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PubMedDate not supplied

Child care health consultants' roles and responsibilities: focus group findings.

PURPOSE: To describe the roles and responsibilities of newly trained health professionals, primarily nurses called Child Care Health Consultants. METHOD: Health professionals hired by county agencies to become Child Care Health Consultants enrolled in the California Training Institute (CTI) for Child Care Health Consultants, a 9-day educational training program divided into three modules. They participated in one focus group during each module. Research staff led the focus groups and the participants were asked, "What are your roles and responsibilities?" Qualitative analyses were conducted and common themes were identified. FINDINGS: The nine focus groups included 44 participants, 95% were nurses with an average of 20 years of work experience. The roles and responsibilities of the Child Care Health Consultants were described by five themes: network, education, sustainability, on-site service, and administration. CONCLUSION: These findings contribute to the new field of child care health consultation by defining the common roles and responsibilities of Consultants.

California↗

PubMed1992

What will happen to the quality of care with fewer junior doctors? A Delphi study of consultant physicians' views.

Hospital medical staffing: achieving a balance proposed a reduction in the number of junior doctors and an expansion in the number of consultant posts. This change was to be subject to the 'safety net'--that the number of staff should not fall below a minimum safe level for 24-hour emergency cover. However, no operational definition of 'safe' was offered. Consultant physicians in one NHS region were interviewed to find out how they thought safety would be affected by a reduction in junior doctor numbers. It emerged that consultants' concerns over reductions in staff covered a wider range of issues than just the clinical effectiveness of care. The interpretation of safety extended to cover general adverse effects on care. A survey, using the Delphi method, revealed that consultant physicians were most concerned over reductions in the humanity of care if numbers of junior staff were reduced. This included such factors as the time spent by patients waiting in outpatient and A&E departments, and the time doctors spend talking to patients. Consultants were less concerned over the effect of reduced staff numbers on the technical efficiency of provision, and least of all on the effectiveness of care. This last point was seen to be a reflection of consultant physicians' confidence in the basic medical knowledge and skill of their junior staff.

Attitude of Health Personnel↗

PubMed2005

[Impacts of a cardiological consultation on the medical treatment of elderly patients].

The prevalence of prescription medication use among older people increases with advancing age and is related to their comorbidities. Cardiovascular medication is the medication category that is the most commonly prescribed. We retrospectively determined the repercussion of the cardiological consultation of the Hôpital de gériatrie de Genève on the cardiovascular medication. For the year 2001, 191 hospitalized patients were randomely selected and their treatment before and after the consultation was compared. The treatment was simplified after consultation considering the number of medication classes, drugs, and pills. Adverse effect (11% of consultations) is the main reason for interrupting a medication. The number of medication before consultation is an important factor to decide whether the treatment needs to be simplified. The medication cost is not modified. By simplifying treatment the cardiological consultation reduces the adverse effects of medication and probably improves therapeutic adherence. A prospective study is necessary to confirm these data and estimate their long term consequences.

Aged↗

PubMed2006

Physician use of the curbside consultation to address information needs: report on a collective case study.

PURPOSE: The author reports key findings from a doctoral dissertation investigating what the curbside consultation is, how and why physicians use it, and what the implications for health sciences library services might be. SETTINGS/INFORMANTS: Primary informants included sixteen primary care physicians at six sites in one Midwestern state. Additional informants included twenty-eight specialists and subspecialists identified by the primary informants as colleagues who provided curbside consultations. METHODS: Qualitative research methods were used, including field observations, formal and informal interviews, and conversations with peer review physicians. RESULTS: Despite a lack of consensus about what constitutes a "good" curbside consultation, physician informants reported that curbside consultations were part of their medical education and that they continued to take part in them for a number of reasons. Tacit rules govern curbside consultation interactions, and negative consequences result when the rules are misunderstood or not observed. DISCUSSION/CONCLUSION: Acknowledging and understanding physicians' use of the curbside consultation to obtain and construct knowledge may suggest new ways for health sciences librarians to work with physicians in locating, diffusing, and disseminating clinical information.

Education, Medical, Continuing↗

PubMedDate not supplied

Consultation to groups in conflict: some aspects of group design.

1. One should carefully consider the broad dynamics and deal with one's own feelings in performing the consultation. One should resist any pull to act hastily in setting up a group. 2. It must be determined if a group would be helpful in dealing with the problem. Then one must ascertain the desire for a group experience at all levels of the nursing hierarchy. Membership in a group should be by choice and not because of obligation or coercion. 3. The boundaries of the group should be worked out after careful evaluation of the problem. This should include discussion with any potential participants about the desire for a group and about issues of membership and other boundary decisions such as time and place. If the boundaries and responsibilities of membership cannot be agreed upon by the consultant and members, then it is far more responsible not to conduct a group. 4. The task of the group should be defined and clear to the members and be consistent with the desired output of the group. In a group in conflict, there should be a defined primary task, that of dealing with any issues related to the understanding of this conflict. It follows that the role function os the consultant must be carefully defined. 5. To do effective work, the consultant must be seen as independent of the ward authority. One should consider with utmost caution any individual consultation with group members, as this may limit the consultant's effectiveness in dealing with the whole group. The consequences of allowing the ward authority to attend group meetings should be thought through carefully as this will greatly increase the complexity of any experience.

Conflict, Psychological↗

PubMed1991

Working with consultants to achieve home health agency goals.

Should we or shouldn't we seek outside help for our home health agency organizational problem? Hiring consultants is an important consideration and can be nonproductive if proper care is not taken. Although not a panacea, the prudent choice of who, when, where, and how to use consultants can enhance the ability of managers to operate home health businesses. The authors discuss well-known reasons for client's resistance to consultants and reasons home care agencies have started to look to consultants to solve their problems. Specific guidelines for selecting and working with consultants are discussed to ensure that maximum benefit is achieved from consulting relationships.

Consultants↗

PubMed1991

Effectiveness of student ratings feedback and consultation for improving instruction in dental school.

The effects of student ratings feedback and consultation on instructional improvement over a four-year time interval were examined. Of the 40 course directors who led the same course over a four-year period, nine sought consultation services after receiving results from their initial student course evaluation. A sample of nine course directors who received student ratings feedback but did not seek consultation were matched to this consultation group, and student ratings comparisons were made over the subsequent three-year period. The consultation group received significantly higher ratings than the ratings only group for six of the nine course rating items. The magnitude of these effect sizes were substantial. When viewed in light of previously reported controlled studies on feedback, the results suggest that consultation is an important adjunct to ratings feedback for improving subsequent instruction in dental education. In response to an attitudinal survey, course directors indicated that students were qualified to rate aspects of instruction and that ratings provided useful feedback for making course improvements. Recommendations for using student ratings feedback are provided.

Analysis of Variance↗

PubMed1990

The relative value of consultation, questionnaires and laboratory investigation in the identification of excessive alcohol consumption.

Alcohol is a major cause of morbidity and mortality in Britain. Consultation, questionnaires and laboratory tests may all be used to help identify alcohol abuse and thereby prevent and treat alcohol-related problems. Consultation which can identify 80% of alcohol abusers involves recording the findings of alcohol and general histories and physical examination. The accuracy of the assessment depends on the reliability of the respondent and the respondent's relations and friends, and on the skill of the investigator; however, thorough assessment is time-consuming and expensive. Questionnaires may identify up to 80% of alcoholics. They are generally based on the Michigan Alcohol Screening Test and CAGE questionnaires and are simple, rapid to complete, inexpensive and not dependent on skilled investigators; however, the principal disadvantage of using questionnaires is that a personal relationship is not developed with the subject. Finally, simple and complex laboratory tests may be used. Of the simple laboratory tests, raised GGT or MCV levels are the most useful and when these values are combined, 90% of alcoholics may be identified correctly. Complex laboratory tests may exhibit greater sensitivity and specificity and provide useful additional information; however, their restricted availability limits their widespread use. The value of each of these methods depends on the objective of the assessment. For population surveys, questionnaires are of greatest relative value and consultation and laboratory tests may be used to confirm the presence of alcohol abuse. In general practice and the hospital setting, it is imperative to include questions on alcohol intake and alcohol-related problems in all interviews with patients. Laboratory tests may be used to confirm suspected alcohol abuse and questionnaires may provide useful screening tools. Finally, in the specialist alcohol unit, consultation, questionnaires and laboratory investigations are all important for identifying alcohol abuse. In this setting, consultation is of particular importance and the alcohol history and physical examination should be recorded by a skilled investigator and the results confirmed with relatives and close friends. Questionnaires are useful as initial screening or assessment tools and computer-based systems may facilitate data collection. Simple and complex laboratory tests may be used to confirm the diagnosis and help ascertain the extent of disease. By assuming that 'all patients have alcohol-related problems until proven otherwise', and through the appropriate application of consultation, questionnaires and laboratory tests, identification of excessive alcohol consumption and the prevention of its sequelae will be facilitated.

Alcoholism↗

PubMed1990

[The psychosocial profile of couples consulting a fertility clinic].

The objective of this study is to draw the psychosocial profile of couples who consult fertility clinics. More specifically, it consists of a) comparing the psychosocial status of subjects who seek fertility consultation with that of normal subjects or individuals at grips with psychological problems; b) determining whether there are profile differences between men and women who seek fertility consultation; and c) assessing whether it is possible to predict the nature of the psychosocial profile of the subjects from various sociodemographic and medical characteristics. The sampling includes 30 couples who are consulting a specialist in a fertility clinic belonging to a Montréal-area hospital. Analysis of results shows that the psychosocial profile of subjects consulting a fertility clinic is midway between that or normal subjects and that of individuals suffering of psychological problems. The psychological status of men and women consulting a fertility clinic is different according to three variables: depression, self-esteem and stress. Finally, multiple regression analysis has allowed the author to identify several medical characteristics linked to the extent of the psychosocial difficulties experienced by the infertile subjects.

Depressive Disorder↗

PubMedDate not supplied

Factors associated with the frequency of after-hours in-person patient consultations.

In this study, 901 after-hours calls to 26 second- and third-year family practice residents in a university based program were audited to determine patient and physician characteristics associated with after-hours rates of in-person consultation. In-person consultation frequency averaged 25.5%, but ranged from 9% to 53% among physicians (P = .02). Male patients were seen more frequently than female patients (P = .008) Younger patients were seen more frequently than older patients (P = .01). Calls for trauma, obstetrics, and respiratory complaints were more likely to result in in-person consultations than were calls for other problems (P less than .00001). Categorical modeling analysis, used for adjustment, confirmed differences in consultation frequencies both among physicians and due to the nature of the caller's complaint. Neither the time of the call, the patient's race, nor the physician's sex, marital status, level of training, distance lived from the family practice center, or personality type as measured by the Myers-Briggs Type Indicator were associated with the frequency of consultation. Additional research is needed to determine the factors responsible for physician differences in after-hours in-person consultation frequency.

Appointments and Schedules↗

PubMedDate not supplied

[Effectiveness of a patient-centered psychosomatic consultation service. Report of a catamnestic study].

After a short review of the latest scientific publications on psychosomatic consultation activity the results of an empirical study of the consultant service in the Department of Psychotherapy and Psychosomatic Medicine at the Frankfurt University Medical Center are presented. Patient documentations and data from a retrospective investigation were analysed in order to trace the effectivity of psychosomatic consultation activities. To document the various dimensions of the consultative process and their interdependence different groups of patients were derived by means of cluster analysis. The results are in many aspects encouraging for psychosomatic consultative practice, as they show that even few consultations can have an important influence on the patient's further development.

Adolescent↗

PubMed1988

Patterns of referral to a university hospital consultation service: failure to accurately predict need for physiatric services.

The purpose of this study was to determine the predictive value of screening the narrative sections of the consultation request form to determine the need for physiatric intervention rather than PT intervention alone. We conducted a review of 107 requests for consultation from various acute care services at our hospital. After reviewing the referring physician's narrative summaries, we determined that 36% of 107 patients would require physiatric evaluation, and that the remaining patients could be "passed through" to PT for treatment. After evaluation of the medical records and examination of the patients, 54% of patients required physiatric assessment and only 45% could be "passed through" to PT. The hypothesis that this narrative information would be an adequate predictor of need for physiatric consultation was rejected at the p less than 0.005 level (chi 2 = 18.63; df = 1). In addition, the referring service indicated whether it wished PT or physiatry to evaluate the patient on the consultation form. The hypothesis that screening for the need for physiatric intervention by the indicated preference of the referral was rejected at the p less than 0.0005 level (chi 2 = 20.45; df = 1). We concluded that we could not reliably predict when patients required physiatric or only PT intervention based on the consultation request narrative. Ongoing physiatric involvement on a consultative basis, educational conferences, and other forms of education for house staff and attending physicians may serve to improve understanding of physiatric services and physiatric utilization.

Health Services Needs and Demand↗

PubMed1987

Utilization of a consultation liaison psychiatry service in a general hospital.

This retrospective study was conducted in response to a need to evaluate the overall utilization rates of the psychiatric consultation liaison service by nonpsychiatric units within Howard University Hospital, which deals almost exclusively with a black, inner-city population. The study covers a three-year period (July 1982 to July 1985). During this time only 815 patients (2 percent) were referred for psychiatric evaluation out of the total number of hospital admissions (40,000 patients).Patient characteristics and general attitudes appear to have had a major role in this low ratio of referrals, particularly a lack of awareness and bias against psychiatry. This latter finding is in disparity with other published reports. Diagnostically, depression, organic mental disorders (acute), and substance abuse (mainly PCP) constituted the greater bulk of the patients seen by the consultation liaison psychiatry service. The review of a random sample of psychiatric inpatients (n = 100) revealed that in 50 percent of the cases there was a coexisting physical illness or abnormality.The role of mental health education and the liaison function needs to be emphasized. It is suggested that efforts should be directed toward a wider acceptance and utilization of consultation liaison psychiatry by primary care physicians in general hospitals. The factors listed by physicians and patients that may account for the observed underutilization of consultation liaison services are discussed. The results of 20 interviews and the reasons given by referring physicians as to whether or not they will seek consultation from the consultation liaison services are also reviewed.

District of Columbia↗

PubMed1987

Consulting patterns: comparison between doctors' perceptions and patients' behaviour.

Changes in the structure of a practice and the gender of the partners were accompanied by the abandonment of a personal list system. Doctors' opinions about the consulting behaviour of patients in the practice were determined by questionnaire. The notes of 100 patients registered with each of the six partners were examined to determine the nature and number of consultations with each doctor for the years 1980 and 1984. Doctors were found to be unaware of the reasons for which patients consulted different partners. In addition, doctors' opinions about how patients should consult did not correlate with patients' consulting behaviour. It was also found that women consulted the female partners in the practice more commonly than the male partners only after the number of women partners in the practice had increased from one to two.

Attitude of Health Personnel↗

PubMed1979

Attitudes of physicians in a general hospital towards psychiatric consultation service.

The attitudes of 77 physicians in a general university hospital towards the psychiatric consultation service were studied using a questionnaire. The main findings were that the physicians found the psychiatric consultation helpful and not too difficult to obtain. Many of them wanted regular participation of the psychiatrist in the routine of their departments and in case conferences. The findings indicate that the expectations of the departments of surgery are for a consultation service and those of medicine for liaison service. The discrepancy between the positive attitudes of the physicians and the dissatisfaction of the consultants strongly suggest that emotional problems of the consultant, i.e. ambivalence about their profession, is the source of the common tension between psychiatric consultant and other physicians.

Attitude of Health Personnel↗

PubMed1984

Difficulties in the physician-patient dyad: invoking the psychiatric consultant.

Drawing upon their studies of physicians' responses to the recommendations and diagnosis of psychiatric consultants, the authors propose that the psychiatric consultant is most often invoked when the primary physician experiences an inappropriate interpersonal distance in the relationship with the patient. Sensing the threat or the reality of the patient as too close or too distant, the physician seeks the presence of the consultant. In the subsequent triadic constellation, the psychiatric consultant is suggested to function principally as buffer between the physician and the patient, restoring, or effecting a more optimal interpersonal distance in the original dyad. This construct helps to explain the consultees' "selectivity" in requesting consultation and the marked disparity between reported prevalence of psychiatric disorders in the medically ill and referral rates. It also calls attention to the role of the psychiatric consultant in assuring that the medical care of the patient with psychiatric features is not compromised or abbreviated.

Humans↗

PubMed1983

Ten commandments for effective consultations.

If internists are not explicitly instructed in how to perform consultations, the outcome of their consultative efforts may be suboptimal. We suggest that consultations will be more helpful if the following principles are followed: the consultant should determine the question that is being asked, establish the urgency of the consultation, gather primary data, communicate as briefly as appropriate, make specific recommendations, provide contingency plans, understand his own role in the process, offer educational information, communicate recommendations directly to the requesting physician, and provide appropriate follow-up. If these ten "commandments" are followed, the consultation is more likely to be effective and satisfactory for all the participants.

Humans↗

PubMed1983

Some observations of a psychiatric consultant to a hospice.

The experience of a psychiatric consultant to the inpatient and bereavement components of a hospice is reported. The bulk of the consultation is to the hospice staff. Activities of the consultant include attendance at a weekly patient care meeting and patient and staff groups, consultation with the bereavement team and the administrative leadership, and the evaluation of patients. Clarification of the inevitable psychologic problems that arise in dealing with the mostly elderly very ill patients with end-stage cancer as well as with their families is a major function. Many of the problems special to the hospice relate to loss, mourning, and death. Psychiatric diagnostic input has been helpful in the treatment of organic and functional psychiatric disorders including the treatment of the emotional components of pain and disordered grief which is manifest as depression. Consultation is provided to individuals at risk of problems in the bereavement period. The psychiatric consultant to a hospice is helpful in establishing and maintaining a sensitive therapeutic system of care for the patient and family. He provides an important presence and a forum for the discussion of psychologic issues for the staff. In addition, he has an important role in clarifying the psychodynamic issues involved with death, loss, and mourning for the patient, family, and staff. He provides input around the treatment of functional and organic psychiatric problems seen in the patient and family. Such activities require the continuing membership and leadership of a psychiatrist on the hospice team. The hospice is a laboratory for the understanding of death, loss, and mourning. Although they have been the subject of much inquiry, these issues can be studied fruitfully at the hospice because of the accessibility to dying patients and the bereaved, both before and after the death of their loved one (Kubler-Ross, 1970; Parkes, 1972; Schoenberg, Carr, Kutscher, Peretz, and Goldberg, 1974; Jacobs and Ostfeld, 1977; Kastenbaum and Costa, 1977; Greenblatt, 1978). Much remains to be learned about the processes and outcomes of mourning, as well as dying styles and character styles and family variables as they relate to death. Psychologic principles around the care of the dying and their families that have application to other settings (Shanfield, 1978; Shanfield, 1982) need to be clarified in the hospice setting.

Aged↗