SEARCH · Search PubMed

Results for “CONSULTATIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 973 records · Page 54Linked to original sources

PubMed1989

Disability, physician consultation, and use of prescription medications in a population-based study of headache.

In a population-based telephone interview survey of 9,380 residents aged 12 to 29 yr in Washington County, Maryland, who reported having had a headache, 60% of females and 41% of males had had one or more headaches during the previous week; 14.4% of females and 6.0% of males in the study group had consulted a physician in the previous 12 months for a headache problem. The likelihood of consulting a physician differed according to the type of headache. Subjects with headache during the week before the interview meeting the criteria for certain migraine or certain mixed tension--migraine were twice as likely as subjects with all other types of headaches to consult a physician during the previous 12 months. Females with tension headache were considerably more likely than males with the tension headache to have consulted a physician during the previous 12 months. On the other hand, males with migraine headache during the previous week were more likely than females with migraine to consult a physician. Disability (defined as being absent from school or from work for all or part of the day) was relatively common among those subjects with a headache during the previous week (13.7% of females and 7.9% of males). However, even among those reporting disability as a result of their headache during the previous week, only 31% of females and 18% of males reported consulting a physician during the previous 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗

PubMed2004

Is the communicative behavior of GPs during the consultation related to the diagnosis? A cross-sectional study in six European countries.

This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.

Adult↗

PubMed2006

Verbal prescribing in general practice consultations.

This paper looks at aspects of doctor-patient communication and focuses on how prescribing decisions fit into the consultation within the context of the use (and non-use) of a technological clinical decision support system (CDSS) in the UK. Analysis of 6 simulated consultations filmed as part of the evaluation of a CDSS system indicated that the general practitioners (GPs) used their computers for a short time during consultations. The data showed that doctors' utterances, occurring at an early stage of the consultations, signalled the prescribing decision and eventual outcome of the consultation. The concept of 'verbal prescriptions' is used to describe these utterances of the GPs, and facilitates an understanding of how prescribing decisions are routinely achieved. Prescribing decisions can occur in the relatively early stages of the consultation, and both prior to and independently of the CDSS. Consequently, we suggest that the pattern of GP decision-making needs to be taken into account in CDSS design. However, this is not just an issue for CDSS design and implementation, as the verbal prescription phenomenon may impact upon patient involvement in decision-making, and even the appropriate use of evidence based medicine.

Communication↗

PubMed2004

[Clinical assessment of the risk of Human Immunodeficiency virus (HIV) infection in the population consulting an anonymous and free screening center].

INTRODUCTION: The anonymous and free AIDS screening centers were developed in France in 1987 to incite the general population to undergo screening for HIV infection. The aim of this paper was to conduct a prospective study describing the principle characteristics and level of risk of those consulting a center in the Year 1999. POPULATION AND METHODS: A face to face physician-consultant questionnaire was proposed to all the consultants that Year. It included 20 questions regrouped in general characteristics of the subject, number of previous screenings, reason for screening, type of risk taken, date of last risk taken, and number of sexual partners during the past 12 Months and throughout their life without the use of a condom. RESULTS: Two thousand six hundred seventy-eight persons consulted (sex ratio=1) aged a mean of 25.8 Years. The men were older than the women (respectively 27 versus 24.6; p<0.05). The reason for screening was a decision made by the couple in 44.6 p. 100, an unprotected sexual relationship in 47.6 p. 100 another reason in 7.6 p. 100 and drug abuse in 0.2 p. 100 of cases. The sex mode declared was heterosexual in 94.5 p. 100 and homo or bisexual in 5.4 p. 100. The majority of those consulting (66.2 p. 100) had had between 0 and 2 partners during the past 12 Months; 66 p. 100 had had more than 10 during their life without using a condom. The assessment of the global risk by the physician was: very high in 1 p. 100, high in 2.5 p. 100, moderate in 13.3 p. 100, low in 70.7 p. 100 and nil in 12.5 p. cent. Five HIV infections were diagnosed, all in persons at high or very high risk. DISCUSSION: These results should stimulate the radical differentiation of the management of persons consulting according to the level of risk identified by the medical questionnaire.

Adolescent↗

PubMed1993

[Prospective evaluation of specialized consultations in a geriatric university hospital].

In a prospective study carried out over a 3 month period we analysed the views of consultants and residents taking part in 771 consultations to patients admitted to the Geriatric University Hospital of Geneva with the help of visual analogue scales. 27 medical subspecialties were involved. Both consultants and residents agreed that most of the consultations were useful for the elderly patient and for postgraduate teaching and learning. But the residents thought that consultations were more important for the patients' welfare than for the residents' education. Residents showed a tendency to underestimate crucial aspects of geriatric medicine (in particular the autonomy of the elderly patient) in preference to more "classical" medical preoccupations (diagnosis and treatment). Consultants were aware of the specificity of geriatric pathology but restricted their teaching during the intervention to what was requested by the resident.

Aged↗

PubMed2002

Tailoring communication in consultations with women from high risk breast cancer families.

This multicentre study examined the influence of patient demographic, disease status and psychological variables on clinical geneticists/genetic counsellors (consultants) behaviours in initial consultations with women from high-risk breast cancer families. One hundred and fifty-eight women completed a pre-clinic self-report questionnaire. The consultations were audiotaped, transcribed verbatim and coded. Consultants did not vary their behaviour according to women's expectations. However, significantly more aspects of genetic testing were discussed with women who were affected with breast cancer (P<0.001), screening and management with unaffected women (P=0.01) and breast cancer prevention with younger women (P=0.01). Prophylactic mastectomy was discussed more frequently with women with medical and allied health training (P=0.02), and prophylactic oophorectomy with women affected with breast cancer (P=0.03), those in non-professional occupations (P=0.04) and with a family history of breast and ovarian cancer (P<0.001). Consultants used significantly more behaviours to facilitate understanding with women who were in non-professional occupations (P=0.04); facilitated active patient involvement more with women affected with breast cancer (P<0.001) and used more supportive and counselling behaviours with affected women (P=0.02). This study showed that patient demographics were more likely to predict consultants' communication behaviours than the woman's psychological status. Methods to facilitate assessment of psychological morbidity are needed to allow more tailored communication.

Adult↗

PubMed1999

Vascular surgical society of great britain and ireland: audit of surgical technique during carotid endarterectomy by intraoperative duplex ultrasonography: trainees compared with consultant

BACKGROUND: There has been increasing interest in audit of outcome following surgery. A previous study reported a significant difference in clinical outcome between consultant and trainees but there is no information on technical factors. Duplex ultrasonography before wound closure was used to compare clinical and technical outcome for consultant and trainees. METHODS: Patients underwent endarterectomy (89 by consultant, 60 by six trainees). In the consultant group nine vessels were patched and 36 patients underwent shunting compared with seven and 31 respectively for trainees. RESULTS: In the consultant group there were two deaths, one stroke, one transient ischaemic attack (TIA) and two cranial nerve injuries. The neurological event rate was 2 per cent, and overall stroke and death rate 3 per cent. There were ten residual flaps (11 per cent) (three re-explored) and eight kinks (9 per cent). The residual stenosis rate was 10 per cent (nine of 89) and following re-exploration this reduced to 7 per cent. In the trainee group there was one death, two strokes, one TIA and one cranial nerve injury. The neurological event rate was 5 per cent, and the overall stroke and death rate 3 per cent. There were nine flaps (15 per cent) (four re-explored) and 13 kinks (22 per cent). The residual stenosis rate was 22 per cent (13 of 60) which reduced to 15 per cent (nine of 60) following re-exploration. There was no significant difference in clinical outcome between consultant and trainees but there was an increased incidence of technical problems among the trainees (t = 2.12, P < 0.05). CONCLUSION: Intraoperative duplex ultrasonography is a valuable method for assessing surgical technique; it gives immediate feedback to the surgeon, enables corrective measures to be taken and may facilitate training.

Journal Article↗

PubMed2003

NIMBY syndrome and public consultation policy: the implications of a discourse analysis of local responses to the establishment of a community mental health facility.

The relocation of mental health services from an institutional to community base in different parts of the UK has witnessed incidents of public opposition in relation to the establishment of community mental health projects. It has been argued that this not-in-my-backyard (NIMBY) syndrome is partly a result of the attitudes held by the public towards people with mental health problems. The present paper reports some findings from a study of community attitudes towards individuals with mental health problems in a Scottish community, and discusses their implications for the development of public consultation guidelines with respect to the establishment of community mental health facilities. Discourse analysis was used to explore people's views about individuals with mental health problems. The study examined the ways in which their views were expressed in letters to the local press, and in subsequent discussions and interviews, when arguing for or against a supported accommodation project in their neighbourhood. Participants formulated their arguments around a number of issues which they claimed were of public concern. One of these related to the way in which the project was set up. In particular, participants argued that it had been established without any prior consultation with local people and in circumstances of secrecy. The findings demonstrate that, while consultation is relatively unproblematically defined in terms of its function, the specific nature of consultation is more problematic. The implications of these findings for mental health policy and practice are considered in the light of current official guidelines on public consultation relating to the establishment of community mental health facilities. It is argued that existing guidelines fail to take account of the concerns of local people, and therefore, that any intervention based on such guidelines is likely to be ineffective. It is suggested that the findings of this study will be of interest to policy makers and practitioners seeking to devise future public consultation strategies.

Community Mental Health Services↗

PubMed1995

Short or long consultations? Primary care nurses' considerations in making appointments with general practitioners.

In Sweden primary care nurses (PCNs) at the health centres (HCs) manage the appointment systems and decide the appointed length of general practice consultation time. This study aims at elucidating experienced PCNs' considerations in booking consultations of different lengths. The grounds for giving long or short appointments were searched for. Qualitative methods were used and 10 PCNs at eight HCs in Umeå Health District in northern Sweden were interviewed. The PCNs take factors from two areas into consideration; one area, often immediately apparent, concerns immediate and straightforward issues such as the patient's reported problem, the patient her/himself, the doctor her/himself and the current situation at the HC and in the catchment area. The other area for consideration usually develops through experience over the years and concerns time consumption in a longer perspective. The overall quality of the consultations is then in focus and the length of a separate consultation is of minor interest. The PCNs do not applicate a straightforward relation between length of time and quality of consultations. Experienced PCNs seem to promote accessibility of primary care and their efforts in allocating time in a practical way probably increase the quality of general practice consultation.

Appointments and Schedules↗

PubMed2001

Learning to consult with computers.

OBJECTIVE: To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. INTERVENTION: An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. DESIGN: Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. OUTCOME MEASURES: Self-reported attitudes and skills with clinical applications before, during and after the intervention. RESULTS: Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. CONCLUSIONS: The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.

Attitude to Computers↗

PubMed2006

The role of culture in the general practice consultation process.

In this paper, we will examine the importance of culture and ethnicity in the general practice consultation process. Good communication is associated with positive health outcomes. We will, by presenting qualitative material from an empirical study, examine the way in which communication within the context of a general practitioner (GP) consultation may be affected by ethnicity and cultural factors. The aim of the study was to provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication. This paper reports on South Asian and white patients' explanations of recent videotaped consultations with their GP. We specifically focus on the ways in which issues of ethnic identity impacted upon the GP consultation process, by exploring how our sample of predominantly white GPs interacted with their South Asian patients and the extent to which the GP listened to the patients' needs, gave patients information, engaged in social conversation and showed friendliness. We then go on to examine patients' suggestions on improvements (if any) to the consultation. We conclude, by showing how a non-essentialist understanding of culture helps to comprehend the consultation process when the patients are from Great Britain's ethnicised communities. Our findings, however, raise generic issues of relevance to all multi-racial and multi-ethnic societies.

Asian People↗

PubMed2006

A framework for comparing video methods used to assess the clinical consultation: a qualitative study.

BACKGROUND: Single-channel video is an established method for assessing clinical consultation in training general practitioners; however, it is hard to infer the body language of the doctor or how information in the consultation is being integrated into the medical record. A three-channel video was developed combining the conventional view with a camera looking at the doctor's facial expression and copying the video output from the monitor. However, the choice of three channels and camera angles selected has not been critically appraised. OBJECTIVE: To develop criteria for comparing single and multi-channel approaches to video recording of the consultation. METHODS: Single channel and three-channel recordings of simulated consultations were shown to a panel of 12 health professionals and interviews were conducted to gather their opinions on the level of information presented, quality and assessment. The transcripts were analysed thematically. RESULTS: It was found that in providing visual information the three-channel video was superior to the single channel video. The major elements needed for comparison of the two techniques would be the ability of the video to pick up quantifiable non-verbal communication of the doctor and the patient, and the ability to qualitatively and quantitatively reflect the use and impact of the computer on the consultation. The information provided by the three-channel video could be further classified to essential, desirable and redundant to guide the future development of the multi-channel video. CONCLUSIONS: Multi-channel methods should be able to capture the following information: body language and facial expression of doctor and patient; and how the doctor's knowledge and information collected in the consultation are synthesized into the medical record.

Computers↗

PubMed2001

Association between air pollution and daily consultations with general practitioners for allergic rhinitis in London, United Kingdom.

Few published studies have looked at the health effects of air pollution in the primary care setting, and most have concentrated on lower rather than upper respiratory diseases. The authors investigated the association of daily consultations with general practitioners for allergic rhinitis with air pollution in London, United Kingdom. Generalized additive models were used to regress time series of daily numbers of patients consulting for allergic rhinitis against 1992--1994 measures of air pollution, after control for possible confounders and adjustment for overdispersion and serial correlation. In children, a 10th--90th percentile increase in sulfur dioxide (SO(2)) levels 4 days prior to consultation (13-31 microg/m(3)) was associated with a 24.5% increase in consultations (95% confidence interval: 14.6, 35.2; p < 0.00001); a 10th--90th percentile increase in averaged ozone (O(3)) concentrations on the day of consultation and the preceding 3 days (6--29 parts per billion) was associated with a 37.6% rise (95% confidence interval: 23.3, 53.5; p < 0.00001). For adults, smaller effect sizes were observed for SO(2) and O(3). The association with SO(2) remained highly significant in the presence of other pollutants. This study suggests that air pollution worsens allergic rhinitis symptoms, leading to substantial increases in consultations. SO(2) and O(3) seem particularly responsible, and both seem to contribute independently.

Adolescent↗

PubMed1996

Real world data--retrieval and validation of consultation data from four general practices.

OBJECTIVE: We aimed to retrieve data on consultations from general practice databases and to develop and use appropriate methods of validation for these data. METHOD: MIQUEST software was used to retrieve the data from four practices. The data were validated by comparing them with figures generated by practice-based searches, measuring the uptake of recording of consultations over time, and comparing records of consultations in the case notes with those on the practice computers. RESULTS: The required data were retrieved from general practice databases, but the path to success was difficult, and typified by uncertainty and unpredictability. The recording of consultations on the computers of four practices was more complete than the recording in the paper case records. There was a time period in the early months of computer use when the recording of consultations was less complete. There were differences in the completeness of recording consultations between practices, doctors, and patients. CONCLUSIONS: This study confirms the potential of general practice databases for research, demonstrates how MIQUEST software can be a useful tool in retrieving data from general practice databases, and indicates how the completeness of data recording permitted further analysis for the purposes of our study.

Data Collection↗

PubMed2002

The final version of the Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient participation in general practice patients with complex health problems. Doctors' and patients' evaluation and guidelines for clinical use.

BACKGROUND: The Patient Perspective Survey (PPS) is a new clinical communication tool designed to stimulate patient involvement in the management of complex health problems in general practice and to improve patient and doctor satisfaction with the consultation. The development of this final 38-item version of the PPS has been described elsewhere. OBJECTIVE: The aims of this article are to present recommendations for clinical use and how GPs and patients have evaluated this new tool. METHODS: The study material included 159 patients (78% females) with a mean age of 45 years, mainly presenting with longstanding musculoskeletal and psychosocial disorders, selected by 32 GPs. After the PPS-based consultation, both doctor and patient were asked to fill in evaluation forms. RESULTS: In as many as 55-85% of the consultations' various aspects, it was perceived by the GPs that the use of the survey helped (to some extent, much or very much) in achieving improved clinical communication and a constructive consultation. The most important elements appeared to be stimulation of positive interaction/processes and obtaining new and relevant information. Similar results were found regarding patient evaluation. There was significantly more positive doctor evaluation if the doctor-patient relationship had lasted less than 1 year, and if the patient agreed to prepare a 'plan of action' for a follow-up consultation. Guidelines for clinical use are presented. CONCLUSION: We now regard the PPS to be completed for daily clinical use and believe that it has been shown to be a potent tool to improve consultation outcome in the large and challenging group of patients with complex health problems in general practice.

Adult↗

PubMed2003

GPs' perspectives on managing time in consultations with patients suffering from depression: a qualitative study.

BACKGROUND: Although there is widespread concern that general practice consultations are too short for doctors to provide a high quality of care for patients, the relationship between the length and outcome of these consultations remains unclear. Research to date has neglected the subjective experience of consultation time of both patients and GPs. OBJECTIVES: Our aim was to investigate GP perspectives on consultation time and the management of depression in general practice. METHOD: A qualitative interview-based study was carried out of 19 GPs from eight West Midlands general practices. RESULTS: The GPs in this study acknowledged the pressure of work and resource constraints in general practice. However, they did not feel these prevented them from providing good support and treatment for depression. They were confident in the effectiveness of antidepressants and their own skills in providing counselling support, and were able to utilize time flexibly in responding to patients' variable needs. Depression was viewed as a relatively straightforward problem that usually could be managed within the resources available to general practice. CONCLUSION: The doctors generally did not experience time to be a limiting factor in providing care for patients with depression. This is in contrast to the more acute sense of time pressure commonly reported by patients which they felt undermined their capacity to benefit from the consultation. GPs need to be more aware of patient anxieties about time, and to devise effective means of raising patients' sense of time entitlement in general practice consultations.

Antidepressive Agents↗

PubMed1992

Differences between black and white women with breast cancer in time from symptom recognition to medical consultation. Black/White Cancer Survival Study Group.

BACKGROUND: Studies in the United States have reported that Black women have higher fatality rates than White women following a diagnosis of breast cancer and are more likely to be diagnosed with late-stage cancers. PURPOSE: To evaluate reasons for these racial differences, we explored the difference between Black and White women in the length of time from symptom recognition to initial medical consultation. We also evaluated the extent to which other factors related to the length of this interval might contribute to any observed racial difference. METHODS: As part of a collaborative study of differences in the survival rates of Black patients and White patients with cancer, we interviewed a sample of 410 Black women and 325 White women from Atlanta, New Orleans, and San Francisco/Oakland who were newly diagnosed in 1985 or 1986 with invasive breast cancer. Retrospective data were collected on symptoms, dates of symptom recognition and initial medical consultation, and several other factors which may affect the interval between symptom recognition and medical consultation. Data were analyzed as if from a follow-up study, using product limit procedures and proportional hazards regression. RESULTS: At diagnosis, Black women with breast cancer were two times more likely to have stage IV breast cancer and one and one-half times more likely to have stage III breast cancer than White women with breast cancer and were only approximately one-half as likely to have stage I breast cancer. Similarly, Black women were almost twice as likely as White women to have tumors that were larger than 5 cm or tumors that had extensions to the chest wall or skin at presentation. However, the average rate at which Black women with breast cancer obtained an initial medical consultation lagged behind that for White women by only a slight but statistically significant difference (15%). The median time between symptom recognition and medical consultation was slightly longer for Black women (16 days) than for White women (14 days) (P = .06). Adjustment for other characteristics predictive of the length of this interval had little effect on racial differences. The racial differences tended to vary somewhat by age and metropolitan area, suggesting that the results may not apply equally to all demographic subgroups and regions in the United States. CONCLUSION: This small difference in the time from symptom recognition to medical consultation is unlikely to account for the large racial differences in survival rates and in stage of disease at the time of diagnosis.

Adult↗

PubMed2005

Impact of mandatory inpatient infectious disease consultation on outpatient parenteral antibiotic therapy.

BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) has had an important impact on infections historically requiring prolonged intravenous antibiotic treatment. Within the past decade, new antibiotics with oral/intravenous bioequivalence, plus recent data on infection management, have increased the potential role of the Infectious Disease (ID) consultant for OPAT. METHODS: We studied the impact of mandatory ID consultation on the use and outcomes of OPAT in patients initially hospitalized. The study was approved by the Institutional Review Board and the Executive Committee of the Medical Staff of Baystate Medical Center. Patients older than 18 years of age being considered for discharge to home on OPAT were identified, primarily through discharge planning. Formal ID consultation was performed to determine both need for OPAT and a variety of issues regarding antibiotic choice. Thirty-day telephone follow-up determined outcomes. Data regarding demographics, outcomes, and costs were analyzed. RESULTS: Forty-four patients received mandatory ID consultation, 39 (88.6%) of whom had some change in antibiotic recommendations. Seventeen (38.6%) were discharged on oral antibiotics, 1 (2.3%) had antibiotics discontinued, 13 (29.6%) had a change in parenteral antibiotic, 5 (11.4%) had a change in antibiotic dose, and 3 (6.8%) had a change in antibiotic duration. Follow-up demonstrated a single rehospitalization for unrelated issues. The total cost savings were 33,667.00 US dollars, approximately 760.00 US dollars per patient. Charges of consults were approximately 11,970.00 US dollars, still resulting in savings of close to 21,700.00 US dollars, or almost 500.00 US dollars per patient. CONCLUSIONS: Mandatory ID consultation resulted in substantial cost savings and excellent outcomes.

Administration, Oral↗