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PubMed1993

[Consultation-liaison psychiatry: a prospective study in a general hospital milieu].

This study was conducted in Halifax, Nova Scotia, in a 740 bed university general hospital. For a period of two years, a prospective collection of data on 692 psychiatric consultations showed that 60% of all consultations came from internal medicine departments. Medical and psychiatric comorbidity was found in 50% of the patients; depression was diagnosed in 27.5% of the cases but schizophrenia in only 1.7%. Suicidal ideation was reported by 24% of the patients, 11.6% of them wishing to die imminently. More than 50% of suicidal patients were under 35 years of age; 42% of them were dependent on alcohol. Almost 30% of the patients seen in consultation admitted to being addicted to alcohol, 22% to benzodiazepines and 14% to illicit drugs. Among the ex-alcoholic patients, a significant dependence in benzodiazepine use was found. The patients with addictions to street drug had a greater suicide risk and were at the same time abusing alcohol. This paper will describe the overall functioning of a consultation-liaison psychiatric service and will analyze the impact of psycho-active substance abuse in a general hospital setting. The results will be compared with those in the literature.

Adolescent↗
PubMed2003

The structure of lay consultation networks: managing illness in community settings.

OBJECTIVE: We examined the structure of lay consultation networks among elderly people. METHODS: Data were gathered through interviews with 548 elderly adults living in Florida retirement communities and in Cleveland. Respondents identified people they consulted about symptom or disease information, health worries, what the doctor said, and consulting health providers. Network size, composition, geographic dispersion, gender homogeneity, and division of labor were assessed. RESULTS: Eighty percent identified at least one network member (range = 1 to 7 consultants). Networks largely consisted of family members, particularly spouses and women. Older adults talked most frequently with network members about physician visits. Widowed individuals were more likely to rely on children and friends and have networks outside their neighborhoods than married elders. Women's networks included a broader range of relationships than men's networks. DISCUSSION: Results reaffirmed the importance of gender in structuring networks in late life. The low prevalence of friends supports Cartensen's Selectivity Theory.

Aged↗
PubMed1995

Symptom consultation in lay networks in an elderly population.

Although lay referrals are known to be important as factors affecting the use of professional services, less is known about how individuals use lay consultation in evaluating symptoms. The amount and type of advice given by persons in the social network is especially important with respect to self care of symptoms that never reach the attention of professional caregivers. This article provides information on how often and from whom elderly citizens seek and receive consultation, such as family and friends, when they experience common symptoms. Findings suggest that female relatives are important sources of advice but that neither gender nor living arrangements are closely related to the tendency to seek lay advice for common symptoms. Subjects who consulted lay advisers about arthritic symptoms also were more likely to seek professional consultation.

Age Factors↗
PubMed2004

Satisfying the patient in primary care: a postal survey following a recent consultation.

BACKGROUND: Factors over and above the skills of the health care professional appear to impact on how well patients can cope with an illness following a consultation in general practice. These other factors appear to relate to the organisation and fabric of the doctor's practice. This study reports a systematic analysis of responses to a questionnaire survey of patients following a telephone consultation in a general practice setting. This study aims to explore how views on specific aspects of a general practice service contrast among patients. METHODS: A structured anonymised postal questionnaire was sent to 916 patients within 24 h of a telephone consultation with a doctor or nurse in five general practices in North Trent, UK. No reminders were sent. Included on the questionnaire were free-text questions that invited opinions on areas for improvement for the patients' registered practice. These were analysed qualitatively using content analysis by two independent researchers. RESULTS: The overall response rate was 52% although responses from young men were under-represented in the survey. One in three responders expressed a need for improvements in the appointments, more access and less delay before practice. Five themes and a number of sub-themes were identified. Patients wanted more appointments. Other themes included a desire for better communication, more patient friendly policies and facilities. Analysis suggests that it would be very difficult to satisfy the contrasting and divergent needs of all patients. CONCLUSIONS: Communication with patients in general practice is influenced by the fabric, policies and reception staff in the practice as much as by the skills and resources of the care provider. Seeking patients' opinions about the practice within the context of a recent telephone consultation unearthed conflicting desires that cannot be satisfied given existing resources in the National Health Service (NHS). Patients favour a speedy, convenient and above all, tailored service. This may be impossible to deliver universally. Attention to the non-doctor aspects of the service may enhance the ability of practitioners to enable patients to cope with illness. The data suggest that patients are not universally satisfied with the service provided and that it would be naive to attempt to please them all.

Female↗
PubMed2005

Satisfaction is not all--patients' perceptions of outcome of general practice consultations, a qualitative study.

BACKGROUND: Evaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP. METHOD: Patients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach. RESULTS: From the patient's perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction. CONCLUSION: General practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.

Adolescent↗
PubMed2000

The 'right kind' of pain: talking about symptoms in outpatient oncology consultations.

Despite improvements in cancer management over the past 25 years, unrelieved symptoms continue to be reported. Little is known about how patients' problems and concerns are communicated to professionals during oncology treatment. This qualitative study investigates the process of communication between cancer patients and oncologists during consultations in outpatient clinics of a regional teaching hospital. Data were collected by nonparticipant observation and audiotaping consultations. Analyses were by qualitative content analysis and conversation analysis. An objectives, strategies and tactics model was applied to organize the findings. Seventy-four consultations between cancer patients and 15 doctors were observed and audiotaped. Pain talk is defined and identified as a substantial topic, occurring in 39 out of 74 consultations. Doctor-initiated questions are the predominant discourse feature and are prominent not only in initiating discussions but also in directing further talk (e.g. over three-quarters of doctor-initiated questions are in a closed form which focus narrowly on limited physical aspects of patients' pain). This limited information exchange is used alongside other communication tactics to identify the 'right kind' of pain that may benefit from cancer therapy and to truncate talk of problems perceived to be outside of this specialist remit. Although individualized, holistic care is the expressed philosophy of the clinic, our data show that doctors tightly control the agenda to focus narrowly on pain which was amenable to radiotherapy, chemotherapy, surgery or hormone manipulation. Inadequate exploration of patients' pain is likely to be detrimental to symptom control.

Adult↗
PubMed2001

Is videotaping of consultations acceptable to patients attending a hospice day centre?

The use of a videotape recorder to analyse consultations in UK general practice is accepted, well established and has been extensively researched. The technique has potential in palliative medicine for training and the continuing assessment of communication skills as part of peer review. However, there have been no published studies on whether or not videotaping of consultations would be acceptable to a hospice population. Using a semi-structured questionnaire, we interviewed 31 patients who had agreed to have their consultation with a doctor videotaped. Although 30 (97%) did not regret having given permission and would 'definitely' or 'possibly' agree to another recording in the future, three (10%) felt that the procedure had been inadequately explained to them, six (19%) felt that they were 'possibly' or 'definitely' not given sufficient notice of the recording and one patient felt under pressure to agree to the recording. These findings suggest that if videotaping of consultations in the hospice setting is to be undertaken, more advanced notice than that usually given in general practice is required and strict safeguards should be in place to protect vulnerable patients.

Ambulatory Care↗
PubMed2000

Lupus patients in an emergency unit. Causes of consultation, hospitalization and outcome. A cohort study.

The objectives were to determine causes of consultation, hospitalization and outcome in a cohort of lupus patients in an emergency unit. Patients with systemic lupus erythematosus (SLE) who visited the emergency department for consultation from 1 September 1996 to 17 May 1997 were included in the study. They were evaluated during the visit by looking at 100 variables such as demographic, socioeconomic, clinical, therapeutical, behavioral, (compliance), emotional (Beck depression inventory), disease activity, (Mex-SLEDAI), disease severity (Lupus SDI), chronic damage (SLICC-ACR), and physician's and patient's global assessments of severity. All causes of consultation, hospitalization and outcome were registered. Descriptive statistics, univariate analysis and multiple logistic regression were used for analysis. Significance was set at the 0.05 level. 180 patients were included. 164 were female, mean age 31.7/11.39 y, mean Mex SLEDAI score 3.8, mean SLICC-ACR 1.3. Fever, poliarthralgia and abdominal pain were the main causes of consultation with 26, 25 and 18 cases each. 49 patients were hospitalized and these were statistically different than non-hospitalized patients in level of formal education (10.2 vs 11.8, P=0.03); compliance (7.6 vs 9, P=0.0001); malar rash (57% vs 82%, OR, 95% CI=0.28, 0.13-0.62, P=0.0008), chloroquine daily dose intake (45 vs 77 mg, P=0.04); disease severity in physician's global assessments (5.6 vs 2.1, P=0.0001) and Beck depression inventory (21 vs 16, P=0.01). Multiple logistic regression identified physician's global assessment, fewer ACR criteria and higher SLICC-ACR scores as the main variables associated with hospitalization. Five patients died; two with community acquired pneumonia, one with pancreatitis, multiple thromboses, and sepsis, one with pulmonary hemorrhage; and one with pulmonary thromboembolism. In conclusion, poor compliance, low level of formal education, severity, depression, lower ACR criteria and higher SLICC-ACR scores were important variables identified with hospitalization. Chloroquine use seemed to have a protective effect. Causes of death were related to infections and antiphospholipid syndrome.

Adolescent↗
PubMed2005

Keynote address: Toward a pragmatic model for community consultation in emergency research.

Under the Final Rule enacted in 1996 by the United States Food and Drug Administration and Office of Health and Human Services, community consultation and public notification are required when emergency research is to be conducted in the absence of prior informed consent by subjects. There is a dearth of published recommendations concerning the degree to which communities must be aware of the existence and parameters of a study for which informed consent might not be obtained prior to enrollment. It is argued that effective community consultation requires empirical measurement of the dynamics of community, and that ordinary notions of community may not capture the populations at greatest risk or those who might for other reasons figure most prominently in community consultation. A pragmatic approach to community consultation would establish benchmarks for such measures, and it is argued that such an approach is possible given the correct empirical measures.

Community-Institutional Relations↗
PubMed2000

Effect of providing cancer patients with the audiotaped initial consultation on satisfaction, recall, and quality of life: a randomized, double-blind study.

PURPOSE: By means of a randomized double-blind study, the effect of providing taped initial consultations on cancer patients' satisfaction, recall, and quality of life was investigated. PATIENTS AND METHODS: Consecutive cancer patients referred to either the gynecology or medical oncology outpatient clinic were eligible. Initial consultations were audiotaped. Patients were either provided with the tape (experimental group) or not (control group). Baseline variables included sociodemographics, preferences for information, coping styles, and clinical characteristics. Follow-up (after 1 week and 3 months) variables included attitudes toward the intervention, satisfaction, recall, and quality of life. Assessments took place through mailed questionnaires and telephone interviews. RESULTS: Two hundred one patients were included (response, 71%), 105 in the experimental group and 96 in the control group. Most patients (75%) listened to the tape, the majority of which (73%) listened with others. Almost all patients, both in the experimental group (96%) and control group (98%) were positive about the intervention. Expectations were confirmed; patients provided with the tape were more satisfied (P <.05) and recalled more information (P <.01) than patients without the tape. The intervention did not have an effect on quality of life. An interaction effect was found between the intervention and patients' age on satisfaction with the taped consultation (P <.01) and recall of diagnostic information (P <.01); access to tapes seems more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients. CONCLUSION: Cancer patients and their families value the taped initial consultation. This intervention enhances their satisfaction and improves their recall of information. Tapes seem more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients.

Adaptation, Psychological↗
PubMed1982

Social work consultation for small hospitals.

Rural health care settings are often small and have limited resources to devote to programs such as social services. This article describes a social work consultation program designed to upgrade health care in small hospitals lacking social service departments or personnel. Consultation services were directed toward the training and use of existing staff, rather than the more common arrangement of direct service provision by the consultant. Strategies for consulting across disciplines are suggested.

Hospital Bed Capacity↗
PubMed2004

The effect of esthetic consultation methods on acceptance of diastema-closure treatment plan: a pilot study.

BACKGROUND: The authors conducted a study to determine which of four consultation methods helped patients best understand a proposed treatment plan for maxillary anterior diastema closure. METHODS: The authors presented 24 subjects with four types of consultation in random order: before-and-after photographs of other patients, diagnostic models with wax setups, resin-based composite/esthetic preview/mock-ups and computer-imaging simulations. After viewing each method, the authors asked the subjects about treatment acceptability. At the end of the demonstrations of all four methods, the authors asked the subjects which consultation method helped them best understand the proposed treatment plan. RESULTS: A total of 87.5 percent of the subjects indicated that they would accept the proposed treatment plan after they were shown the computer-imaging simulation, 50 percent said they would after they were shown the resin-based composite/esthetic preview/mock-up, 41.7 percent said they would after they were shown photographs of other patients, and 25 percent said they would after they were shown diagnostic models with wax setups. When asked which method helped them best understand the proposed treatment, 54.2 percent of the subjects selected computer-imaging simulation, 33.3 percent selected resin-based composite/esthetic preview/mock-ups, and 12.5 percent selected before-and-after photographs of other patients. None of the subjects selected diagnostic models with wax setups. A chi2 test for goodness of fit indicated that these differences were statistically significant. CONCLUSION: Subjects preferred computer-imaging simulation to the other three consultation methods, and they indicated that computer-imaging simulation provided a better understanding of the proposed treatment plan for diastema closure. CLINICAL IMPLICATIONS: The use of computer-imaging simulation enhances the patient's understanding of a proposed treatment plan concerning maxillary anterior diastema closure.

Adolescent↗
PubMed2004

Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport.

If the practitioner uses a clinical computer during consultation with the patient there may be adverse effects on the quality of interpersonal communication in the consultation. Greatbach et al showed in 1995 that these adverse effects might be minimised when the practitioner is well-practised and able to put in the background the tasks involving the computer. In the subsequent seven years, as clinical computer systems have become more sophisticated, the clinician may be called on to pay more attention to the content displayed on the computer screen. This study shows that this required level of attention cannot be put in the background, and that general practitioners (GPs) are not able to multitask at this level. Clinicians can use specific communication skills to manage the consultation, so that they are not called on to concentrate on the computer screen and the patient at the same time. The two tasks can be accomplished in the same consultation, but not simultaneously.

Attitude of Health Personnel↗
PubMed2006

[Epidemiological profile of consulting women at the prenatal service of a university hospital].

The characteristics of pregnant women in prenatal consultation are described in this article in a quantitative approach. The aim of this study is to identify this group by sketching its epidemiological profile. 118 attendance reports dated from January to June 2003 were investigated in the obstetrics service in a city of Rio de Janeiro public hospital. The analysis showed that the highest percentage is comprised of women in the age group of 19-25 years (39.8%); that are married (38.9%); have basic consultation between 14 and 17 weeks of pregnancy (18.6%); had previous vaginal birth (79%); have basic school education (29.6%); are housewives (33.8%); have more than one child (58.4%); and did not mention complaints in the first consultation (39%). It can be concluded that obstetric consultation can substantially help reduce morbi-mortality of pregnant women, since it makes possible the guiding of intercurrences and the prevention of troubles during and after the period of pregnancy.

Adult↗
PubMedDate not supplied

The effect of incomplete knowledge on the diagnoses of a computer consultant system.

The knowledge bases (KBs) of diagnostic decision support systems are often incomplete, and gaps in the KB could potentially lead systems to reach diagnoses that are implausible to physicians. To investigate this possibility we studied Iliad (Version 2.01), a computer consultant system that generates differential diagnosis across the domain of internal medicine. Data from the history, physical examination, and laboratory findings of 50 grand-rounds cases were entered into Iliad by a computer consultant aware of the diagnosis but blinded to its presence or absence in Iliad's KB. Two experienced internists were asked to diagnose these cases before and after seeing the results of the computer consultation, and to assess the plausibility of the computer's diagnoses. Twenty-eight of the 50 cases (56.0%) were diseases contained in Iliad's KB. After seeing Iliad's diagnoses for cases in the KB, physicians assigned to their correct diagnoses a higher mean ranked position (1.5 versus 2.0, p less than 0.008) and a higher mean probability (84.0% versus 77.6%, p less than 0.008) compared with their pre-Iliad values, whereas for cases not in the KB, mean position and probability for correct diagnoses did not change. Physician diagnostic accuracy did not change after consultation on cases included or not included in the KB. After adjusting for case difficulty, mean plausibility of Iliad's diagnoses was judged significantly higher (on a seven-point scale) for cases in the KB than for cases not in the KB (4.2 versus 3.2, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗
PubMed2001

A Descriptive Study of Psychiatric Consultations in a Community Primary Care Center.

BACKGROUND: This retrospective chart review study describes on-site psychiatric consultations at a large, urban community primary care center. The referral population, diagnostic reliability of primary care providers (PCPs) and social workers, appropriateness of PCP-initiated treatment, impact of treatment recommendations, and outcomes are examined. METHOD: Charts of all patients who received psychiatric consultations (N = 78) during an 8-month period (August 1996 to April 1997) were reviewed. RESULTS: Prereferral diagnoses by PCPs matched the psychiatrist's diagnosis based on DSM-IV diagnostic criteria approximately half the time. PCPs initiated psychopharmacology in half the referrals (39/78) and used generally appropriate medications (30/39) based on diagnosis by a psychiatrist, but at subtherapeutic doses (21/39). PCPs tended to continue medications recommended by the psychiatrist. At 1 year, PCPs clearly documented improvement in nearly a third of the consults (24/78). CONCLUSION: Diagnostic disagreement of caregivers, inadequate PCP psychopharmacology practices, and patient nonadherence are 3 main problems that impede optimal care within the model of psychiatric consultation described in this study.

Journal Article↗
PubMed1984

Non-consultant peripheral clinics: a new approach to diabetic care.

A system of non-consultant peripheral clinics (NCPCs) established on the Isle of Wight is described. For the first phase of the study 182 diabetics attending the consultant clinic were allocated to the appropriate peripheral clinic (group 1). In the second phase, 152 new referrals were prospectively allocated between the consultant and appropriate peripheral clinics (group 2). Evaluation was made of the patients' random blood sugar and glycosylated haemoglobin. The savings in cost and time to patients resulted in over 90% of patients preferring the peripheral clinics. NCPCs are discussed in relation to hospital-based clinics and to other alternative systems of care. It is concluded that NCPCs could be incorporated into the diabetic service in other regions in the United Kingdom with advantages to diabetics and hospital services alike. These peripheral clinics are suited to all types of diabetics and perhaps the only clinical restriction is the desirability for metabolic deterioration to be managed by a consultant clinic until the patient is satisfactory.

Adolescent↗
PubMed1999

Prenatal consultation after a fetal anomaly scan: videotaped exploration of physician's attitude and patient's satisfaction.

The main aim of the study was to evaluate the relationship between the physician's attitude (using the non-verbal Global Affective Measure of the Roter Analaysis System and the Counselor Rating Form-short version) and the satisfaction of the pregnant women with the prenatal consultation. A secondary aim was to evaluate the women's recall of essential information (i.e. location, severity, prognosis and cause of the anomaly). To this end, 24 prenatal consultations (pregnant women, partners and physicians) were videotaped following a fetal anomaly scan, and a few days later, the pregnant women completed questionnaires to assess their perception of the physician's attitude and their satisfaction with the consultation and the extent to which they could recall the essentials of the information given about the fetal anomaly. In descending order, the physician's dominance/assertiveness (i.e. being self-confident and decisive) (assessment of the videotapes by two psychologists), trustworthiness (women's report) and expertise were significantly positively associated with the women's overall satisfaction, i.e. satisfaction with the information given and affective behaviour on the part of the physician during the prenatal consultation. All the women (n=24) recalled the essentials of the information given about the location of the fetal anomaly. The majority of them correctly reproduced the severity, the prognosis and the cause of the anomaly. Our findings indicate that women in whom a fetal anomaly has been detected derive particular benefit from a self-confident, decisive, expert and trustworthy physician.

Adult↗