consultants, two psychiatrists and one psychologist. The results suggest that recommendations more likely to be followed are those easily performed by a consultee and leading to direct, tangible results. Adherence to consultants' recommendations is discussed in the context of resistance to psychiatric consultation.

Hospital Departments↗
PubMed1992

A retrospective study on the perceived need for and actual use of psychiatric consultations in older medical patients.

OBJECTIVE: The authors examined the (under) utilization of the psychiatric consultation service for patients aged sixty to seventy-five who were hospitalized for medical reasons, and explored whether one could retrospectively document and identify a greater need for psychological support than the one reflected in the number of actual consultations requested. Three questions were addressed: 1) the psychiatric consultation rate; 2) the frequency of unrecognized medical, psychiatric, and psychosocial complicating factors; and 3) whether the distribution of these factors differed by gender. METHOD: Records of 203 consecutively-admitted elderly patients hospitalized on medical wards were reviewed by two experienced general hospital psychiatrists for any indication of medical, psychiatric, and psychosocial risk factors. The frequency of actual psychiatric consultations was also recorded. RESULTS: Three or more risk factors were noted in the records of 36 percent of all patients. Consultation was sought for only 3 percent. Gender differences in type and distribution of risk factors were identified. CONCLUSIONS: Indicators and profiles that define probable need for psychiatric consultation were identified and briefly discussed. More well-designed, prospective studies testing these indicators and profiles are needed.

Aged↗
PubMed1976

The value of consultation among radiologists.

The value of group consultation in improving the accuracy of radiologic diagnosis was assessed. Abnormalities on 24 films were pointed out to six groups of three radiologists each. They were asked to reach a specific diagnosis for each case. Accuracy was compared in three settingss: (1) without consultation; (2) with consultation leading to a diagnosis by group consensus; and (3) with consultation followed by independent diagnoses. The accuracy of over 75% of the radiologist improved after consultation in either setting. The extent of improvement was inversely related to the initial accuracy level of the individual. When two or three radiologists agreed initially, they were more frequently correct than not. Group discussion followed by individual diagnosis is a practical approach to radiologic consultation.

Diagnostic Errors↗
PubMed1994

Psychiatric consultation with substance abusers in early recovery.

The frequent co-occurrence of mental and substance use disorders ("dual diagnosis") has created a role for addiction-trained psychiatric consultants in drug and alcohol treatment programs. The complex treatment needs of the dually diagnosed required that the consultant psychiatrist have knowledge about the existing treatment models of chemical dependency, the recovery process, and the complex relationship between substance abuse and psychopathology. This paper reviews the existing clinical models for understanding and treating chemical dependency and then proposes an approach to consultation practice that employs a developmentally-based clinical model. The consultation work of three academic addiction psychiatrists who utilize a developmental approach is described. The demographic and diagnostic characteristics of their consultation cases from three substance abuse inpatient rehabilitation programs for a 1-year period are summarized. Five major tasks for addiction psychiatry consultants are identified and discussed: diagnostic evaluation, identification of recovery barriers, identification of relapse triggers, recovery-oriented brief psychotherapy, and pharmacotherapy.

Adult↗
PubMed2002

Consultation-liaison psychiatry in obstetrics and gynecology.

Data documenting the activity of Modena and Reggio Emilia University Hospital Consultation-Liaison Psychiatry Psychosomatic Service (C-LPPS) to the 59 bed gynecological-obstetric unit are compared to the corresponding European Consultation Liaison Workgroup (ECLW) study results and discussed in the light of recent epidemiological studies suggesting a low rate of detection and psychiatric referral in obstetric and gynecological patients. All psychiatric consultations of gynecological-obstetric inpatients during a 3-year (1996-1998) period were included in this study and data were derived from valid and reliable consultation forms tested for reliability. Within the 3-year period 55 patients were referred to C-LPPS by the gynecological-obstetric unit for psychiatric consultation. Referral rate was 0.5% of the admitted patients in the unit. The gynecological-obstetric group represented 2.5% (vs. 4.5% ECLW study) of all psychiatric consultations requested in the study period. The most frequent reasons for referral were: current psychiatric symptoms (47.3% Modena study vs. 39% ECLW), psychiatric history (20% vs. 7.3%), unexplained physical symptoms (12.7% vs. 16.2%) and coping-compliance problems (3.6% vs. 16.6%). The most common ICD-10 psychiatric diagnoses were: neurotic, anxiety and adjustment disorders (41.8% vs. 31.2%), mood disorders (29% vs. 18.4%), personality disorders (7.3% vs. 6.1%), schizophrenic and other psychotic disorders (5.5% vs. 7%).

Adult↗