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Satria, Dedi, Zulfan Zulfan, Munawir Munawir, and Dewi Mulyati. "FINAL PROJECT CONSULTATION INFORMATION SYSTEM INTEGRATED NOTIFICATION SYSTEM BASED ON SMS GATEWAY." Cyberspace: Jurnal Pendidikan Teknologi Informasi 2, no. 2 (January 10, 2019): 135. http://dx.doi.org/10.22373/cj.v2i2.4002.
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The process of final project research consultations is now often done by making a schedule to meet with supervisors within the time set by students and supervisors. It is known that the consultation process by the way it is done now still has problems from the effectiveness of student research time and the distance between the research center and the location of the supervisor. With these problems resulted in students not being timely in conducting research consultations with their supervisors. Therefore, a system is needed that can provide a system of research consultations remotely using internet facilities that are integrated with the consultation notification system via the SMS Gateway. The methodology is built using the phases of context diagrams, data flow diagrams and entity relationships. The system is built using PHP programming, mySQL database and Gammu. The results of the final project consultation information system research integrated with the notification system using the SMS Gateway have produced several tables and forms, namely student forms, lecturer forms, consultation forms and document forms. The form has been able to provide a remote consultation system using web media and has been able to provide notification notifications to students and lecturers regarding the consultation status using the SMS gateway service. It is expected that this information system can facilitate students and lecturers in conducting more effective and efficient consultations.
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Bauer, Brenton S., Ai Len Nguyen-Phan, Michael K. Ong, Boback Ziaeian, and Kim-Lien Nguyen. "Cardiology electronic consultations: Efficient and safe, but consultant satisfaction is equivocal." Journal of Telemedicine and Telecare 26, no. 6 (February 25, 2019): 341–48. http://dx.doi.org/10.1177/1357633x19828130.
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Background Cardiovascular electronic consultation is a new service line in consultative medicine and enables care without in-person office visits. We aimed to evaluate accessibility and time saved as measures of efficiency, determine the safety of cardiology electronic consultations, and assess satisfaction by responding cardiologists. Methods Using a mixed-methods approach and a modified time-driven, activity-based, costing framework, we retrospectively analysed cardiology electronic consultations. A random subset of 500 electronic consultations referred between 2013–2017 were reviewed. Accessibility was determined based upon increased number of patients served without the need for an in-person clinic visit. To assess safety, medical records were reviewed for emergency room visits or hospital admission at six months from the initial electronic consultation date. Responding cardiologist satisfaction was assessed by voluntary completion of an online survey. Results The majority of electronic consultations were related to medication advice, clearance for surgery, evaluation of images, or guidance after abnormal testing. Recommendations included echo (10.8%), stress testing (5.0%), other imaging (4.0%) and other subspecialist referrals (3.8%). Electronic consultations were completed within 0.7±0.5 days of the request, with a time to completion of 5–30 min. Over a six-month follow-up, 13.9% of patients had an in-person visit and 2.2% of patients were hospitalised, but none were directly related to the electronic consultation question. Satisfaction by responding cardiologists was modest. Conclusion In conclusion, within a single-payer system, cardiology electronic consultations represent a convenient and safe alternative for providing consultative cardiovascular care, but further optimization is necessary to minimise electronic consultation fatigue experienced by cardiologists.
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Oemar, Hirawati, Sumarto Sumarto, Aan Komariah, Maulana Malik Ibrahim, and Anis Saleh. "INFORMATION SYSTEM DESIGN FOR FINAL PROJECT CONSULTATION." Journal of Industrial Engineering Management 6, no. 3 (December 20, 2021): 65–73. http://dx.doi.org/10.33536/jiem.v6i3.1055.
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This Final Project is one of the graduation requirements for Industrial Engineering students at the Islamic University of Bandung. Currently. The final project consultation process is conducted manually using physical documents owned by each student as proof of consultation in the form of a consultation card. The problem faced was the difficulty in monitoring consultations and recording consultation discussions which were not well organized. The purpose of this study is to design a consulting information system using the prototyping method. The prototyping method is a system development method used to describe the system. The stages in this method consist of: (1) The planning stage is the identification of system requests. (2) the analysis phase analyzes the existing business processes in the final project section and identifies functional and non-functional requirements, (3) the design phase includes the interaction design of systems, processes, data and logical systems and physical interfaces. (4) Implementation phase of database and website development using PHP language and MySQL database. The results obtained from this study are business process consulting for the Final Project after the implementation of the proposed information system; final project consulting information system design which is expected to facilitate the consultation process in terms of time and consultation file documentation
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Farr, Michelle, Jonathan Banks, Hannah B. Edwards, Kate Northstone, Elly Bernard, Chris Salisbury, and Jeremy Horwood. "Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production." BMJ Open 8, no. 3 (March 2018): e019966. http://dx.doi.org/10.1136/bmjopen-2017-019966.
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ObjectivesTo examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved.DesignMixed-method evaluation of a primary care e-consultation system.SettingPrimary care practices in South West England.MethodsQualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients’ records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients’ and staff touchpoints.ResultsWe found different expectations between patients and staff on how to use e-consultations ‘appropriately’. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation.ConclusionsWhere both patients and staff interact with technology, it is in effect ‘co-implemented’. How patients used e-consultations impacted on practice staff’s experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints.
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Limanto, Susana, and Ellysa Tjandra. "IMPROVING EFFICIENCY AND EFFECTIVENESS OF CONSULTATION PROCESS BETWEEN LECTURERS AND STUDENTS THROUGH AN INFORMATION SYSTEM SOFTWARE BASED INTRANET." Jurnal Sistem Informasi 7, no. 2 (July 15, 2012): 102. http://dx.doi.org/10.21609/jsi.v7i2.300.
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Students need to consult their problem such as final projects, academic problem, or personal problems to their lecturers. This consultation’s processes are helped by administrative staffs that make the processes relatively slow due to the high workload of the staffs. Therefore, this research tries to address this problem by creating intranet based information system to reduce the role of administrative staffs. This system provide several features such as schedule the regular consultation by lecturers, schedule the addition consultation by lecturers, cancel a scheduled consultations, change the schedule of consultations by lecturers, register for consultation by students, record the implementation consulting by lecturers, and reports. The consultation software was implemented at Informatics Engineering department, University ‘X’ for one month. After one month, a test was conducted involving five lecturers and twenty students. Testing result showed that the consultation process becomes more efficient, effective and satisfying. Mahasiswa perlu berkonsultasi mengenai masalah mereka seperti tugas akhir, masalah akademik, atau masalah pribadi kepada dosen mereka. Proses konsultasi ini dibantu oleh staf administrasi yang membuat proses relatif lambat karena beban kerja yang tinggi dari staf. Oleh karena itu, penelitian ini mencoba untuk mengatasi masalah ini dengan menciptakan sistem informasi berbasis intranet untuk mengurangi peran staf administrasi. Sistem ini menyediakan beberapa fitur seperti menjadwalkan konsultasi rutin oleh dosen, jadwal konsultasi Selain oleh dosen, membatalkan konsultasi dijadwalkan, mengubah jadwal konsultasi dengan dosen, mendaftar untuk konsultasi oleh siswa, merekam pelaksanaan konsultasi dengan dosen, dan laporan. Perangkat lunak konsultasi diterapkan di departemen Teknik Informatika, Universitas ‘X’ selama satu bulan. Setelah satu bulan, tes dilakukan melibatkan lima dosen dan dua puluh siswa. Hasil pengujian menunjukkan bahwa proses konsultasi menjadi lebih efisien, efektif dan memuaskan.
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Edwards, Hannah B., Elsa Marques, William Hollingworth, Jeremy Horwood, Michelle Farr, Elly Bernard, Chris Salisbury, and Kate Northstone. "Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England." BMJ Open 7, no. 11 (November 2017): e016901. http://dx.doi.org/10.1136/bmjopen-2017-016901.
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ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.
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Rasmussen, Anne. "Participation in Written Government Consultations in Denmark and the UK: System and Actor-level Effects." Government and Opposition 50, no. 2 (August 7, 2014): 271–99. http://dx.doi.org/10.1017/gov.2014.16.
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Despite the proliferation of instruments of public consultation in liberal democracies, little is known of how the design and use of these instruments affect stakeholder participation in practice. The article examines participation in written government consultations in an analysis of approximately 5,000 responses to consultations in Denmark and the UK in the first half of 2008. It shows that participation is highly conditional upon system- and actor-level characteristics in practice. Our findings indicate that, even if liberal democracies have adopted similar procedures for actor consultation in the last decades, the design and application of crucial rules vary considerably between systems. They emphasize how the conduct of consultation is heavily conditioned by the design of these processes, which is in turn constrained by the historical legacy of state–society structures of the system in question.
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Băcilă, Ciprian, and Claudia Anghel. "Telepsychiatry in the Romanian Health System During COVID-19 Pandemic." Acta Medica Transilvanica 25, no. 3 (September 1, 2020): 75–77. http://dx.doi.org/10.2478/amtsb-2020-0056.
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AbstractWith the covid-19 pandemic and the related restrictions to reduce the spread of the virus, the interaction between doctor and patient has changed, especially in the outpatients department. Thus, the need for remote consultations also appeared in the Romanian health system, especially in the psychiatric one. Although in other countries psychiatrists were familiar with this form of consultation, for Romanian psychiatrists, who were not trained either in residency or during medical school, it was a great challenge. If until March 2020 the patient’s consultation had to be performed only in the physical presence of a doctor, once the COVID-19 pandemic appeared, the Romanian government and the president, through the legislative acts issued, provided a legal framework for conducting this remote consultations. With the advent of telepsychiatry, discussions arose in the psychiatric community about the advantages and disadvantages of this type of consultation.
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Leung, Katherine, and Saffan Qureshi. "Managing high frequency users of an electronic consultation system in primary care: a quality improvement project." BMJ Open Quality 10, no. 2 (June 2021): e001310. http://dx.doi.org/10.1136/bmjoq-2020-001310.
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The COVID-19 pandemic prompted a rapid change in primary care provision. There was a significant shift from face-to-face appointments to remote methods such as electronic consultation (e-consultation). Patients from a primary care provider in London were actively encouraged to use an online consultation platform called ‘Dr iQ’. A group of high frequency users of Dr iQ emerged and clinicians were concerned their health needs were not being met through the platform. High frequency attendance in a traditional general practice setting is associated with increased time and healthcare costs.This project evaluated the number of high frequency users (identified as 10 or more consultations a month) of Dr iQ in one busy inner city practice over a 5-month period. We aimed to decrease the subsequent monthly usage frequency of all Dr iQ high frequency users from 10 or more consultations to less than 10 consultations. Our interventions included a semi-structured telephone interview, discussion among the multidisciplinary team, and regular scheduled telephone or face-to-face appointments. Following two Plan–Do-Study–Act cycles, all 12 high frequency users showed a decrease in the number of consultations submitted to Dr iQ to less than 10 consultations a month.This project proposes a method of case managing high frequency users of e-consultation. The majority of high frequency users had unmet health needs and felt a lack of continuity of care on Dr iQ. They often had complex physical and mental health problems. As remote consulting technology continues to develop, more research is required to understand the epidemiology and aetiology of e-consultation high frequency use in order to improve patient outcomes.
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Loula, P., E. Rauhala, M. Erkinjuntti, E. Raty, K. Hirvonen, and V. Hakkinen. "Distributed clinical neurophysiology." Journal of Telemedicine and Telecare 3, no. 2 (June 1, 1997): 89–95. http://dx.doi.org/10.1258/1357633971930922.
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We have developed a consultation forum for clinical neurophysiology in Finland. The system connects local digital electroencephalography EEG recording and analysing networks using a high-speed asynchronous transfer mode ATM network. Clinicians can obtain a second opinion using interactive data and video consultations or using data-only consultations. In addition, the system can be used for off-line review of prerecorded data. During a one-month evaluation, 66 EEG recordings were made altogether in Satakunta Central Hospital and consultations were required on 12 occasions. Nine of them were data-only consultations and three were data and video consultations. A data consultation lasted 15-20 min and a data and video consultation 35-45 min. Clinically, there were numerous benefits for the hospitals. The system established a link to a centre of excellence for second opinions or continuing education. It also helped with on-duty arrangements and enabled the construction of national data banks.
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Miller, Diane, Angela M. Loftus, Peter J. O'Boyle, Martin McCloskey, John O'Kelly, Donna Mace, Neil McKeon, et al. "Impact of a telephone-first consultation system in general practice." Postgraduate Medical Journal 95, no. 1129 (July 20, 2019): 590–95. http://dx.doi.org/10.1136/postgradmedj-2019-136557.
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Purpose of the studyIncreasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically deprived population.Study designAn interrupted time series of preplanned outcomes for 2 years before and 1 year postintroduction of a telephone-first system was used to measure the volume and type of general practitioner (GP) consultations and the number of patients consulted per year. Emergency department (ED) and GP out-of-hours attendances, the number of outpatient referrals, and the number of requests for laboratory tests were measured as secondary outcomes.ResultsThe telephone-first system was associated with a 20% increase in total GP consultations (telephone and face-to-face, effect estimate at 12 months, p=0.001). Face-to-face consultations decreased by 39% (p<0.001), while telephone consultations increased by 131% (p<0.001). The volume of individual patient requests for a GP consultation and the number of treatment room nurse consultations did not change. Secondary outcome measures showed no change in hospital outpatient referrals, number of requests for laboratory tests, and ED or GP out-of-hours attendances.ConclusionsA telephone-first system in a deprived urban general practice can decrease delays to GP–patient contacts. The number of patients seeking a medical intervention did not differ irrespective of the consultation system used. The telephone-first system did not affect GP out-of-hours, laboratory investigations or secondary care contacts.
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Banks, Jon, Michelle Farr, Chris Salisbury, Elly Bernard, Kate Northstone, Hannah Edwards, and Jeremy Horwood. "Use of an electronic consultation system in primary care: a qualitative interview study." British Journal of General Practice 68, no. 666 (November 6, 2017): e1-e8. http://dx.doi.org/10.3399/bjgp17x693509.
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BackgroundThe level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.AimTo evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.Design and settingA qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.MethodPractices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.ResultsTwenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.ConclusionThe experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.
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Jimenez, Geronimo, Shilpa Tyagi, Tarig Osman, Pier Spinazze, Rianne van der Kleij, Niels H. Chavannes, and Josip Car. "Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review." Journal of Medical Internet Research 22, no. 8 (August 28, 2020): e18109. http://dx.doi.org/10.2196/18109.
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Background Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient. Objective Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions. Methods A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work. Results A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general. Conclusions Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.
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Baird, Anne. "The Consultation." Nurse Prescriber 1, no. 3 (March 2004): 1–4. http://dx.doi.org/10.1017/s1467115804000306.
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Summary Some of the best-known consultation models derived from general practice are briefly described and discussed in terms of their relevance for nurse and pharmacist prescribers. The communication skills needed by the nurse prescriber are also considered, along with an introduction to the concept of the patient's health belief system. Some of the literature that compares nurse and GP consultations is also looked at, as is the concept of diagnosis by nurses. Concordance with medication and consultations with pharmacists are also mentioned.
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Voroszheykin, Vladimir, and Aleksandr Baranov. "The task of organizing telemedicine consultations in emergency situations for hospitals remote from the clinics of the city center." Digital Technology Security, no. 2 (June 25, 2021): 49–66. http://dx.doi.org/10.17212/2782-2230-2021-2-49-66.
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The use of telemedicine consultations has become particularly popular and relevant in 2020 in the face of restrictive measures due to the COVID-19 pandemic. However, the use of means of communication for the transmission of medical indications began at the beginning of the XX century: the first transmission of electrocardiography signals by telephone was carried out in 1906. And in 1959, the first television consultation was held in the United States. To date, most telemedicine consultations are scheduled. Doctors submit applications and the necessary set of documents, after which the applications are considered, and the date of the consultation is set. For emergency situations, this procedure is not suitable, because the number of requests may not correspond to the system bandwidth. The paper considers the problem of using telemedicine consultations in emergency situations. Technological accidents, severe epidemics do not allow to send the victims to the city center and require. This problem is related to the solution of the following tasks: construction of a telemedicine consultation management system; development of a mathematical model for the distribution of telemedicine consultations between hospitals that significantly exceed the number of clinics; development of algorithms for optimal management (time criterion) of the execution of telemedicine consultation requests in real time; consideration of issues related to the information security of the system. As a result, an approach to the construction of a system for organizing telemedicine consultations with the use of dispatching and medical centers was proposed. The mathematical formulation of the problem is formulated. An algorithm for the distribution and operation of the system, including hospitals, dispatching and medical centers and clinics, has been developed. The algorithm uses a mathematical model that implements the problem under consideration. For the developed system, software and hardware support for information security is proposed.
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Gonzalez, Francisco, Blanca Cimadevila, Julio Garcia-Comesaña, Susana Cerqueiro, Eladio Andion, Jorge Prado, Jorge Bermudez, and Felix Rubial. "Telephone consultation in primary care." Journal of Health Organization and Management 32, no. 2 (April 9, 2018): 321–37. http://dx.doi.org/10.1108/jhom-08-2017-0201.
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Purpose The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal. Design/methodology/approach This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency. Findings Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation. Originality/value Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services.
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Thilen, Stephan R., Christopher L. Bryson, Robert J. Reid, Duminda N. Wijeysundera, Edward M. Weaver, and Miriam M. Treggiari. "Patterns of Preoperative Consultation and Surgical Specialty in an Integrated Healthcare System." Anesthesiology 118, no. 5 (May 1, 2013): 1028–37. http://dx.doi.org/10.1097/aln.0b013e31828ea68a.
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Abstract Background: Many patients scheduled for elective surgery are referred for a preoperative medical consultation. Only limited data are available on factors associated with preoperative consultations. The authors hypothesized that surgical specialty contributes to variation in referrals for preoperative consultations. Methods: This is a cohort study using data from Group Health Cooperative, an integrated healthcare system. The authors included 13,673 patients undergoing a variety of common procedures—primarily low-risk surgeries—representing six surgical specialties, in 2005–2006. The authors identified consultations by family physicians, general internists, pulmonologists, or cardiologists in the 42 days preceding surgery. Multivariable logistic regression was used to estimate the association between surgical specialty and consultation, adjusting for potential confounders including the revised cardiac risk index, age, gender, Deyo comorbidity index, number of prescription medications, and 11 medication classes. Results: The authors found that 3,063 (22%) of all patients had preoperative consultations, with significant variation by surgical specialty. Patients having ophthalmologic, orthopedic, or urologic surgery were more likely to have consultations compared with those having general surgery—adjusted odds ratios (95% CI) of 3.8 (3.3–4.2), 1.5 (1.3–1.7), and 2.3 (1.8–2.8), respectively. Preoperative consultations were more common in patients with lower revised cardiac risk scores. Conclusion: There is substantial practice variation among surgical specialties with regard to the use of preoperative consultations in this integrated healthcare system. Given the large number of consultations provided for patients with low cardiac risk and for patients presenting for low-risk surgeries, their indications, the financial burden, and cost-effectiveness of consultations deserve further study.
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Bang, Min-Jung, So-Kyung Yoon, Kyoung Won Yoon, Eunmi Gil, Keesang Yoo, Kyoung Jin Choi, and Chi-Min Park. "Analysis of Medical Consultation Patterns in Medical and Surgical Intensive Care Units: Changes in the Pattern of Consultation after the Implementation of Intensivist-Directed Care." Journal of Acute Care Surgery 11, no. 3 (November 30, 2021): 102–7. http://dx.doi.org/10.17479/jacs.2021.11.3.102.
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Purpose: Critically ill patients often require multidisciplinary treatment for both acute illnesses and pre-existing medical conditions. Since different medical conditions are managed in the intensive care unit (ICU), consultation is often required. This study aimed to identify the frequency and type of consultation required and analyze changes in consultation patterns after the introduction of intensivist-directed care in the surgical ICU (SICU).Methods: Between June 2006 and December 2013, a retrospective cohort study was conducted to identify the frequency and type of consultation at 3 different ICUs. Consultations for patients who were admitted to the ICUs for more than 48 consecutive hours were included. The pattern of consultations in each ICU was investigated. In addition, the pattern of consultations before and after the implementation of intensivist-directed care in the SICU was compared.Results: During the study, 11,053 consultations were requested for 7,774 critically ill patients in a total of 3 ICUs. Consultations with the Departments of Cardiology, Infectious Diseases, and Pulmonology were requested most frequently in the SICU. However, after the implementation of the intensivist-directed care approach, there was an increase in the frequency of consultation requests to the Department of Neurology, followed by the Departments of Cardiology, and Infectious Diseases.Conclusion: Analysis of consultation patterns is an important method of assessing the complexity and severity of illnesses, and of evaluating the needs of available health system resources. Based on our findings, we suggest the development of an appropriate protocol for frequently consulted services.
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Azogil-López, Luis, Juan Pérez-Lázaro, Esther Medrano-Sánchez, Juan Gómez-Salgado, and Valle Coronado-Vázquez. "DETELPROG Study. Effectiveness of a New Model of Scheduled Telephone Referral from Primary Care to Internal Medicine. A Randomised Controlled Study." Journal of Clinical Medicine 8, no. 5 (May 16, 2019): 688. http://dx.doi.org/10.3390/jcm8050688.
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In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20–33) regarding specialised consultation, 47 days (95% CI: 17–74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.
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Fitria Adyati Mardha and Ria Astriratma. "Expert System for Diagnosing Respiratory Diseases in Cats." Jurnal Riset Informatika 6, no. 2 (March 11, 2024): 45–56. http://dx.doi.org/10.34288/jri.v6i2.249.
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Cats are the most common pet in Indonesia with a cat ownership rate of 47% (Rakuten Insight, 2021). Cat owners need to know and recognize the signs and symptoms of the diseases that often occur in cats, especially respiratory problems and diseases. Although vaccines in cats can significantly reduce the incidence of respiratory diseases, they do not eliminate infectious disease pathogens. During the COVID-19 pandemic, it was necessary to adjust health consultations that could reduce the transmission of COVID-19, which is the contactless method. In animal health, there is an online consultation through the WhatsApp platform between veterinarians and cat owners. Cat owners manually type every symptom experienced by the cat. However, there are several shortcomings in the online consultation, including that the symptoms described by the cat owner are unclear, so the diagnosis data is lacking and the consultation fee is quite expensive. Based on the problems that have been mentioned, the purpose of this study is to create an expert system for diagnosing respiratory diseases in cats using the Certainty Factor method. The result of this study is the availability of an expert system that can be used to diagnose respiratory diseases in cats.
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Okuno, Hiroshi, Takeshi Kawakami, Fumitaka Watanabe, and Hidehiko Horikoshi. "Arrangements for Telephone Consultation on Radiation Health Effects in a Nuclear Emergency in Japan: Lessons Learned from the Nuclear Accident in Fukushima, Japan, 2011." Journal of Disaster Research 18, no. 8 (December 1, 2023): 911–17. http://dx.doi.org/10.20965/jdr.2023.p0911.
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The Japan Atomic Energy Agency (JAEA) established a telephone consultation system at the request of the Ministry of Education, Culture, Sports, Science and Technology in response to residents’ concerns about the radiation health effects following the nuclear accidents at the Fukushima Daiichi Nuclear Power Station of the Tokyo Electric Power Company (TEPCO) in March 2011. Eight toll-free telephone lines were established and employees with knowledge of radiation health effects were assigned for consultation. The JAEA expert response group for telephone inquiries comprised a telephone response team, a question-and-answer team, and a manager. Approximately 35,000 consultations were conducted from March 17, 2011 to September 18, 2012. Japan’s Basic Disaster Prevention Plan was revised following the accident, where one of the JAEA’s roles for nuclear emergency response was to provide telephone consultation on radiation health effects. The JAEA’s system for telephone consultation was improved following this experience. The description of telephone hotlines in the International Atomic Energy Agency’s guide, GSG-14, published in 2020, was discussed for further improvement in the JAEA’s telephone consultation system.
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Halili, Ruzhdi, and Qerkin Berisha. "Public Consultation in Kosovo." Hrvatska i komparativna javna uprava 23, no. 1 (May 11, 2023): 61–90. http://dx.doi.org/10.31297/hkju.23.1.4.
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The primary aim of the paper is to explore whether the public consultation system in Kosovo enables respective stakeholders to contribute and protect their interests during the process of drafting government policies and legislation. Based on the analysis of Kosovo’s legal framework in place, and findings from the empirical research with CSOs, we can conclude that Kosovo has undertaken substantial legislative steps and introduced new tools and guidelines to improve the public consultation system at the central and municipal level of government. Therefore, from the legal point of view, minimum standards for the consultation process are established under Kosovo’s legal framework. Considering the role of civil society organisations and their influence on policymaking in Kosovo, particular attention has been paid to the CSOs’ perception of this issue. The analysis of a sample of documents and CSOs’ responses reveals concerns on whether stakeholders are enabled to contribute to the drafting of policies and legislation. A major issue of concern with regard to the effectiveness of the current consultation system in Kosovo is the low response rate from stakeholders as compared to the number of documents open to consultation. The study demonstrates a lack of clarity about how institutions select, invite and involve stakeholders, whether they select the appropriate stakeholders to participate in the drafting and consultation process, and whether sufficient information and feedback is provided to them about the individual consultations.
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Richardson, Greg, and Ian Partridge. "Child and adolescent mental health services liaison with Tier 1 services: a consultation exercise with school nurses." Psychiatric Bulletin 24, no. 12 (December 2000): 462–63. http://dx.doi.org/10.1192/pb.24.12.462.
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Consultation with Tier 1 professionals is an integral part of comprehensive child and adolescent mental health services (CAMHS) (NHS Health Advisory Service, 1995; Audit Commission, 1999). Despite enthusiasm for consultative approaches and clearly described advantages (Steinberg, 1993), the evidence base for consultation work is thin. In schools, the consultation intervention has been found to be the least effective of four interventions (Kolvin et al, 1981). Consultation enables the development of an integrated tiered system, improves communication, provides a greater understanding of the roles of CAMHS by Tier 1 professionals and fosters more relevant referral patterns.
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Tyler, Carl V., and Michael D. Wells. "A Community-Health System Intervention to Improve the Primary Healthcare of Adults With Down Syndrome Through Electronic Consultations." Intellectual and Developmental Disabilities 59, no. 3 (May 24, 2021): 256–64. http://dx.doi.org/10.1352/1934-9556-59.3.256.
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Abstract Health systems often fail to tap the expertise of the developmental disabilities community support and service system. In this 9-month pilot health system-level quality improvement project, a multi-disciplinary team of physician, pharmacist, and disabilities advocate reviewed electronic records of patients with Down syndrome in advance of pre-scheduled appointments with their primary care physician (PCP) and generated 100 electronic consultations. Post-consultation chart review documented meaningful uptake of clinical recommendations, including screening for thyroid disease, celiac disease, and heart disease, pneumococcal vaccination, and screening physical examination for myelopathy. In addition to clinical recommendations regarding screening, diagnosis, and treatment, each consultation provided an average of eight tailored suggestions for potential community-based resources related to mental and behavioral health, recreation, socialization, and other relevant services and supports. “Push” multi-disciplinary electronic consultations in advance of primary care appointments enriched with input from disabilities community experts have the potential to improve the quality of health care provided to persons with developmental disabilities.
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Ito, Koji. "A gait analysis consultation system." Journal of the Society of Biomechanisms 14, Special (1990): 169–76. http://dx.doi.org/10.3951/sobim.14.169.
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Jayashree, B. "Farming System for Nutrition Consultation." Current Science 115, no. 1 (July 10, 2018): 18. http://dx.doi.org/10.18520/cs/v115/i1/18-19.
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Quaglini, S., M. Stefanelli, G. Barosi, and A. Berzuini. "ANEMIA: An expert consultation system." Computers and Biomedical Research 19, no. 1 (February 1986): 13–27. http://dx.doi.org/10.1016/0010-4809(86)90003-0.
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Živanović, Slavoljub, and Miloranka Petrov-Kiurski. "Consultation length in ambulatory clinic of Belgrade Emergency Medical Service." Acta Facultatis Medicae Naissensis 38, no. 3 (2021): 279–90. http://dx.doi.org/10.5937/afmnai38-28252.
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The aim of the study was to analyze and compare consultation lengths in Emergency Medical Service (EMS) Belgrade ambulatory clinic which relates to patient age, gender, existing diagnoses and prescribed treatment (therapy or referral to another healthcare institution). We analyzed the data from the electronic database on consultation lengths from one EMS Belgrade Ambulatory Clinic. For patients who were further referred to another healthcare institution transfer, the waiting time was included in the total consultation time. We used the statistical package SPSS 11.0 for Windows for the statistical processing. Statistical significance was defined for the level of p < 0.05. The average consultation time was 21.07 ± 13.44 minutes. Usually, it lasted between 10 to 20 minutes. Consultations lasted longer in female patients (21.68 minutes), patients over 65 years of age (24.65 minutes), in patients with multiple diagnoses (26.1 and 27.28 minutes), as well as in patients where therapy was prescribed and administered in the ambulatory clinic (25.72 minutes), or in patients referred to other healthcare institutions. Statistically, the differences were highly significant (p < 0.01). When considering patients' diagnoses, longest consultations were in patients diagnosed with infectious diseases (average 30.88 minutes), followed by patients diagnosed with diseases of the circulatory system (27.86 minutes) and patients with diseases of the respiratory system (21.56 minutes). The differences were statistically significant (p < 0.01). Patients' age, gender, disease diagnosis and administered therapy affect the consultations time. Depending on the diagnosis, consultations last longer for infectious, cardiovascular and respiratory diseases.
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Weise, Sebastian, and Mike Chiasson. "Infrastructuring Public Consultation in Town Planning— How Town Planners Translate Public Consultation into a Socio-Technical Support System." Computer Supported Cooperative Work (CSCW) 29, no. 5 (September 29, 2020): 533–61. http://dx.doi.org/10.1007/s10606-020-09384-y.
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Abstract For public consultation in town planning, town planners can employ various software systems to improve the dialogue with citizens. This article looks at attempts to do so by following the work of a team of municipal town planners across four stages of public consultation held between 2012 and 2015. The study is based on detailed semi-structured interviews, field notes from regular visits to the planners’ office, and a database of public consultation comments and attendance at consultation events across the stages. Using an approach that considers planners’ work in the selection and implementation of software within institutional objectives and constraints as “infrastructure” work, we examine the joint deployment, use and effects of nine software tools and arising practices for public consultations. Our findings demonstrate how the infrastructure work of planners involved numerous interpretations about the possibilities for software adaptation and the effects of software use, which were enabled and constrained by consultation and planning requirements. The results also indicate a role for researchers in helping planners mediate between formal processes and public concerns, and illustrates how this technological-institutional struggle in infrastructuring work forms an essential part of town planners’ practice.
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Rhode, Jason, and Murali Krishnamurthi. "12: A CONSULTATIONS TRACKING DATABASE SYSTEM FOR IMPROVING FACULTY DEVELOPMENT CONSULTATION SERVICES." To Improve the Academy 32, no. 1 (June 2013): 199–214. http://dx.doi.org/10.1002/j.2334-4822.2013.tb00706.x.
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Álvarez-Dobaño, José Manuel, Malena Toubes, José Ángel Novo-Platas, Francisco Reyes-Santías, Gerardo Atienza, Manuel Portela, Carlos Rábade, et al. "Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation." Canadian Respiratory Journal 2022 (October 31, 2022): 1–10. http://dx.doi.org/10.1155/2022/2423272.
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Introduction. This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods. A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results. In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 ( p < 0.001 ). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions. Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.
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Ka, Teh Yu, and Wahyu Tisno Atmojo. "DECISION SUPPORT SYSTEM FOR SELECTING DOCTORS IN APPLICATION X USING ANALYTICAL HIERARCHY PROCESS (AHP)." Jurnal Teknik Informatika (Jutif) 3, no. 4 (August 20, 2022): 857–62. http://dx.doi.org/10.20884/1.jutif.2022.3.4.284.
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Doctors are one of the human resources contributing to the world of health, especially in the current COVID-19 pandemic situation. With the pandemic and increasing technological developments, this sat have sprung up many digital-based health service applications that can help the community, especially its users in health consultations, looking for health articles, and hospital searches. In this digital-based health service, if you want to consult online or make an appointment, there are many choices of doctors available with various criteria. This method is used to obtain weighting (Eigen Vector) criteria used to facilitate making decisions, which is to choose a doctor for consultation or appointment. With three criteria (experience, consultation price, and user satisfaction level) and alternatives (Dr. A, Dr. B, Dr. C) obtained weighting (Eigen Vector) or the best alternative option is Dr. A with a weighting value of 0.509, which has 27 years of experience criteria, a consultation price of Rp. 30,000.00, and a user satisfaction rate of 96%.
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Al-Ababneh, Nedal, and Hasan Aldiabat. "Optimum consultation for serial distributed detection systems." International Journal of Electrical and Computer Engineering (IJECE) 12, no. 3 (June 1, 2022): 2636. http://dx.doi.org/10.11591/ijece.v12i3.pp2636-2644.
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<p>This paper considers a distributed detection system which consists of sensors that are connected in series. The observations of each sensor in this system design are considered to be statistically independent of all other sensors. In contrast to the popular serial decision fusion systems, we assume that consultations are allowed in a serial manner between successive sensors that make up the system. In addition, the paper demonstrates the similarity between the proposed consulting serial system and the optimal serial one in terms of detection probabilities for a give probability of false alarm. However, it should be emphasized that the proposed system has the benefit of conditional nonrandom consultation among the sensors. Consequently, its survivability is higher than that of serial systems. Numerical evaluations for the cases of two and three sensors are provided and compared with those of the serial as well as the centralized schemes.</p>
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Timpka, T., and Elisabeth Arborelius. "The GP’s Dilemmas: A Study of Knowledge Need and Use During Health Care Consultations." Methods of Information in Medicine 29, no. 01 (1990): 23–29. http://dx.doi.org/10.1055/s-0038-1634768.
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AbstractFor use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.
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Rankin, Ivan. "Natural language generation in critiquing." Knowledge Engineering Review 8, no. 4 (December 1993): 329–47. http://dx.doi.org/10.1017/s0269888900000333.
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A central area of application for knowledge-based systems is for giving consultative advice to the user. Such systems engage the user in a dialogue in the process of collecting enough information to be able to infer a conclusion from the knowledge base. Traditionally, then, the main initiative in the consultation process has been allocated to the system
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Perrin, Kathleen Ouimet, and Mary Kazanowski. "Overcoming Barriers to Palliative Care Consultation." Critical Care Nurse 35, no. 5 (October 1, 2015): 44–52. http://dx.doi.org/10.4037/ccn2015357.
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Palliative care consultations for patients with life-threatening illnesses provide benefits for the patients and their families as well as for the health care team. Patients have better quality of life and live longer but cost the health care system less. Still, many patients are not offered the opportunity to receive a palliative care consultation. Barriers to palliative care consultation for patients in critical care units include misunderstandings about palliative care and not having agreed upon criteria for referral. Critical care nurses can assist in overcoming these barriers.
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Murphy, Mairead, Chris Salisbury, Anne Scott, Lucia Sollazzi-Davies, and Geoff Wong. "The person-based development and realist evaluation of a pre-consultation form for GP consultations." NIHR Open Research 2 (July 29, 2022): 19. http://dx.doi.org/10.3310/nihropenres.13249.2.
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Background: Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients’ concerns. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework. The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the pre-consultation questionnaire. Methods: A person-based approach was used to develop the pre-consultation form. An online questionnaire system was designed to allow patient self-completion of a form which could be shared with GPs. This was tested with 45 patients in three rounds, with iterative adjustments made based on feedback after each round. Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results: Intervention Development: 15 patients were recruited per practice. Twelve patients, six GPs and three administrators were interviewed and 32 changes were made iteratively in three rounds. Recruitment rates (proportion of patients responding to the text) increased from 15% in round one to 50% in round three. Realist evaluation: The pre-consultation form was most useful for people comfortable with technology and with hidden concerns or anxiety about the consultation. It resulted in more issues being discussed and support provided, more effective use of time and greater patient satisfaction. Conclusions: The person-based approach was successful. The pre-consultation form uncovers more depth and improves satisfaction in certain consultations and patients. Technological improvements are required before this could be rolled out more widely.
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Murphy, Mairead, Chris Salisbury, Anne Scott, Lucia Sollazzi-Davies, and Geoff Wong. "The person-based development and realist evaluation of a pre-consultation form for GP consultations." NIHR Open Research 2 (February 17, 2022): 19. http://dx.doi.org/10.3310/nihropenres.13249.1.
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Background: Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients’ concerns. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework. The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the pre-consultation questionnaire. Methods: A person-based approach was used to develop the pre-consultation form. An online questionnaire system was designed to allow patient self-completion of a form which could be shared with GPs. This was tested with 45 patients in three rounds, with iterative adjustments made based on feedback after each round. Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results: Intervention Development: 15 patients were recruited per practice. Twelve patients, six GPs and three administrators were interviewed and 32 changes were made iteratively in three rounds. Recruitment rates (proportion of patients responding to the text) increased from 15% in round one to 50% in round three. Realist evaluation: The pre-consultation form was most useful for people comfortable with technology and with hidden concerns or anxiety about the consultation. It resulted in more issues being discussed and support provided, more effective use of time and greater patient satisfaction. Conclusions: The person-based approach was successful. The pre-consultation form uncovers more depth and improves satisfaction in certain consultations and patients. Technological improvements are required before this could be rolled out more widely.
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Halter, Mary, Louise Joly, Simon de Lusignan, Robert L. Grant, Heather Gage, and Vari M. Drennan. "Capturing complexity in clinician case-mix: classification system development using GP and physician associate data." BJGP Open 2, no. 1 (January 9, 2018): bjgpopen18X101277. http://dx.doi.org/10.3399/bjgpopen18x101277.
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BackgroundThere are limited case-mix classification systems for primary care settings which are applicable when considering the optimal clinical skill mix to provide services.AimTo develop a case-mix classification system (CMCS) and test its impact on analyses of patient outcomes by clinician type, using example data from physician associates’ (PAs) and GPs' consultations with same-day appointment patients.Design & settingSecondary analysis of controlled observational data from six general practices employing PAs and six matched practices not employing PAs in England.MethodRoutinely-collected patient consultation records (PA n = 932, GP n = 1154) were used to design the CMCS (combining problem codes, disease register data, and free text); to describe the case-mix; and to assess impact of statistical adjustment for the CMCS on comparison of outcomes of consultations with PAs and with GPs.ResultsA CMCS was developed by extending a system that only classified 18.6% (213/1147) of the presenting problems in this study's data. The CMCS differentiated the presenting patient’s level of need or complexity as: acute, chronic, minor problem or symptom, prevention, or process of care, applied hierarchically. Combination of patient and consultation-level measures resulted in a higher classification of acuity and complexity for 639 (30.6%) of patient cases in this sample than if using consultation level alone. The CMCS was a key adjustment in modelling the study’s main outcome measure, that is rate of repeat consultation.ConclusionThis CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation.
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Bungard, Tammy J., Marcie J. Smigorowsky, Lucille D. Lalonde, Terry Hogan, Evelyn Maier, and Stephen L. Archer. "Cardiac EASE (Ensuring Access and Speedy Evaluation) — Design of a Single Point of Entry and a Multidisciplinary Team to Reduce Waiting Times in the Canadian Health Care System." Healthcare Management Forum 21, no. 3 (September 1, 2008): 35–40. http://dx.doi.org/10.1016/s0840-4704(10)60273-6.
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Out-patient cardiac consultation in academic group practices often lacks a coordinated intake process, making it difficult to perform prospective testing or to direct undifferentiated consultations to the cardiologist with the shortest waiting list. We created a programmatic approach, with a single point of entry to improve the efficiency of cardiology consultation, without departing from the Canada Health Act. The purpose of this paper is to describe the design of Cardiac EASE.
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Darby, Padraig L., and Peter J. Schmidt. "Psychiatric Consultations in Rheumatology: A Review of 100 Cases." Canadian Journal of Psychiatry 33, no. 4 (May 1988): 290–93. http://dx.doi.org/10.1177/070674378803300411.
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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.
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Casey, Michael, Sara Shaw, and Deborah Swinglehurst. "Experiences with online consultation systems in primary care: case study of one early adopter site." British Journal of General Practice 67, no. 664 (October 9, 2017): e736-e743. http://dx.doi.org/10.3399/bjgp17x693137.
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BackgroundThere is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care.AimTo explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices.Design and settingMixed methods case study in an inner-city general practice.MethodThe study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis.ResultsThree interrelated themes were identified: online consultation systems as innovation, managing the ‘messiness’ of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The ‘messiness’ of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice.ConclusionTele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs’ workload. Tele-Doc’s potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.
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Kurtser, M. A., R. I. Shalina, D. S. Spiridonov, I. I. Kurtsikidze, A. G. Smirnova, and A. A. Belkina. "Telemedicine Consultations in Obstetrics and Gynecology." Doctor.Ru 22, no. 1 (2023): 7–10. http://dx.doi.org/10.31550/1727-2378-2023-22-1-7-10.
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Aim: To study the possibilities of using telemedicine consultations in the work of an obstetrician-gynecologist. Design: Retrospective case series. Materials and methods. An analysis of 319 doctor — patient telemedicine consultations conducted by obstetricians-gynecologists of the MD Medical Group “Mother and Child” was carried out. Each consultation was characterized by 7 parameters: the format of communication, the relevance of the topic of the question to the profile of “obstetrics and gynecology”, the motivation to consult with a doctor remotely, the patient's complaints, the type of the follow-up medical care required and its urgency, the possibility to complete the consultation without a mandatory visit to a face-to-face appointment. Results. 313 (98.1%) consultations had the subject of obstetrics, gynecology or reproduction. Most often (210; 61.7%) patients wanted to receive a preliminary consultation to determine the need for face-to-face visit to the doctor. The most common issues for consultation (100; 31.9%) were topics related to the management of pregnancy. The vast majority of requests (296; 94.6%) did not require an emergency call for an ambulance or an urgent visit to a doctor. In 148 (47.3%) consultations, the consultant's qualification allowed answering all questions, but despite this, according to the Russian Federation legislation, it was recommended to consult a doctor face-to-face. Conclusion. With a systematic approach to the introduction of telemedicine consultations, their effectiveness may not be lower compared to the effectiveness of similar traditional visits with comparable safety and significant savings in resources for both the patient and the healthcare system as a whole. Keywords: telemedicine, telemedicine consultations.
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Sha, Yutian, Tianxin Feng, Xue Xiong, and Ting Yang. "Designing Online Psychological Consultation Expert System Using Human-Computer Interaction." Mobile Information Systems 2021 (June 8, 2021): 1–12. http://dx.doi.org/10.1155/2021/6458924.
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Traditional online psychological consultation expert system has low efficiency. It is because of limited human-computer interaction and lack of intelligence. As a result, an expert system for psychological consultation is needed. Therefore, in this paper, we design an online psychological consultation expert system based on human-computer interaction. Using human-computer interaction technology, the basic principles of the system’s design are formulated. The design is used to build a psychological consultation expert system framework suitable for numerous applications. Human-computer interaction knowledge is imported into the system to determine the consultation process based on fuzzy set. To complete the online psychological consultation preset, the adjustment of human-computer interaction accuracy is determined. Moreover, a psychological state of the user in human-computer interaction is achieved using the expression of psychological counseling results. Comparing the simulated psychological consultation process, the results show that the design system is 30% more efficient than the traditional consultation system. The consulting success rate is more than 20%. The comprehensive consultation time is shortened, and its effectiveness is proved.
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Hylander, Ingrid. "Entry-Level Activities in System Consultation." Journal of Educational and Psychological Consultation 24, no. 4 (October 2, 2014): 345–53. http://dx.doi.org/10.1080/10474412.2014.929966.
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Hovorka, R., Š. Svačina, E. R. Carson, C. D. Williams, and P. H. Sönksen. "A consultation system for insulin therapy." Computer Methods and Programs in Biomedicine 32, no. 3-4 (July 1990): 303–10. http://dx.doi.org/10.1016/0169-2607(90)90113-n.
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Zhang, Ni, Yi-Fei Pu, Sui-Quan Yang, Ji-Liu Zhou, and Jin-Kang Gao. "An Ontological Chinese Legal Consultation System." IEEE Access 5 (2017): 18250–61. http://dx.doi.org/10.1109/access.2017.2745208.
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Tachakra, Sapal, Mary Dawood, Camilla Wiley, Alistair Stinson, Alganandan Sivakumar, and Jesus Hayes. "Telemedical consultation system how to choose." Emergency Nurse 7, no. 6 (October 1999): 11–13. http://dx.doi.org/10.7748/en1999.10.7.6.11.c1293.
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