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At least 1,531 records · Page 85Linked to original sources
PubMed1996

The value of consultation-liaison interventions to the general hospital.

Changes in health care funding have greatly enhanced the value of consultation-liaison services to their parent hospitals. This paper reviews representative studies showing that consultation-liaison interventions improve patient care, enhance patients' satisfaction with treatment, and reduce polypharmacy, adverse drug reactions, and subsequent hospitalizations. Reductions in costs of hospitalization realized by consultation-liaison interventions are also described, including average reductions in hospital stays of one to one and a half days, upgrades in diagnosis-related group (DRG) codes, and timely patient transfers to inpatient medical-psychiatric units or inpatient psychiatric facilities. These data suggest that consultation-liaison services will become increasingly important over the next few years.

Combined Modality Therapy↗
PubMed1997

Consumer satisfaction with telemedicine child psychiatry consultation in rural Kentucky.

Forty-three rural Kentucky families who obtained child psychiatry consultation during the initial eight months of the University of Kentucky's telemedicine program completed questionnaires assessing their satisfaction with telemedicine. Respondents were 46 parents and nine children. All respondents reported that they were very satisfied with the consultation; all of the children and 98 percent of the parents reported that they were as satisfied with the telemedicine consultation as with an in-person visit. Few respondents reported nervousness about using the equipment. These results suggest that child psychiatry consultation via telemedicine provides high levels of satisfaction for both children and adults.

Academic Medical Centers↗
PubMed1975

Consultation with the filipino boarding home: an after-care facility in Hawaii.

This report describes a unique Hawaiian after-care facility the Filipino operated boarding home, and the approaches useful in consultation with the operators. The majority of the boarding homes for psychiatric patients are operated by recent Filipino immigrants. This fact is explained by their current social position and also by cultural values--such as aiding others and an extended family system--which are present in the Philippines. In consultation with seventeen such boarding home operators, cultural beliefs and values played a great part in their approach to patients. These approaches created special problems and assets in their management of patients from other ethnic groups such as Japanese, Caucasian and Hawaiian. A problem-oriented approach to consultation proved useful initially and set the stage for other forms of intervention. This included allowing the operator to ventilate her feelings about the patient; bridging the communication gap between operators and patients; dissipating the operators' stereotypic perception of patients; and educating the operators about mental illness. Our impressions and indirect evidence indicated that Filipino boarding home operators perform a useful service and, with consultation sensitive to their values, can become even more effective.

Aftercare↗
PubMed2001

Cover arrangements for consultants on leave: an analysis of job descriptions.

There is much ambiguity about consultant leave allowances and arrangements for cover in the National Health Service. We analysed job descriptions for 47 consultant posts advertised in mid-2000. 35 defined a duty rota but only 3 mentioned specific available leave (all different). In 32 there was no mention of cover for colleagues on leave. When a consultant is absent, colleagues tend to provide cover for emergency cases but not for elective admissions, which are managed largely by junior doctors. This arrangement is particularly hazardous in surgical specialties. If elective surgery is to continue when the consultant is absent, arrangements for leave and cover need to be more clearly defined.

Consultants↗
PubMed2005

The development of behaviorally based public school consultation services.

This article describes the development of behavioral school care consultation services to public schools within a not-for-profit community behavioral health organization. An overview of the process of behavior consultation is presented. A description of the growth of behavioral school consultation services is outlined in regard to (a) the types of consultation, including individual, school-wide, and district-wide services; (b) trainings in empirically validated assessment and interventions; and (c) the development of an internship and postdoctoral fellowship program. A review of the growth of applied research, particularly in the area of school-wide interventions and its dissemination, also is presented.

Behavior Therapy↗
PubMed1986

The use of surveys as a critical tool in consultation: the coronary primary prevention trial.

Selected findings from each of three surveys administered to the staff of the Canadian site of the Coronary Primary Prevention Trial during a consulting assignment are provided to illustrate the benefits of using surveys in Mental Health consultation. As demonstrated, survey results can assist the consultant to identify and prioritize staff concerns, convince management of the need for action and direct and monitor consulting activities over time.

Anticholesteremic Agents↗
PubMed1988

[Psychiatric consultation at a general hospital (II): The problem of the patient with a somatic disorder].

The article presents the difficulties of the psychiatric consultation with patients having somatic complaints. A model of evaluation and intervention is proposed in which the link between the somatic complaint and the doctor-patient relationship is emphasized. A closer look at the manifest request for consultation often leads to interpreting the consultation as a symptom of the patient's relationship to his doctor. The consultation is often a confrontation with the hidden conflict of the patient embedded in his symptom, but actualized with his referring doctor. The focus is on the patient as the agent of his trouble. A clinical vignette is presented.

Adult↗
PubMed1988

Alcohol and drug problems: a challenge to consultation-liaison psychiatry.

Although alcohol and drug problems are prevalent in the population at large and among patients in general hospitals, they have not been a major concern of consultation-liaison psychiatry. A setting in which all psychiatric consultations are directed to such problems, the Clinical Institute of the Addiction Research Foundation, is described, and parameters of its consultation experience are explored. It is suggested that dealing with alcohol and drug problems should become an integral aspect of consultation-liaison psychiatry. Such a development may prove to be especially fruitful in teaching a comprehensive approach to patient care.

Alcoholism↗
PubMed1988

Psychiatric consultations in rheumatology: a review of 100 cases.

Consultation-liaison psychiatry has contributed much to our understanding of the psychological complications of physical illness, both in general responses to illness and in particular problems related to specific diseases. We reviewed 100 psychiatric consultations from a specialized rheumatology unit. Eighty percent of the consultations consisted of patients with systemic lupus erythematosus (36%), rheumatoid arthritis (29%), and fibrositis (15%). The majority of S.L.E. patients had organic brain syndromes related to central nervous system involvement or corticosteroids, while the majority of rheumatoid arthritis patients had a depressive diagnosis. Fibrositis patients showed no specific psychiatric diagnosis. Some future areas of research for consultation-liaison psychiatry in this area are suggested.

Adaptation, Psychological↗
PubMed1997

Child psychiatric consultation service to community agencies: a collaborative approach involving three community agencies.

OBJECTIVE: To report the early experience of a multiagency child psychiatric consultation service. METHOD: The program is described, and the demographic characteristics of clients referred to the consultation program over the first 25 months of operation are presented. Referrals were examined for demographics and the questions consultees wanted to have answered. RESULTS: In 59 of 100 consultations, physical and/or sexual abuse was proved or highly suspected. In 82 of the 100 cases, consultees had questions pertaining to management issues. Questions related to diagnostic issues numbered 62, and there were 45 questions about safety issues. CONCLUSION: Effective psychiatric consultations services to rural areas can be established. Once established, the questions of consultees can provide an effective training ground for future community-oriented child psychiatrists.

Adolescent↗
PubMed2004

An initial evaluation of the design of pediatric psychology consultation service with children with diabetes.

The objective of this study was to review the process of psychology consultation with an outpatient pediatric diabetes service, and provide data regarding assessment and outcome. The purpose was to demonstrate that the inclusion of psychology in the care of the child would enhance the effectiveness of treatment delivery. Over a one-year period, 91 psychological consultations were reviewed for information related to reasons for referral, diagnosis, and treatment. Processes of assessment and collaboration are described. Nearly half of all the participants that were referred for a consultation met the criteria for a psychiatric disorder, including Attention-Deficit Hyperactivity Disorder, mood disorder or anxiety. Paired t-tests revealed significant improvement in metabolic control from referral to the next clinic appointment. Psychological consultation appears to have a positive impact on selected health outcomes. Given the large number of children with psychiatric disorder, psychological intervention may facilitate adherence and reduce complications associated with poor metabolic control.

Adolescent↗
PubMed1995

A comparison of consecutive orthodontic referrals seen by a consultant unit and specialist orthodontic practitioners.

It has been suggested that the consultant orthodontic service and specialist practitioner service should have different roles, with the former concentrating its treatment input on the management of severe malocclusions. In an attempt to determine whether referring dental practitioners appeared to be aware of these differences, 100 consecutive orthodontic referrals seen at a consultant orthodontist's clinic were compared and contrasted with the same number seen at each of four specialist orthodontic practices located in the same city, and within 4 miles of the consultant unit. Comparisons were made both on the basis of clinical information obtained from study models and from analysis of referral letters. The consultant sample contained a greater proportion of requests for treatment plans, but there were few differences in terms of the range and severity of the actual malocclusions referred to each of these specialist services. The implications of these findings are discussed in relation to possible future developments of orthodontic services in the U.K.

Community Dentistry↗
PubMed1998

Association between health-related quality of life and consultation for respiratory symptoms: results from the DIMCA programme.

In general practice, diagnosis of chronic obstructive pulmonary disease (COPD) is hampered by underpresentation. A substantial proportion of subjects experiencing respiratory complaints do not consult their general practitioner (GP). In this study, the relationship between disease-specific quality of life and presentation of respiratory symptoms to a GP is investigated. A random sample from the general population (undiagnosed subjects) was screened for symptoms and objective signs of COPD (n=1,155). The lung function of subjects with symptoms of COPD was monitored for 6 months. During this period, 48 new COPD patients with a persistently reduced lung function (forced expiratory volume in one second (FEV1) less than or equal to the predicted value minus 2 SD) were detected. A disease-specific quality-of-life questionnaire (chronic respiratory questionnaire (CRQ)) was administered and clinical and GP consultation data were collected. Multivariate analysis showed that quality-of-life impairments due to dyspnoea and fatigue and variability in lung function (bronchial hyperresponsiveness, reversibility and peak expiratory flow rate variability) were related to medical consultation. Only 31% of the newly detected patients reported that they had ever visited their GP for respiratory complaints. A similarly low percentage was found in the rest of the sample (26%). It is concluded that the mere presence of respiratory symptoms or a (gradually) reduced lung function is insufficient reason for patients to seek medical help. Subjects are more likely to consult their general practitioner once their quality of everyday life is affected or they experience variability in lung function.

Adult↗
PubMed2006

Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation.

BACKGROUND: Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. METHODS: For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. RESULTS: The mean NTAA rate was 27.5%--ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48-1.76) and lower with increasing age (RR 0.96, CI 0.93-0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51-0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18-1.78) and lowest for chest pain (RR 0.18; CI 0.06-0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04-1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). CONCLUSION: Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.

Adult↗
PubMed2002

Communication between consultants and referring physicians: a qualitative study to define learning and assessment objectives in a specialty residency program.

BACKGROUND: Outpatient consultation constitutes a major part of medical practice. However, little is known about the skills which should be taught to residents in order for them to improve their consultant-referring physician relationships. PURPOSES: To specify the consultant skills which are required to ensure an effective communication between specialists and referring physicians. METHODS: A qualitative study based on (a) a literature search and (b) focus group interviews. RESULTS: Skills thus identified and described are classified in two groups: observable skills and principles/attitudes. CONCLUSIONS: The consensual specification of these abilities permits a greater efficacy in the teaching of consultant skills.

Ambulatory Care↗
PubMed2003

Remote critical care consultation: telehealth projection of clinical specialty expertise.

Remote critical care consultations have been employed between the Naval Hospital in Guam and the Tripler Army Medical Center in Hawaii, a distance of 5300 km. During a 10-week study period there were physician-physician daily consultation rounds for patients in the intensive care unit at the Naval Hospital. Physiological data, video-images and sound were transmitted via a 768 kbit/s frame relay connection, albeit with a 1-3 s delay. During the study there were 87 consultations concerning 25 patients. Preliminary results showed that a broad range of critical care patients could be managed effectively through daily remote critical care consultation. Broader implementation of this strategy may represent a method of making critical care expertise available to front-line military health-care facilities and to remote civilian facilities with limited critical care expertise.

Critical Care↗
PubMed2006

How to do a telemedical consultation.

In a telemedical consultation, medical information is sought at a distance. Two techniques may be used: asynchronous ('store and forward') and synchronous ('realtime'). Asynchronous consultations have the advantage that the two parties do not have to be available simultaneously; email, for example, has been used successfully for teledermatology. Synchronous consultations depend on communication media such as the telephone, radio or videoconferencing. Successful videoconferencing will involve consideration of four factors: the environment, session initiation, dialogue and session closure. The environment is very important for good-quality consultations and involves planning, equipment and training. Recognizing the advantages and limitations of the available media combined with appropriate planning and training will maximize the utilization of teleconsultations.

Delivery of Health Care↗
PubMed1999

Tele-otolaryngology consultations between two rural primary-care centres in southern Lapland and the University Hospital of Umeå.

In 1996 a telemedicine link was established between two primary-care centres of Västerbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultation. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.

Health Care Costs↗