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At least 1,207 records · Page 67Linked to original sources
PubMed2001

Veterinary practice management: teaching needs as viewed by consultants and teachers.

A study was conducted to assess veterinary practice management (VPM) educational and research needs from the perspective of consultants and teachers. An online focus group discussion was designed, involving two separate groups (consultants and teachers). One week was allocated to each group, with five to eight questions posed per day. Pseudonyms were used to provide confidentiality. Teachers were selected by inviting the primary VPM course coordinator at each AAVMC school. Consultants required at least two recommendations and were selected in a stratified, non-random manner to achieve both geographic and disciplinary diversity. Participation was stronger within the consultant group: 98 pages of data were generated by the consultants and 35 pages by teachers. Participants agreed that the sub-optimal economic conditions that characterize the veterinary profession are reflective of relatively low-level management skills. This situation establishes the need to strengthen VPM educational and research programs. Many specific suggestions were provided. It was recommended that a cooperative effort between academia and the private sector be employed. However, participants recognized that successful DVM education programs in VPM will be difficult to achieve and sustain without strong support from college administrators and faculties.

Consultants↗
PubMedDate not supplied

The consultation role of a nurse educator.

Consultation is one component of the nurse educator's role. This role is rapidly expanding as health care changes. Nurse educators are being called on to provide support for the educational process in areas outside their clinical specialty. This article describes the educational consultation process in a large medical center where nurse educators have expanded their roles to ambulatory care areas. Key principles guiding the educational consultation process are delineated as well as possible uses. A five-stage process is described to aid the nurse educator in implementing the educational consultation process. In addition, some of the barriers that may be encountered during a consultation are identified.

Ambulatory Care↗
PubMed1986

Procedures for designing an occupational therapy consultation contract.

Occupational therapists have been asked with increasing frequency to function as consultants, yet most of the research on consultation has been published in other fields. Issues that have been investigated include negotiating consultation sponsorship, conducting needs assessments, and evaluating the consultant's effectiveness. For the purposes of our research the literature was used to generate a list of steps for designing a consultation package. The steps were then used in a six-month pilot contract to assess their usefulness for occupational therapy practice.

Contract Services↗
PubMedDate not supplied

From psychosomatic medicine to consultation-liaison psychiatry.

OBJECTIVE: To trace the movement from psychosomatic medicine to consultation-liaison psychiatry, the forces at work in shaping the change, and the extent to which the change is reflected in the latest revisions of the International classification of diseases (ICD-10) and the Diagnostic and statistical manual of mental disorders, third revision (DSM-III-R). DATA SOURCES AND SELECTION: Identification of important trends in the field was aided by discussions with fellow members of the panel of compilers of the consultation-liaison psychiatry literature review expert list published bi-annually in General Hospital Psychiatry. The expert list is based on appropriate literature searches. DATA SYNTHESIS: Psychosomatic medicine continues as a science, studying the relationships between biological, psychological and social phenomena in health and disease. The main advocates of the clinical application of the concepts and findings of psychosomatic medicine are now the general hospital consultation-liaison psychiatrists and their allied health professional colleagues. The mainstreaming of psychiatry into medicine has accentuated the role of the consultation-liaison psychiatrist. In attempting to translate the advances in the field into a new taxonomy, both ICD-10 and DSM-III-R have created a new language that hinders understanding by a medical profession perhaps now less prone to resistance to holism. CONCLUSIONS: There is a need for a valid taxonomy that addresses the most common form of psychiatric presentation in the community, that of physical/psychiatric co-morbidity, and for outcome studies based on such a taxonomy. Consultation-liaison psychiatrists need to educate their colleagues about the changes in concepts and terminology.

Holistic Health↗
PubMed1993

Leading healthcare consultants speak out. Interview by Bill Childs.

In 1993 American consulting firms worked overtime helping executives of healthcare delivery systems cope with recent developments and anticipate coming events. From vertical integration to mergers and acquisitions, from reengineering to downsizing, it appeared that industry activity amounted to full employment for consultants. Recently Bill Childs, Healthcare Informatics' editor-in-chief and market observer, took the opportunity to visit with two leaders in the healthcare consulting field--Jim Reep, Chairman of First Consulting Group, Long Beach, Calif., and Richard Helppie, CEO of Superior Consultant Co., Farmington Hills, Mich.--and record their views of the state of the industry and their visions for its future. Excerpts from their discussions follow.

Antitrust Laws↗
PubMedDate not supplied

Selecting and managing a professional consultant to a clinical laboratory.

Managers of clinical laboratories, like those in other complex organizations, will often seek the advice of external professional consultants to provide solutions to current problems. Optimizing the process of selecting and managing consultants to clinical laboratories is the topic of this article. A number of practical tips are offered, including a discussion of the use of nontraditional consultants. Special emphasis is placed on developing a request for proposal and evaluating responses to the request for proposal by the various consulting firms bidding for the engagement. The use of consultants in the health-care arena in general and clinical laboratories in particular will undoubtedly increase as financial and organizational challenges to the industry continue to proliferate.

Competitive Bidding↗
PubMed1997

Is contingency-fee consulting an endangered species?

Consulting firms that assist hospitals in optimizing Medicare and Medicaid reimbursement sometimes charge contingency fees for their services. These fees are based on a percentage of the increased revenue they can help a hospital capture. Although contingency-fee arrangements are not considered unethical, they can result in illegal billing practices because consulting firms may be tempted to up-code to increase their fees. The 1994 investigation of Metzinger Associates, Voorhees, New Jersey, a consulting firm providing services to 200 hospitals in 17 states, found evidence of illegal billing practices and resulted in a complaint filed by the United States Attorney's Office. Several hospitals were named as defendants. A Fraud Alert issued by the HHS's Office of the Inspector General earlier this year indicates the government intends to target consulting firms that charge contingency fees. Before engaging consulting firms that charge contingency fees, hospitals should carefully evaluate each firms to determine whether its recommended billing submissions will be accurate, credible, and defensible.

American Hospital Association↗
PubMedDate not supplied

When consultants and clients clash.

This fictitious case study explores the issues that surround the relationships between consultants and their clients, as well as the dynamics of a newly merged organization. Susan Barlow, a senior consultant with the Statler Group, dreaded her upcoming status meeting. She had thought it a lucky break when she got assigned to the Kellogg-Champion project. Royce Kellogg, the CEO of the newly merged firm, had engaged the Statler Group for what seemed a simple project: to reconcile the policies and practices of the two former firms now that they had become one. But once on the job, Barlow realized that the issues were much more complex than they had seemed. The new firm needed help badly-but not the kind of help that the client had led Barlow to believe it needed. What would she and Jim Roussos, her partner on the assignment, tell Kellogg at the meeting? Kellogg, for his part, was not looking forward to the status meeting, either. From his point of view, the consultants had caused more problems than they had solved. What's more, he wasn't even dealing with the consultants he had hired. Where was George Gray, the senior partner he had met with originally? Maybe Barlow and Roussos were just too young and inexperienced. Kellogg felt he was getting a raw deal. How would he approach them in the morning? Should he fire them or make an attempt at damage control? Two experts advise the consultants and two advise the client on how to handle the status meeting.

Consultants↗
PubMed1978

Practice of social work consultation: a survey.

In an effort to find out more about what social work consultants actually do--arrangements and motives for consultation, identification of consultees, and typical examples of consultative intervention--the authors conducted a survey of some 500 social work consultants. The results indicate the indeterminate state of social work consultation.

Attitude↗
PubMed1999

Consultation length and case mix in a general practice clinic.

OBJECTIVE: This study was conducted to determine the mean consultation length in a general practice clinic for all cases as well as for acute and chronic conditions. METHODS: The main diagnosis or reason for encounter in a general practice clinic from 25 April to 15 May 1994 was coded for all consultations using a customized clinic management software. RESULTS: The case mix of the clinic was comparable to the general practice pattern described in the 1993 Morbidity Survey of Outpatients. The overall mean consultation length was 9.3 minutes, the median was 6.0 minutes and the mode was 3.0 minutes. The mean consultation length for representative acute, chronic, and chronic relapsing and remitting conditions were 7.1 minutes (acute upper respiratory tract infection), 7.6 minutes (hypertension), and 9.9 minutes (bronchial asthma), respectively. CONCLUSION: Consultation length for a practice is dependent on the case mix of the practice, which is in turn dependent on the number of tasks required.

Acute Disease↗
PubMedDate not supplied

[Predictors of behavioural disorders and consultation-liaison psychiatry in patients with HIV disorders].

OBJECTIVE: The aim was to identify the features of patients admitted into an Infectious Disease Unit in a Hospital due to pathology related to HIV and/or addiction that originate the demand for consultation liaison psychiatry. METHOD: During the first six months of 1997, 232 admissions into the Infectious Disease Unit at Ramón y Cajal Hospital (191 patients) were systematically evaluated by the nursery staff. A specific questionnaire was designed for this interview. After having performed univariants analysis, a logistic regression was used to identify the most relevant variables in the claim for consultation liaison. RESULTS: The claim for consultation liaison was associated to: consume in the unit OR (yes/no)= 7.9, confusional syndrome OR (yes/no)= 5.6, social worker consultation liaison OR (yes/no)= 2.1. use of benzodiazepines OR (yes/no)= 2.4. No medical treatment respect to bad accomplishment OR= 3.6. Only taking into account the known features after the first examination: use of benzodiazepines OR (yes/no)= 2.1, use of cocaine OR (yes/no)= 1.8, recognized income (yes/no)= 2.2, no medical treatment due to bad accomplishment OR= 2.1. CONCLUSIONS: In our environment the demand for consultation liaison psychiatry is related to behavioural problems due to the use of substances and marginality. The variables which predict the demand and may be identified at the time of admission are: the use of benzodiazepines, cocaine, the lack of a recognized income and the absence of medical treatment for the HIV infection. Recognizing these features will allow us to identify patients who are going to have behavioural problems and demand psychiatric assistance.

Adult↗
PubMedDate not supplied

[Analysis of the neurologic consultations in an oncologic hospital: contributions of neuro-oncology].

OBJECTIVE: To determine the reasons for consultation to the neurology service in a cancer center. METHODS: A retrospective examination of all neurology consultations over a 3-month period. RESULTS: A total of 247 patients were examined. The most frequent symptoms included, pain (34%), motor weakness (25%) and altered mental status (22%). The most frequent diagnoses were spinal cord compression (18%), brain metastases (15%), metabolic and/or toxic encephalopathies (14%) and stroke (7%). Spinal cord compression was demonstrated in 50% of patients with back pain or radiculopathy. Pain and motor weakness resulted from metastatic complications in 75% and 69% of the cases, respectively; however, only 18% of the cases of altered mental functions resulted from metastatic complications. At the time of the neurology consultation, 41% of the patients were receiving corticosteroids and 43% suffered from one or more of its adverse effects. The diagnostic test most frequently requested by the neurologist was the MRI. In 101 patients the neurological symptoms were followed for at least 5 days; when the cause of the neurological deficit was a metastatic complication, the effect of the treatment was evaluated one month later. Overall, 64% of the patients with metastatic complications improved with treatment, 19% remained stable, and 17% worsened or died. CONCLUSIONS: In a cancer center, the three symptoms that most frequently resulted in neurologic consultation were pain, motor weakness, and altered mental status. These were most commonly due to brain or epidural metastases, toxic and/or metabolic encephalopathy, and stroke. The use of neuroimaging does not appear to replace the need for neurologic consultation. The neurologist assists in establishing the diagnosis and initiating the appropriate treatment. In this study, two out of three patients improved after treatment of the neurologic deficit.

Adult↗
PubMed1999

Access to an outpatient cardiology consultation in southwestern Ontario.

OBJECTIVE: To determine whether there were differences in waiting time for a consultation for a nonurgent cardiology problem among specialists in an academic centre compared with those in community practice. DESIGN: Cross-sectional telephone survey. SETTING: Southwestern Ontario. PARTICIPANTS: Academically affiliated and community-based specialists in cardiology or internal medicine with an interest in cardiology. OUTCOME MEASURE: Waiting period in weeks for outpatient consultation. RESULTS: Among community specialists, those with cardiology training had significantly longer waiting times than those without for nonurgent cardiology consultation (median 8.6 versus 3.8 weeks, P=0.0077). Waiting times for consultation were significantly longer for academic specialists than for those in community practice (median 9.1 versus 4.1 weeks, P=0.0013). Significantly longer waiting times exist in communities with a population greater than 100,000 (median 9.1 versus 4.0 weeks, P=0.0005). CONCLUSIONS: Waiting times for consultation for a nonurgent cardiology problem are long. Waiting times are longer for physicians with certification in cardiology, in the academic medical centre and in larger communities.

Academic Medical Centers↗
PubMed1999

The addition of an audiocassette recording of a consultation to written recommendations for patients with advanced cancer: A randomized, controlled trial.

BACKGROUND: Communication between physicians and advanced cancer patients is frequently difficult. Patients often report poor levels of satisfaction with communication. The purpose of this study was to assess the impact on patients' recall of and overall satisfaction with their consultation by the addition of an audiocassette recording of a consultation to written recommendations. METHODS: Sixty patients with advanced cancer were randomized to either receive a tape recording of their consultation or receive no tape in addition to written recommendations in this randomized, double-blind trial. Patients gave their global ratings of the clinic, were tested for their recall of information given, and responded to questions about the utilization and role of the cassette in influencing family communication. RESULTS: The addition of the audiocassette to written communications significantly increased patient satisfaction with the clinic (8.7 +/- 1.7 vs. 7.7 +/- 2.0 on a scale of 0-10; P = 0.04) and significantly improved recall of the information given during the consultation (88% +/- 8.7% vs. 80% +/- 15.5%; P = 0.02). Patients expressed a high level of satisfaction with the audiocassette. Patients listened to the tape a median of 2 (range 1-4) times, whereas family members and friends listened to the cassette a median of 2 (range 1-3) times. CONCLUSIONS: The addition of an audiocassette recording of an outpatient consultation to written recommendations for patients with advanced cancer is capable of increasing both the overall patient recall of the visit and satisfaction with the outpatient clinical setting. Patients expressed a high level of satisfaction with the audiocassette.

Aged↗
PubMedDate not supplied

[Telephone consultation in child neurology practice: quantification and contents].

INTRODUCTION: The workload of telephone consultations has been scarcely studied except at the Emergency Units, in spite of the considerable amount of time consumed by the task in normal practice. OBJECTIVE: To asses the workload of telephone consultations in a Neuropediatric Unit, during normal working hours. METHODS: A prospective analysis of all calls received during a year, at the out-patient hospital-based neuropediatric clinic. RESULTS: 150-200 telephone consultations were received every month, decreasing during the holiday seasons. They amount to two thirds of the face-to-face contacts at the clinic, during the same period of time, and require about 10% of our day-time working hours. Disorders more likely to produce the calls: epilepsy (40%), mental retardation (19%), cerebral palsy (11%), all others with a frequency lower than 5%. These percentages, and those of hydrocephalus, autism and spina bifida, are similar to those encountered in normal practice, while headaches, speech delay, hyperactivity, syncopes, etc. produced half the number of calls expected; myopathies doubled the number of calls expected. The monthly frequency of calls varied significatively, along the year, for epilepsy, mental retardation, hyperactivity, migraine and autism. Calls were made especially by the family (49%), but it depends of the purpose and the patient's diagnosis. The purpose was most frequently to consult about the symptomatology of the illness; treatments produced 7% of calls; and discussion about citations, 19.5%, regardless of the diagnosis. CONCLUSION: In neuropediatric practice, telephone consultations should be recognized and provided for in order to manage effectively the clinical demand.

Child↗
PubMedDate not supplied

Hospital services for patients with acute stroke in Ireland: the Volunteer Stroke Scheme survey of consultant opinion.

A national postal survey of hospital based consultants with responsibility for acute care of stroke admissions was performed in November, December 1998. Of 162 survey forms, 140 (86.4%) were returned representing consultants working in all 38 acute general hospitals (total 10,067 hospital beds) of whom 135 indicated that stroke patients were admitted under their care. Patients were admitted under 11 different subspeciality groups to various medical and surgical wards. Only 18.5% of consultants worked in hospitals where there was a physician/neurologist with specific responsibility for stroke, whilst only 19.5% were aware of a policy in their hospital for implementation of minimum standards of care for stroke patients or a recent audit of stroke care (9%). A substantial number of hospitals in certain health board areas have no access to a consultant led rehabilitation unit within their own health board area whilst 18/38 hospitals have no on-site CT brain scanning. Despite the proven value of organised hospital stroke care, this survey documents major deficiencies in this country. We suggest that each health board would review its services to include in each hospital a consultant physician with special responsibility for co-ordination and development of appropriately staffed and funded stroke services.

Health Services Accessibility↗
PubMedDate not supplied

What is it like to work for a big five consulting firm? Interview by Barbara J. Linney.

Is consulting for a big five a career direction you've thought about pursuing? In this column, Barbara Linney interviews physician executive Don Gessler, MD, MBA, CPE, FACPE, to talk about his experience in working for a big five consulting firm. He discusses how he got his position at ABC Consulting Firm, the nature of the work, the rigorous travel schedule, the pluses, and the type of physician executive that is satisfied in this environment. He describes some of the projects and tasks he has been involved in as a consultant. He emphasizes that if physicians don't like to do selling, consulting is not a place for them to be and that it is a very team-based structure.

Consultants↗
PubMed2002

Time for care. Length of general practice consultations in Australia.

BACKGROUND: Past estimates of the length of Australian general practice consultations have been based on Medicare item numbers claimed, which carries probable serious inaccuracies. AIMS: To describe the length of general practitioner consultations. METHODS: A random sample of 926 GPs recorded the start and finish times in minutes of their consultations for which a Medicare item number was claimed between April 2000 and March 2001, within a continuous cross sectional national study of general practice activity. RESULTS: Mean length of the consultations was 14.8 minutes (range 1-106). Mean length per GP varied widely (mean of means 14.8, range 3-39, mode 15.0 minutes). Female GPs had significantly longer consultations than males. Younger (< 45 years) male metropolitan GPs had the shortest mean length. Most attendances (85.7%) were designated Level B, 1.5% as Level A, 11.7% Levels C and 1.1% as level D. Mean length of Level A was 7.1 minutes, Level B-13.0, Level C-26.1, and Level D-44.9 minutes. CONCLUSION: This study suggests that the majority of GPs are not practising 'six minute medicine', and may assist cost projections of any changes to the Medicare Schedule.

Adult↗