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At least 1,441 records · Page 80Linked to original sources
PubMed2001

A pilot study of the technical quality of telemedical consultations for remote trauma management.

The technical performance of a telemedical system when used for remote trauma management was compared with face-to-face consultation. Two rooms, 20 yards apart, were linked telemedically in the same Accident & Emergency Department. Two hundred patients, with 'minor' and 'moderate' injuries, underwent the two types of consultation. The Accident & Emergency consultant marked physical parameters using a five-point pre-determined Likert scale. The following parameters were thought to be of excellent quality when compared to face-to-face consultation: overhead fluorescent lighting for the background illumination, video lighting for a close-up view, sound quality after volume adjustment, echo-cancellation after adjustment and lip synchronization. However, the following parameters scored poorly: sound before volume adjustment, echo-cancellation before adjustment, fine and coarse movements. It can be concluded that the quality of lighting and image quality are good in telemedicine. Sound and movement still present some problems. This technology is likely to be used more frequently for remote trauma management.

Humans↗
PubMed2004

Use of the psychiatric consultation letter as a therapeutic tool.

OBJECTIVE: Carefully crafted medical consultation letters can serve the dual purpose of transmitting the consulted psychiatrist's opinion to the referring doctor and enhancing the quality of the doctor-patient therapeutic relationship. Using the same document for both purposes simultaneously can enhance the consultation letter's overall effectiveness, as illustrated by three case examples. CONCLUSIONS: Future teaching programmes for undergraduate and postgraduate psychiatry students should incorporate consultation letter writing workshops to improve students' skills in clearly expressing their opinions and management recommendations in written form.

Adolescent↗
PubMed2004

Are the therapeutic effects of homeopathy attributed to the consultation, the homeopathic remedy, or both? A protocol for a future exploratory feasibility trial in patients with rheumatoid arthritis.

Systematic reviews suggest that homeopathy has a greater effect than placebo, however, the mechanisms of its action are unknown. The clinical effects of homeopathy could be attributed to the specific effects of the remedy and/or to the contextual effects of the consultation process; these factors have not been critically evaluated. We have developed a model that attempt to separate the consultation effects from the specific effects because of the remedy. We propose to investigate this design in a chronic condition, rheumatoid arthritis, for which previous research has evaluated both classical and complex homeopathic interventions. The following protocol describes the study design. The aims of this exploratory trial are to assess the feasibility of the study design, identify effect sizes of the consultation, the complex treatment, and the individualized remedy, as well as possibly efficacy, for the two types of homeopathic treatment and the homeopathic consultation. Data collection will take place in 2004.

Adolescent↗
PubMed2003

An economic analysis of a store and forward teledermatology consult system.

Our objective was to assess the economic impact of store-and-forward teledermatology in a United States Department of Veterans Affairs (VA) health care setting. Patients being referred to the Dermatology Consult Service from the Primary Care Clinics at the Durham, North Carolina VA Medical Center were randomized either to usual care or to a teledermatology consultation. Fixed and variable costs for both consult modalities were identified using a microcosting approach. The observed clinical outcomes from the randomized trial generated probability and effectiveness measures that were inserted into a decision model. A cost analysis and a cost-effectiveness analysis that compared the two consult modalities was performed. Teledermatology was not cost saving when compared to usual care using observed costs and outcomes. Sensitivity analyses indicated that teledermatology has the potential to be cost saving if clinic visit costs, travel costs, or averted clinic visits were higher than observed in the study. Teledermatology was cost-effective for decreasing the time required for patients to reach a point of initial definitive care. Cost-effectiveness ratios ranged from $0.12-0.17 (U.S.) per patient per day of time to initial intervention.

Adolescent↗
PubMed2005

The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data.

This report describes the multiple complementary analytic methods used to create a composite evaluation of the benefits of a hospital-based inpatient palliative care consultation service at Montefiore Medical Center in its preliminary phase. We evaluated data regarding 592 consecutive patients consulted by the palliative care service between November 2000, through March 2002. Standardized medical record reviews indicated that over 90% of interventions recommended by the palliative care team were accepted and acted on by the primary team; audit of the medical records of 368 patients confirmed that pain and other symptoms improved in 87% of patients after palliative care intervention. Ninety-five percent of respondents to a telephone survey of family caregivers described themselves as likely to recommend the service to others. High levels of referring provider satisfaction were evidenced by a Likert- scale provider satisfaction survey and an increase in the rate of referral for palliative care consultation from 2% to 21% of all patients dying at our medical center during the study period. There were also significant reductions in charges for ancillary tests and ventilator charges after palliative care consultation. A matched case control study of mechanically ventilated patients demonstrated significant savings in hospital charges (n = 160 pairs). Length of stay was significantly reduced for patients referred for hospice (n = 112). This type of multifaceted approach is necessary for the evaluation of a service with multiple components that would be difficult to capture with a single analytic approach. This report suggests efficacy of our palliative care service in terms of patient outcomes, provider satisfaction, caregiver satisfaction, and cost savings.

Adolescent↗
PubMed2006

What is most important for you to achieve?: an analysis of patient responses when receiving palliative care consultation.

BACKGROUND: Hospitalized patients with a wide range of serious, but not necessarily terminal illnesses are now receiving palliative care consultations. The purpose of this report is to describe what palliative care patients say is "most important to achieve" at the time of initial consultation. METHODS: We conducted a retrospective descriptive content analysis of patient responses to the question "What is most important for you to achieve?" recorded at the time of initial inpatient palliative care consultation. Two hundred fifteen patient records had documented first-person patient responses recorded. These responses were independently reviewed and categorized in a four-phase iterative process. RESULTS: Responses were divided into four major categories: (1) Improving quality and meaning ("I want to be able to sit on my front porch and watch the farm go by.") (52%); (2) Achieving relief or comfort ("Can you get rid of my pain?") (34%); (3) Altering the trajectory of illness ("If there is a treatment that can make me well, I want it.") (22%); and (4) Preparing for dying ("I am not afraid of dying. I just don't want to suffer.") (11%). Five percent of responses were unable to be reliably categorized ("You ask hard questions."). Some respondents gave more than one response, so the total is greater than 100%. CONCLUSIONS: Patients receiving palliative care consultation give a wide range of responses to the question "What is most important for you to achieve?" Such patient-centered inquiry about priorities deserves more systematic study in the future if patient-specific goals are to be a marker of high-quality palliative care.

Aged↗
PubMed1998

Patient satisfaction with telemedicine consultation in primary care: comparison of ratings of medical and mental health applications.

OBJECTIVE: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. METHODS: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis. RESULTS: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction. CONCLUSIONS: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.

Adjustment Disorders↗
PubMed1981

Consultation in the coagulation laboratory. A conceptual analysis.

Physicians can play an important role as consultants in the utilization of laboratory data by providing interpretation, recommending action, and presenting rationale. These activities have been quantitated in 382 consecutive consultations provided by pathologists in the coagulation laboratory, and their statistical interrelationships have been analyzed. Quantitative characterization of the consultation is important, since the pathologist's professional role in patient care may no longer remain informal and undocumented. However, analogous evaluations can be applied to expose, evaluate, and improve the properties of clinical consultation in general.

Blood Coagulation Tests↗
PubMed1995

Collaborating with re-engineering consultants: maintaining resources for the future.

The negotiations of a pharmacy department with a consulting firm hired to help cut the institution's staff are described. In July 1994 Duke University Medical Center announced its intention to reduce the number of full-time equivalents (FTEs) from 6500 to 5000 and hired a consulting firm. The pharmacy department was scheduled to be studied for 16 weeks. The entire pharmacy staff was educated about the initiative and about what management expected of the staff during the process. Each assistant director of pharmacy was asked to lead the "operations improvement process," as the re-engineering plan was called, in his or her area of responsibility. The assistant directors were to describe key work activities and their time requirements and develop instruments for measuring work activities. Data were collected on supplemental resource requirements for paid time off and educational and meeting time. Resource requirements for clinical pharmacy specialists and other selected staff members were determined separately. The data were collected for one fiscal month, and the assistant directors then began negotiating human-resource requirements with the consultants. The director finalized the negotiations and presented the results to the hospital's leaders and the consulting firm's executives. It was proposed to reduce total pharmacy FTEs by only 5%, and the department actually gained 1 pharmacist FTE. Far greater reductions were proposed for most other departments (the entire medical center lost more than 800 FTEs). The pharmacy department at Duke dealt successfully with a re-engineering initiative. Strategies that contributed to the success included teamwork, active participation by the entire staff, empowering a core group to help lead in the process, and substantiating the value of the pharmacy's services to the medical center and its patients.

Consultants↗
PubMed1983

Psychometric comparisons of trainees and consultants in anaesthesia and psychiatry.

Two psychometric tests were taken by trainees in anaesthesia and psychiatry, and by consultant practitioners in these specialties. The Cattell 16 Personality Factor Questionnaire measured primary and secondary aspects of personality. The Strong-Campbell Interest Inventory assessed interests, and compared the results with those of the test's control subjects who worked satisfactorily in one of 162 occupations. All clinician groups scored highly in intelligence, innovation, self-sufficiency, and interests in the arts and medical science. Anaesthetic trainees were very similar to psychiatric trainees except in the quality, tender-mindedness, in which the psychiatrists' mean score was much higher. Trainee anaesthetists closely resembled consultants in that specialty, except that the younger group was more apprehensive and less conscientious. Consultant anaesthetists were more conscientious, realistic, conventional, and had more "tough-poise" than consultant psychiatrists, who were higher in social interests and tender-mindedness. These differences appear to be largely the result of the types of practice in these specialties, rather than reasons people chose their fields. It is unlikely that these tests would be useful in the process of trainee selection, but the possibility that psychometric tests could be devised for that purpose must be considered.

Adult↗
PubMed1994

Postal survey of paediatric practice and training among consultant anaesthetists in the UK.

A postal survey of previous paediatric anaesthetic training, current paediatric experience and management of an infant pyloromyotomy was undertaken among consultant anaesthetists in the UK. A total of 851 questionnaires were returned, giving a response rate of 31%; 352 (41%) consultants had at least one paediatric list each week, 180 (21%) anaesthetized more than one infant less than 6 months old each month and 373 (44%) had obtained more than 6 months' specialist training. Consultants trained most recently had received significantly longer (P < 0.001) specialist training than their senior colleagues: 558 (66%) consultants dealt with infants requiring a pyloromyotomy, 348 with one or two cases annually. Two-thirds preferred to use an i.v. induction technique and less than half used cricoid pressure. Choice of technique was related to the duration of specialist paediatric training and when it was received, but not to current paediatric anaesthetic experience. The results are discussed in relation to recently published recommendations on paediatric anaesthetic services.

Anesthesia↗
PubMed1996

"Curbside" consultation and informal communication in medical practice: a medicolegal perspective.

In assessing whether a consulting physician is liable as a result of an informal ("curbside") communication, courts examine all of the facts and circumstances to determine if a physician-patient relationship existed. Merely answering a colleague's question or performing a curbside consultation may not give rise to a physician-patient relationship; hence, there is no liability. When duty of care can be established, a physician may be liable for medical malpractice. Infectious diseases physicians with contractual managed-care roles may have an unrecognized duty of care and may actually be at increased risk of liability. Physicians are also under duty to act as any reasonably prudent person would act on the basis of any foreseeable risk of injury to others. In general, physicians should encourage formal consultation when expert advice is sought because a more reliable and complete exchange of information occurs before an opinion is rendered in this setting. While informal interchange between colleagues is often of educational benefit, consultants should avoid giving specific advice about a patient whom they have not examined, answer queries in general terms, and consider keeping a written record of the interaction.

Communication↗
PubMed1996

A comparison of methods for measuring patient satisfaction with consultations in primary care.

BACKGROUND: Attention needs to be paid to comparing and standardizing methods for measuring patient satisfaction with consultations in primary care. OBJECTIVES: To compare the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ) in terms of acceptability, distribution of responses, reliability and gather evidence of validity. In addition, to compare the scores of patients completing the questionnaires immediately after the consultation in the general practitioners' surgeries with those completing the questionnaires later at home. METHODS: The two questionnaires were bound as a single instrument with order determined at random. This was given to patients immediately after their consultations in eight practices in South Glamorgan. RESULTS: One hundred and ninety-eight of 316 (63%) patients completed and returned questionnaires. The distributions of patient satisfaction scores for the two questionnaires were very similar. For the MISS: mean 76.6% (SD 11.4); for the CSQ mean 7.2% (SD 12.6). Correlations between sub-scales ranged from 0.58-0.84 for the MISS and from 0.40-0.79 for the CSQ. The correlation between the overall scales was 0.82. Levels of reliability for the scales and sub-scales were fair to good ranging from 0.78-0.96 for the MISS and from 0.73-0.94 for the CSQ. CONCLUSIONS: The study does not identify one scale as being superior in psychometric terms, however by demonstrating consistency of responses it provides support for the scales as measures of patient satisfaction for use in primary care. The level of inter-correlation suggests that the sub-scales may not be clearly independent of each other and suggests that total scores may be preferred. Lower levels of satisfaction are expressed if patients complete questionnaires at home rather than in general practitioners' surgeries.

Adolescent↗
PubMed2000

Using video-recorded consultations for research in primary care: advantages and limitations.

BACKGROUND: Video-recording primary care consultations is an established technique for primary care research. Despite the widespread use of video-recording to help answer a variety of research questions, little is known about how this recording technique influences the findings of studies in which it is employed. OBJECTIVE: This article investigates how video-recorded consultations have been used in research and discusses how this technique may influence both the internal and external validity of studies. CONCLUSION: Using video-recorded consultations for research purposes may cause bias in the characteristics of doctors and patients who agree to participate in research. There is little evidence, however, that video-recording influences the behaviour of either GPs or patients. Recommendations are made for researchers who are considering using video-recorded consultations in their research.

Bias↗
PubMed2001

Are headache patients who initiate their referral to a neurologist satisfied with the consultation? A population study of 927 patients--the North Norway Headache Study (NNHS).

BACKGROUND: Headache is a common problem in primary care. Although most patients are treated by GPs, many are referred to specialist consultation. Knowledge of how the referrals can be improved is therefore an important issue. OBJECTIVES: The aim of this study was to determine the relationship between self-initiating referral to a neurologist and the patient's satisfaction with the specialist consultation. METHODS: All patients who had been examined by a neurologist for headache within a 2-year period from three neurological centres in North Norway completed a questionnaire. RESULTS: A total of 1052 patients from a population of 1403 headache patients (75%) returned the questionnaire while 927 patients answered questions about initiating the referral to the specialist. Two hundred and twenty patients (24%) initiated the referral to the neurologist themselves; 52% of those who self-initiated the referral were dissatisfied with the specialist consultation compared with 42% of those referred by the doctor, P = 0.002. Chronic headache, tension-type headache (TTH) and daily use of analgesic drugs were associated with dissatisfaction. CONCLUSIONS: Patients with headache who initiated the referral to a neurologist themselves were less satisfied with the specialist consultation. Selecting referrals containing proper medical information may improve satisfaction in severe headache patients treated in a neurological practice.

Adult↗
PubMed1990

The association between peer consultations and three aspects of clinical competence.

The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1991

Costing consultations in general practice: towards a standardized method.

The cost of a consultation with a general practitioner forms an integral part of many economic evaluations. If resources are to be allocated efficiently it is necessary to provide accurate costings. Despite this, the research literature lacks any established method for costing consultations. This paper reviews some of the approaches used in previous studies, considers some of the issues involved in costing consultations, and provides some guidelines to follow when costing general practitioner consultations.

Costs and Cost Analysis↗
PubMed2004

Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee.

BACKGROUND: Symptomatic knee problems in elderly people are considerably more common than hip problems, yet far more hips are replaced. OBJECTIVE: The purpose of this study was to investigate whether systematic differences occur in early primary care management of elderly patients who first consult with hip versus knee symptoms. METHODS: A prospective analysis was carried out of anonymized records in the MediPlus general practice database. This was a 3 year (1996-1998) prospective study of 310,843 patients aged 65+ regarding consultations about a new hip or knee problem. Survival analysis techniques were used to analyse time to and frequency of various interventions. RESULTS: A total of 1410 new hip and 3152 new knee consulters were identified. Baseline characteristics of the two groups were very similar. By 3 years following the first consultation, more of the hip cases had referral to a specialist (38.2% hips versus 31.5% knees, P <0.001) and joint replacement (9.6% hips versus 1.8% knees, P <0.001) recorded. Non-steroidal anti-inflammatory drug (NSAID) prescribing was high for both groups, with approximately 51% prescribed one of the safer forms and approximately 15% prescribed one with a lower safety record within 3 years. CONCLUSION: Rates of specialist referral and joint replacement in older people are much lower, or slower, for those with symptomatic knees relative to hips. In the absence of surgery, prescriptions for pain killers are similar for both groups. Elderly people with symptomatic knees are therefore at increased risk of drug side effects relative to those with symptomatic hips. This may represent another facet of unmet need for surgery in people with knee disease.

Aged↗