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PubMed2004

[Study of the derivations to an external consultation of Internal Medicine: can be managed the waiting list?].

BACKGROUND: The lack of coordination and organization between primary and specialized attention, generates inefficiency bags in the area of external consultations. MATERIAL AND METHOD: The characteristics of the attention of 120 patients derived consecutively to an external Internal Medicine consultation of a local hospital are analyzed. RESULTS: Of the 120 mentioned patients 19 did not appear (16.23%). 70.3% of the taken care of patients came from primary attention and 29.7% did it of specialized attention. Of the patients derived by primary attention: 63.3% went without data adapted in the derivation leaf, 59.2% did not contribute complementary diagnostic tests and 40.8% were registered in the first consultation. Of the patients derived from specialized attention: 100% contribute clinical information to the consultation, 90% contribute complementary studies and 56.65% are registered in the first consultation. CONCLUSIONS: The discontinuity in the attention between primary and specialized attention generates an inefficient use of the resources, that in the area of external consultations influences in the appearance of waiting lists.

Delivery of Health Care↗
PubMed1998

The relationship between census-derived socio-economic variables and general practice consultation rates in three town centre practices.

BACKGROUND: The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices. AIM: To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care. METHOD: A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables. RESULTS: Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components. CONCLUSIONS: Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis.

England↗
PubMed1995

Getting the most for your consulting dollars.

Major changes in the health care financing and delivery system have usually been accompanied by an increase in demand within the health care field for consulting services. The passage of Medicare/Medicaid in 1965 is one example. The passage of the DRG-based prospective pricing system in 1983 is another. Both spawned a substantial amount of work, and income, for consulting firms. Now the health care field is engaged in nearly total transformation as the forces of health care reform at the national level are met with myriad adjustments at the local and regional levels. Managed care, already a byword, is being strengthened by a multitude of so-called integrated system initiatives. It is not easy to survive, and the call is out to consultants to save the day, or at least stave off disaster. In the following four articles, Marilyn Kennedy, a member of the ACPE faculty and a consultant herself, gives some advice on how to make the consulting arrangement successful; three physician executives provide a glimpse at consults that have worked, and some that did not work.

Consultants↗
PubMed1993

HIS (healthcare information systems) consultants: when are they necessary, and why?

The rapid escalation of consulting fees for the installation of healthcare information systems and the potential abuses associated with consulting relationships has prompted some to question the need to hire consultants for systems installation. Consulting arrangements were considered cost effective when information systems were first being automated, but the rising cost of consulting services along with the increasing sophistication of hospital personnel regarding computerization suggest that the use of consultants receive close scrutiny. Following some simple guidelines may limit potential abuses and allow hospitals to obtain maximum service for their investment.

Computers, Mainframe↗
PubMed2000

A new method for surgical consultations with videoconference.

BACKGROUND: The aim of our prospective study was to examine the technical ability and the medical suitability of a realtime teleconferencing system in surgical consultations. METHOD: A personal computer-based-videoconferencing system was used over an architecture of the IP (Internet Protocol) over ATM (Asynchronous Transfer Mode) area network connecting Satakunta Central Hospital, Pori with a health center in the community of Noormarkku (15 km apart from Pori). A document camera was used for transfering the radiographs and paper documents. The material consisted of 50 patients who needed surgical consultation. The patients were examined by a physician in the health center of Noormarkku, and the surgeon interviewed and observed the physical examination with the aid of teleconference. RESULTS: Technically the videoconferencing system functioned reliably, and the visual quality of the videopicture was good after more powerful personal computers (Pentium II with a 266 MHz prosessor and 64 Megabits RAM-memory) were changed for the videoconferencing system. All patients, except one, saved the travelling to the face-to-face appointment because they got a definite decision of the treatment already at the videoconsultation. According to the opinion of the consulting surgeon, the decision which was made in the teleconference was good or very good, except in one case very poor. The physicians of the health centers were satisfied both with the decisions of the treatment of their patients and with the educational effect of a consultation where two physicians are present at the same time. All patients thought that it was good to be in consultation with two doctors. CONCLUSION: Surgical videoconsultations are a reliable method and a real alternative to sending a patient to a distant place for consultation.

Female↗
PubMed2001

School crisis consultation.

School crisis consultations are services necessary to assist school communities recover from disruptions that interfere with a learning environment. Child and adolescent psychiatrists are ideal participants in such consultations owing to their knowledge of child development, familiarity with school systems, family dynamics, stress reactions in children, and crisis intervention skills. The exciting challenge is to tailor a consultation based on a needs assessment, degree of impact of event, and other resources. Every consultation is a unique and stimulating learning experience. Those who develop expertise in this area will be poised to lead future consultation efforts. These consultations are now informed by an increasing body of research on children's stress reactions and various types of interventions.

Adolescent↗
PubMed2001

[Consultation skills in urology: a model for teaching and evaluation].

OBJECTIVE: Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology. MATERIAL AND METHOD: Two-step qualitative protocol: 1) Establishment of an initial list of skills based on data of the literature; 2) Submission of this list to a series of "focus groups" (urologists, interns, referring physicians) in order to validate and progressively refine the model. RESULTS: The items identified were classified into 3 distinct lists: 1) theoretical knowledge; 2) technical skills specific to urology, predominantly performed in the consulting setting, 3) interpersonal skills exclusively concerning the consultant-referring physician relationship. CONCLUSIONS: The consensual specification of these skills can be used to objectively define teaching and evaluation strategies for urology consultancy skills.

Referral and Consultation↗
PubMed2001

[Liability of the consulting physician].

Problems of the malpractice law in telemedicine was hardly discussed until now. The consulting doctor in the centre is consulted by a "primary treating physician" to take part in treating the patient directly or indirectly. In the doctor's establishment, the consulting doctor is usually not the assistant of the "primary treating physician" and is therefore not legally responsible by contract. In hospital, the legal responsibility depends on the hospital contract-whether it is total or split. In the case of a total contract, all doctors involved in treating the patient are assistants of the hospital. In the case of a split contract, the consulting doctor has his own contract with the patient. With this premise the consulting doctor is also legally responsible for damage through a third party. In the field of communication and organization mistakes, all doctors that are involved might be legally responsible. From the view of the criminal law, the responsibility of the consulting doctor is considered regarding physical injury resulting from negligence, manslaughter through culpable negligence and denial of assistance. As the boundaries for the duty of assistance are not locally restricted but drawn with the criteria of reasonableness, telemedicine would lead to an enormous extension of the people who have the duty to help.

Consultants↗
PubMed2002

Internal and external consulting. Assisting clients with managing work, health, and psychosocial issues.

1. Consulting is the art of influencing people at their request. It means reaching a conclusion of acceptable quality, maintaining an acceptable commitment to that conclusion, supporting the client to prevent or minimize any detrimental outcomes as a result of the conclusion, and being perceived as helpful and efficient by the client. 2. Occupational and environmental health nurses are involved in a variety of consulting roles along with different types of consulting relationships, including both internal and external consulting. 3. To be an effective consultant, occupational and environmental health nurses need specialized knowledge and skills. Effective consultants work hard at developing sensitivity and competency to help others, and leave them self sufficient when the project is complete.

Data Collection↗
PubMedDate not supplied

Low-bandwidth, low-cost telemedicine consultations in rural family practice.

BACKGROUND: Telemedicine, based on the use of interactive video consultations, is being used more commonly in rural settings. This development is potentially important to rural patients because there are fewer physicians, particularly specialist physicians, in rural areas. Declining costs of telemedicine equipment and transmission have created increased access to these technologies for rural family physicians and their patients. METHODS: This study considers satisfaction levels of rural family physicians, academic-based specialists, and rural patients in 130 consultations between rural physicians, rural patients, and urban academic specialists. To increase the practicability for rural use, low-cost equipment and low-bandwidth digital telephone transmission lines were utilized. Data were collected using questionnaires that were completed by patients, family physicians, and specialist consultants after each consultation. RESULTS: All categories of participants noted very high levels of satisfaction. CONCLUSION: Telemedicine-based consultations are well accepted by rural patients, rural family physicians, and urban academic specialist consultants. This approach could offer a useful adjunct to rural health care.

Attitude of Health Personnel↗
PubMed2002

[Systemic consultation--about possibilities and limitations].

The paper presents the role of systemic consultation in the diagnostic and therapeutic process of the people hospitalised for the first time because of a psychotic episode. The following questions are going to be put: What is the role of systemic family consultation in the diagnostic and therapeutic process on the inpatient ward? What are the differences between systemic consultation and others forms of family interventions f.e. family interviews, psycho--education, systemic therapy? What are possibilities and limitations of consultation? What does it invite to? These are only some of those questions, which are typical for daily clinical practice, in which the family consultation takes an important part. In this paper according to our clinical experience, we would like to share some of our thoughts on the questions put. In spite of difficulties the family consultation confronts us with, we are deeply convinced that it has an important part in therapeutic and diagnostic process.

Communication↗
PubMedDate not supplied

The pediatric nurse's role as health consultant to a child care center.

An experienced pediatric nurse can perform a valuable service by becoming a health consultant to a child care center. Consultation and collaboration with child care providers and parents can foster health and safety for the steadily increasing number of young children being cared for in this type of community setting. The nurse with a strong pediatric background possesses the expert knowledge and skills needed to promote health and prevent illness and injury in this population. To exemplify the typical tasks encountered by a child care health consultant, a case is described in which a daycare director contracts the services of a nurse consultant to address problems with infection control procedures and illness transmission at a particular center. The consultant organizes the approach to this assignment by using a nursing consultation model as an action guide to achieve a positive outcome for the consultee.

Child↗
PubMed2002

Otolaryngology consultations by real-time telemedicine.

We aimed to assess the value of real-time telemedicine using low cost videoconferencing equipment for otorhinolaryngology consultations. A general practitioner, using low cost videoconferencing equipment, presented patients to an otorhinolaryngologist. After history taking and clinical examination, investigations were requested if required and a diagnosis and management plan formulated. The patients were then seen, by the same otorhinolaryngologist, for a conventional face-to-face consultation. Differences in the history, clinical examination and investigation requests were reported. The accuracy of diagnosis and correlation of management plans between the two consultations were analysed. Forty-three patients were admitted to the study but one, a young child, refused examination either by tele-link or the conventional approach and had to be excluded. There were thus 42 patients with 55 diagnoses included in the trial, 26 (62%) females and 16 (38%) males. Age range was 5 months to 70 years. There was no difficulty with any of the patients in obtaining an accurate history and ordering investigations, if required, via the telelink. Clinical examination during the tele-link consultation was inadequate for eight out of the first 20 patients, resulting in a wrong diagnosis in three patients and a missed diagnosis in five patients. All of the next 22 patients had a correct diagnosis and management plan. Comparison of data from the two types of consultation showed that a correct diagnosis and management plan was made in 34 patients. Low cost real-time telemedicine is a useful technique, providing reliable otorhinolaryngology consultations in a general practice setting. However initial difficulties due to inexperience in using the equipment need to be overcome.

Adolescent↗
PubMed2003

Telerehabilitation consultations for clients with neurologic diagnoses: cases from rural Minnesota and American Samoa.

Telerehabilitation is the provision of rehabilitation services at a distance using electronic information and communication technologies. This paper describes two clinical programs that utilize videoconferencing to provide rehabilitation specialist consultations to individuals living in remote areas. Needs assessments for the two areas revealed that local clinicians were interested in access to specialty consultation. Administrative processes and a data collection tool were developed for these programs. High speed videoconferencing that allows for real-time audio and video interaction was used. Each consultation includes the patient, the local caregivers and specialists from our facilities interacting via videoconferencing. A total of 117 telerehabilitation encounters have been completed. All consultations resulted in changes to the plan of care. Clinicians who participated in the projects consistently rated the clinical effectiveness of teleconsults as good or excellent. Thirty-eight consultations have been neurologic in nature. Of that set, 25 of the visits were initial assessments, and thirteen were follow-up visits. Two case studies of individuals with neurologic diagnoses are presented. Recommendations to others who are providing rehabilitation services via telehealth technologies are included. The authors conclude that the care of individuals with neurologic issues can be augmented and supported via specialty consultation using telehealth technology.

Adolescent↗
PubMed2003

A prospective analysis of inpatient consultations to a gastroenterology service.

The provision of a formal consultation service for inpatients between subspecialists is little studied. We prospectively surveyed the pattern of inpatient consultations from hospital-based generalists and surgeons to the gastroenterology (GI) service for inpatients in a large urban teaching hospital over a 5 month period. There are two GI consultants/attendings and five GI registrars/fellows on the service. A formal consultation is made by the requesting team to the GI service using the hospital computer network. All referrals over a 5 month period were prospectively analysed. 242 consecutive inpatient referrals were sent to the GI service over 5 months. Average age was 56 years, 48.8% males. 32 consultants/attendings from other disciplines sent referrals. Most patients were seen within one working day. Urgent referrals were seen without delay. The commonest reasons for referral were abdominal pain (15.8%), percutaneous endoscopic gastrostomy (PEG) tube insertion (13.6%), diarrhoea (12.8%), abnormal liver blood tests (10%), nausea and vomiting (8.2%), anaemia (6.2%), and melaena (4.9%). Iatrogenic diseases accounted for 6.2% of consultations. Ongoing patient care was assumed by the GI team in 9.5% of referrals. 15.3% required a second consultation visit before discharge. 22.7% of referrals were followed in the GI outpatients' clinic after discharge. 51.2% underwent an endoscopic procedure. 13.6% of referrals were for PEG tube insertion. A quarter of these were considered unsuitable for immediate PEG tube insertion. Subspecialty consultation provides an expert opinion, encourages discussion and learning, and improves patient care. In our experience, the provision of specialist advice and reassurance often speeded up a patient's work-up and expedited discharge. However, evaluating referral patients and subsequently providing ongoing inpatient and outpatient care and provision of endoscopy for these referrals contributes significantly to the workload of the GI service.

Adolescent↗
PubMed2004

[Emergency service consultations and the list patient system].

BACKGROUND: We wanted to analyse the frequency of list patient consultations in the off-hour emergency service in Skien. MATERIAL AND METHODS: Over one year, all emergency service consultations between 4 PM and 11 PM on workdays were registered according to the general practitioner (GP) patients used and divided by the number of patients on each list. We performed a multiple linear regression analysis with number of consultations adjusted for the total patient number on the list as the dependent variable. RESULTS: We found great variation in the consultation rate among patients listed by various GPs. The consultation rate was significantly associated with the practice in which the GP worked. Quarterly feedback of the results to doctors did not change the consultation pattern. INTERPRETATION: The use of the off-hour emergency service is associated with certain practice characteristics. We assume that the variation results from differences in accessibility by telephone, in the capacity for taking in patients needing urgent attention, and in varying degree of attention to service in the practices.

Adult↗
PubMed2002

[Factors determining demands for medical consultations in family practice].

UNLABELLED: The aim of this study was to determine the demand for general practitioner medical consultations (after three years workings of common insurance wholesome system in Poland). A cohort study of 1700 patients under general practitioner's care (952 women, 748 men) was examined over the period of 36 months (from 1st March 1999 to 28th February 2002). The index of consultations (with very good, monitoring organizational availability of services) was chosen as a measure of demand for general practitioner consultations. CONCLUSIONS: A significant differentiation of demand for general practitioner consultations according to the patients' age and sex was ascertained. 1. Demand for general practitioner consultations was lower for men (4.71) than for women (7.17). 2. The demand curves have similar characteristics for both men and women. Both curves have three major characteristic periods; the first one having the highest demand for medical consultations, the intermediate one having the lowest and steadiest demand, and the third one being characterized by the continuously growing demand. 3. The results can aid the financial analyses of primary health care.

Adult↗
PubMed1992

Effect of nonmedical factors on family physicians' decisions about referral for consultation.

OBJECTIVES: To identify nonmedical factors perceived by family physicians (FPs) and consultants as important influences on decisions about referral for consultation, to determine the relative frequency with which such factors are cited and to identify those factors ranked as most important by the FPs and consultants. DESIGN: Survey with semistructured interview between July 1989 and April 1990. PARTICIPANTS: A total of 41 FPs and 20 consultants who were practising or had practised previously in Nova Scotia. INTERVENTIONS: The questionnaire comprised 10 questions: 4 were nondirective "probes" designed to elicit responses without suggesting possible answers, 2 asked the participants to rank such responses in order of importance, and 4 were "prompts" that asked for comments about a list of factors based on a review of the literature. RESULTS: A total of 4845 discrete items were mentioned as being capable of influencing FPs' decisions about referral for consultation. Aggregation of related items resulted in a list of 35 nonmedical factors, of which 11 were identified by at least half the respondents and 14 by less than half but more than 10. These 25 factors fell into three categories: patient and family factors (e.g., patient's wishes), FP and consultant factors (e.g., FP's capabilities), and other influences (e.g., style of practice). On the basis of both frequency of identification and priority scores "patient's wishes" emerged as the most important factor. Two medical factors that were consistently cited--type of problem and age of patient--were thought to interact with the other factors. CONCLUSION: Certain nonmedical considerations may substantially affect physicians' referral practices.

Data Collection↗