Journal articles on the topic 'Consultation'
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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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Saraswat, Charvi, and Catherine Bright. "Review of Remote Consultations in Learning Disability During COVID Pandemic." BJPsych Open 8, S1 (June 2022): S144—S145. http://dx.doi.org/10.1192/bjo.2022.415.
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AimsThe aim of this project was to assess the efficacy of remote consultations in patients with Learning Disability (LD). In Aneurin Bevan University Health Board, teleconsultation or “Attend Anywhere” (Video) platforms are the two types of remote consultation that is being offered.MethodsA 9- point Questionnaire was used to assess the efficiency of the consultation. During consultation (Either telephone or attend anywhere), data were collected by the consultants by answering the questionnaire. 23 clinics organised between 04/06/2020 to 23/06/2020 for Service Users' (SU) follow-up.The following key points were covered in the questionnaire: 1.Mode of consultation- telephone or attend anywhere2.Presence of the SU3.Introduction4.Availability of information (patient notes/shared drives) prior to consultation5.Time constraints6.Information not covered due to lack of face-to-face consult7.Technical difficulties8.Expectations from SU9.Feedback from SUResults1.The most common mode of consultation was via telephone (70%), followed by Attend Anywhere (30%)2.The majority of conversations were with SU's family or carers (70%); consultations with SU were only 30%. SU were unable to attend the consultation due to: Communication difficulty (26%), follow-ups provided by carer's/family's feedback (21.7%), SU away due to physical health reasons, or in day care (17.3%).3.Introductions were done and sufficient information regarding the service users were available in all consultations.4.Expectation of SU/carers/family was with regards to medication review (43%).5.52% of remote consultation were disrupted due to technical problems, for instance call drops and line disruptions, microphone issues and SU not being able to use attend anywhere because of its complexity.ConclusionIt was demonstrated that remote consultation could possibly be most effective for medication reviews or regular follow-up appointments.Some of the aspects that were not covered due to the shortcomings of remote consultations were: a.Difficulty in assessing body language and facial expressionsb.Difficulty in assessing the level of function of SUc.Unable to monitor physical health parametersd.Difficulty in picking up non-verbal cues, and assess eye contact to ascertain mood component of presentation.In summary it seems in the early stages of the pandemic, telephone consultation was the predominant form of remote consultation. Further work would be useful to obtain the views of people with LD, their carers and families as to which form of consultation would be their preference and whether remote consultation is acceptable for this patient group.
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Koffi-Tessio, VES, S. Oniankitan, C. Hé, AE Ataké, K. Kakpovi, F. Yibé, E. Mba, et al. "Profil épidémio-clinique des patients en primo-consultation rhumatologique au CHU Sylvanus Olympio (Lomé-Togo)." Rhumatologie Africaine Francophone 4, no. 1 (December 18, 2022): 1–6. http://dx.doi.org/10.62455/raf.v4i1.39.
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Introduction : décrire le profil pathologique des patients en primo-consultation de rhumatologie au CHU-SylvanusOlympio (CHU-SO)Matériels et méthodes : il s’est agi d’une étude transversale et analytique portant sur les patients admis en consultationde rhumatologie du CHU SO pour la première fois du 1er novembre 2020 au 30 Avril 2021Résultats : quatre cents trente et un des 1266 consultations (34%) relevaient d’une première consultation. Les 431 patients se répartissaient en 306 femmes (71%) et 125 hommes (29%). L’âge moyen des patients à la consultation était de 48 ± 12,4 ans (extrêmes : 12 et 85 ans). 326 patients (75,6%) ne bénéficiaient pas de couverture médicale. La durée d’évolution de la maladie, en moyenne de 46 ± 16,3 mois (extrêmes : une semaine et 360 mois), était d’au moins trois mois chez 176 patients (87,2%). Deux cents soixante-trois patients (58,7%) étaient adressés par des paramédicaux, 68 patients par des médecins généralistes, 26 patients par d’autres spécialistes, 34 patients par des proches et 18 sont venus d’eux -mêmes Les pathologies dégénératives du rachis et la gonarthrose étaient les principaux diagnostics retrouvés respectivement chez 324 patients (75,2%) et chez 99 patients (23%). L’automédication avant la primo consultation aété retrouvée chez 67,7% des patients dominés par l’usage des anti-inflammatoires non stéroïdiens chez 48,3%.Conclusion: la primo-consultation représente le tiers des consultations dans le service de rhumatologie avec un long délai de consultation. Il serait donc primordial de déterminer les facteurs favorisants ce retard de consultation afin d’améliorer la santé des patients.
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Pitrová, Markéta, and Jana Zatloukalová. "Reflection of the decade of the European Commission’s public consultation practice and position of the stakeholders." Czech Journal of International Relations 50, no. 1 (March 1, 2015): 46–72. http://dx.doi.org/10.32422/cjir.270.
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The Lisbon revision of the primary law led to the confirmation of the pre-existing Commission’s commitment to carry out “broad consultations” whilepreparing European legislative acts. The aim of this article is to elucidateformulation of the Commission’s public consultation practice and evaluatepositions of the interest groups to the Commission’s strategy. The attentionis accorded to the analysis of the consultation’s level of formalization andinclusivity, the two principal consultation’ components. The analysis is buildupon the study of the selected interest groups’ positions brought forwardduring the years 2002–2012 and upon the reaction of the Commission tothe interest groups’ feedback. The available empirical data suggests thatthe interest groups appreciated the introduction of the minimum standardsfor consultation, however, they have been steadily alerting to their frequentbreach and arbitrary application.
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Schmidt, Robert L., Christopher A. Garcia, Jeanne Panlener, Edward R. Ashwood, Brian R. Jackson, and Jerry W. Hussong. "An Analysis of Clinical Consultation Activities in Clinical Chemistry: Implications for Transformation and Resident Training in Chemical Pathology." Archives of Pathology & Laboratory Medicine 138, no. 5 (May 1, 2014): 671–77. http://dx.doi.org/10.5858/arpa.2013-0017-oa.
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Context.—Clinical consultation is a key role of pathologists. Many have advocated that pathologists expand their consulting activities to improve laboratory utilization. Although many have suggested that residency programs need to provide experience in clinical consultation, little has been written on the nature of consultation or on the methods of training. Objective.—To characterize the content of consultations and to describe training in consultation in chemical pathology within the residency program at the University of Utah, Salt Lake City. Design.—Retrospective review of the consultation database for the period between July 2011 and July 2012. Results.—Residents performed an average of 159 consultations a month covering 276 topics during the course of a year. Each topic involved 1 or more specific tests. Eighty percent of the topics received fewer than 12 calls. The most common topics involved virus testing (eg, hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Consultations most often involved test interpretation (53%), selection (38%), and performance characteristics (21%). Twenty-seven percent of consultations involved 2 or more consultation categories (eg, interpretation and performance). Conclusions.—Consultation calls in chemical pathology are widely distributed across topics. Consultations most often involve test interpretation and selection. Methods to assess the effectiveness of consultations and resident teaching should be devised.
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Huygens, Martine W. J., Ilse C. S. Swinkels, Robert A. Verheij, Roland D. Friele, Onno C. P. van Schayck, and Luc P. de Witte. "Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records." BMJ Open 8, no. 1 (January 2018): e019233. http://dx.doi.org/10.1136/bmjopen-2017-019233.
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ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.
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Prathivadi Bhayankaram, N., R. J. Lacey, L. A. Barnett, K. P. Jordan, and K. M. Dunn. "Musculoskeletal consultations from childhood to adulthood: a longitudinal study." Journal of Public Health 42, no. 4 (November 28, 2019): e428-e434. http://dx.doi.org/10.1093/pubmed/fdz141.
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Abstract Background The Global Burden of Disease reports indicate that musculoskeletal conditions are important causes of disability worldwide. Such conditions may originate in childhood, but studies investigating changes longitudinally and from childhood to adulthood are infrequent. Methods Nine birth cohorts of children (starting at ages 7–15 years) were followed. Participants were identified from Consultations in Primary Care Archive, an electronic health record database of 11 English general practices. Musculoskeletal consultation prevalence figures were calculated, and reasons for consultation evaluated. Results Annual musculoskeletal consultation prevalence was similar across cohorts for each age. Prevalence increased from 6 to 16% between ages 7 and 22 and was higher in males until age 15, after which prevalence was higher in females. Pain was the most common reason for consultation. Back pain consultations increased from 1 consultation/1000 7 year olds to 84 consultations/1000 22 year olds. Lower limb pain consultations increased from 21 consultations/1000 7 year olds to 56 consultations/1000 22 year olds. Conclusions This study shows that from childhood, individuals are more likely to seek healthcare for musculoskeletal consultations as they age, but rates are not increasing over time. Changes in consultation rates by age, gender and pain region may inform studies on the development of chronic musculoskeletal pain over the life-course.
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Williams, Emlyn. "“Consultation, Consultation, and Consultation”." Business Law Review 22, Issue 4 (April 1, 2001): 80–83. http://dx.doi.org/10.54648/350308.
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Babaniamansour, Sepideh. "The Quality of Medical Consultations in a Teaching Hospital: A Cross-Sectional Study." Journal of Biomedical Research & Environmental Sciences 2, no. 5 (May 2021): 392–98. http://dx.doi.org/10.37871/jbres1247.
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Background and objectives: Medical consultations became undeniable elements for the quality of health care and training of medical residence. This study aimed to assess the quality of performed consultations. Methods: This retrospective cross-sectional study at Shohadaye Tajrish hospital, affiliated to Shahid Beheshti University of Medical Sciences, in Tehran, Iran between 20th April 2018 and 4th May 2019. The reported items and quality score of medical consultation requests and responses between emergency and non-emergency consultations and between the faculty members and medical residents were assessed by SPSS version 21.0. Results: Among 431 medical consultations, most were non-emergency, requested by residents, and responded to by faculty members. The quality of consultations requested (p < 0.001) or responded (p < 0.001) by faculty members was higher than by medical residents. Higher year residents performed higher quality consultation requests (p = 0.008) and responses (p < 0.001). The quality score of consultation requests (p = 0.51) and responses (p = 0.1) had no significant difference between types of consultation. Conclusion: Underreported items of consultation impressed its quality. Faculty members and higher-year residents performed higher quality consultations.
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Stevens, Sarah, Clare Bankhead, Toqir Mukhtar, Rafael Perera-Salazar, Tim A. Holt, Chris Salisbury, and F. D. Richard Hobbs. "Patient-level and practice-level factors associated with consultation duration: a cross-sectional analysis of over one million consultations in English primary care." BMJ Open 7, no. 11 (November 2017): e018261. http://dx.doi.org/10.1136/bmjopen-2017-018261.
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ObjectivesConsultation duration has previously been shown to be associated with patient, practitioner and practice characteristics. However, previous studies were conducted outside the UK, considered only small numbers of general practitioner (GP) consultations or focused primarily on practitioner-level characteristics. We aimed to determine the patient-level and practice-level factors associated with duration of GP and nurse consultations in UK primary care.Design and settingCross-sectional data were obtained from English general practices contributing to the Clinical Practice Research Datalink (CPRD) linked to data on patient deprivation and practice staffing, rurality and Quality and Outcomes Framework (QOF) achievement.Participants218 304 patients, from 316 English general practices, consulting from 1 April 2013 to 31 March 2014.AnalysisMultilevel mixed-effects models described the association between consultation duration and patient-level and practice-level factors (patient age, gender, smoking status, ethnic group, deprivation and practice rurality, number of full-time equivalent GPs/nurses, list size, consultation rate, quintile of overall QOF achievement and training status).ResultsMean duration of face-to-face GP consultations was 9.24 min and 5.32 min for telephone consultations. Nurse face-to-face and telephone consultations lasted 9.70 and 5.73 min on average, respectively. Longer GP consultation duration was associated with female patient gender, practice training status and older patient age. Shorter duration was associated with higher deprivation and consultation rate. Longer nurse consultation duration was associated with male patient gender, older patient age and ever smoking; and shorter duration with higher consultation rate. Observed differences in duration were small (eg, GP consultations with female patients compared with male patients were 8 s longer on average).ConclusionsSmall observed differences in consultation duration indicate that patients are treated similarly regardless of background. Increased consultation duration may be beneficial for older or comorbid patients, but the benefits and costs of increased consultation duration require further study.
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Pecina, Jennifer L., and Frederick North. "A retrospective analysis of medical record use in e-consultations." Journal of Telemedicine and Telecare 23, no. 5 (June 14, 2016): 544–49. http://dx.doi.org/10.1177/1357633x16654607.
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Introduction Under certain circumstances, e-consultations can substitute for a face-to-face consultation. A basic requirement for a successful e-consultation is that the e-consultant has access to important medical history and exam findings along with laboratory and imaging results. Knowing just what information the specialist needs to complete an e-consultation is a major challenge. This paper examines differences between specialties in their need for past information from laboratory, imaging and clinical notes. Methods This is a retrospective study of patients who had an internal e-consultation performed at an academic medical centre. We reviewed a random sample of e-consultations that occurred in the first half of 2013 for the indication for the e-consultation and whether the e-consultant reviewed data in the medical record that was older than one year to perform the e-consultation. Results Out of 3008 total e-consultations we reviewed 360 (12%) randomly selected e-consultations from 12 specialties. Questions on management (35.8%), image results (27.2%) and laboratory results (25%) were the three most common indications for e-consultation. E-consultants reviewed medical records in existence more than one year prior to the e-consultation 146 (40.6%) of the time with e-consultants in the specialties of endocrinology, haematology and rheumatology, reviewing records older than one year more than half the time. Labs (20.3%), office notes (20%) and imaging (17.8%) were the types of medical data older than one year that were reviewed the most frequently overall. Discussion Management questions appear to be the most common reason for e-consultation. E-consultants frequently reviewed historical medical data that is older than one year at the time of the e-consultation, especially in endocrinology, haematology and rheumatology specialties. Practices engaging in e-consultations that require transfer of data may want to include longer time frames of historical information for those specialties.
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Atherton, Helen, Anne-Marie Boylan, Abi Eccles, Joanna Fleming, Clare R. Goyder, and Rebecca L. Morris. "Email Consultations Between Patients and Doctors in Primary Care: Content Analysis." Journal of Medical Internet Research 22, no. 11 (November 9, 2020): e18218. http://dx.doi.org/10.2196/18218.
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Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.
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Matsumura, Martin E., Kelly Austin, Yasser Khalil, James C. Blankenship, and Bryan Martin. "Feasibility of Telephone-Based Cardiology Consultation: Comparison of Resource Use and Outcomes vs In-Person Consultation." Open Cardiovascular Medicine Journal 15, no. 1 (August 24, 2021): 47–51. http://dx.doi.org/10.2174/1874192402115010047.
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Introduction: The COVID-19 (Coronavirus infectious disease 2019) pandemic has highlighted the need for alternative modalities to connect with outpatients beyond in-person clinic visits. In the present study, we evaluated the feasibility of a telephone-based teleconsultation cardiology service and compared the use of testing and outcomes between teleconsultation and traditional in-office consultations Methods: The study took place prior to the COVID-19 pandemic July 2019 to March 2020. Consult lists were reviewed by a cardiologist for patients appropriate for teleconsultation. Those patients were contacted directly and, if agreeable, a consultation was completed and any required testing was arranged. A series of patients seen in the clinic, matched for a reason for consultation and consulting a cardiologist, were compared in terms of testing frequency and outcomes. Results: Of 157 patients who felt appropriate for teleconsultation, 100 (63.7%) were successfully contacted and a teleconsultation was completed. Comparing patients undergoing teleconsultation with a matched series of patients seen in person in the clinic, there were no significant differences in testing utilization or outcomes, including emergency room or hospital admission within 30 days of consultation or death or adverse cardiac events at six months following consultation. Conclusion: Telemedicine can be successfully utilized as an alternative to traditional clinic consultation for selected patients needing cardiology consultation. This consultative modality does not appear to lead to utilization of increased testing or decreased quality or patient outcomes. Larger studies are needed to assess this mode of consultation.
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Buvik, Astrid, Einar Bugge, Gunnar Knutsen, Arvid Småbrekke, and Tom Wilsgaard. "Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial." Journal of Telemedicine and Telecare 25, no. 8 (July 4, 2018): 451–59. http://dx.doi.org/10.1177/1357633x18783921.
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Introduction Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations. Methods This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ). Results This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively ( p = 0.42). Discussion We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.
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Böling, Susanna, Johan M. Berlin, Helene Berglund, and Joakim Öhlén. "No ordinary consultation – a qualitative inquiry of hospital palliative care consultation services." Journal of Health Organization and Management 34, no. 6 (August 4, 2020): 621–38. http://dx.doi.org/10.1108/jhom-04-2020-0130.
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PurposeConsidering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards.Design/methodology/approachFocus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis.FindingsVariations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards.Originality/valueA lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
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Carr-Hill, Roy, Sue Jenkins-Clarke, Paul Dixon, and Mike Pringle. "Do Minutes Count? Consultation Lengths in General Practice." Journal of Health Services Research & Policy 3, no. 4 (October 1998): 207–13. http://dx.doi.org/10.1177/135581969800300405.
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Objective: To document the variability in consultation length and to examine the relative weight of different kinds of characteristics (of the patients, of the general practitioner (GP), or of the practice) in affecting consultation length, and, thus, to assess whether consultation length can legitimately be used as a quality marker. Design: A multilevel statistical analysis of 836 consultations across 51 GPs in ten practices. Setting and subjects: Ten general practices across four regions in England with varying list sizes, number of partners and fundholding status. Main outcome measures: Length of time face-to-face with patients in consultation measured in minutes and fractions of minutes. Results: There is substantial inter-practice variation in consultation length, from a mean of 5.7 minutes to one of 8.5 minutes. In some practices the longest average GP consultation time is about twice that of the shortest. Trainees and new partners spend, on average, about 1 minute less than their longer-serving colleagues. Consultation lengths for individual GPs range from a mean of 4.4 minutes to 11 minutes. Late middle-aged women (55–64 years) receive the longest consultations, followed by elderly people, with children receiving the shortest consultations. The number of topics raised affects the length of the consultation by about 1 minute per additional topic. When female patients consult female GPs, approximately 1 minute is added to the average consultation. A significant fraction of the variability in consultation lengths can be explained in terms of characteristics of patients, of GPs and of practices. Conclusions: The fact that there is little unexplained variation in GP consultation lengths that might be attributable to variations in quality (i.e. GP-related) throws doubt on the proposition that length of consultation can be used as a marker for quality of consultation in general practice.
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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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Vizueta, Nathalie, Catherine A. Sarkisian, and Peter G. Szilagyi. "A CTSA-based consultation service to advance research on special and underserved populations." Journal of Clinical and Translational Science 4, no. 4 (January 16, 2020): 271–78. http://dx.doi.org/10.1017/cts.2020.6.
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AbstractIn this report, we describe the implementation and short-term outcomes of a Special Populations Consultation Service within the University of California, Los Angeles (UCLA) Clinical and Translational Science Institute (CTSI). With the goal of increasing the quality and quantity of special population (SP) research, the UCLA CTSI Integrating Special Populations program designed a consultation service to support faculty and trainees conducting research involving one of three CTSI “special populations:” children, older adults, and/or minority; underserved; or health disparity populations. The Special Populations Consultation Service offers three types of activities: grant proposal studios, career consultations, and project reviews. UCLA CTSI faculty with appropriate content expertise serve as consultants. We evaluated this consultation model using satisfaction surveys and by quantifying funded grants and reported changes in career goals in SP research. Between 2016 and 2019, the Special Populations Consultation Service provided 59 consultations including 42 grant studios and was used by researchers at all levels from all four UCLA CTSI institutions. Recipients rated the consultations very highly. Funding success rates were 57% following K-level grant studios and 28% following R-level grant studios. Users of project and career consultations commonly attributed career accomplishments in part to their consultation experiences. The SP Consultation Service is feasible and acceptable and appears to enhance careers of investigators studying special populations.
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Vestesson, Emma Maria, Kaat Lieve An De Corte, Elizabeth Crellin, Jean Ledger, Minal Bakhai, and Geraldine M. Clarke. "Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study." JMIR Public Health and Surveillance 9 (May 2, 2023): e44944. http://dx.doi.org/10.2196/44944.
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Background The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). Objective This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. Methods We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. Results Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. Conclusions The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Sood, Ajay, Sharon A. Watts, Julie K. Johnson, Stacey Hirth, and David C. Aron. "Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial." Journal of Telemedicine and Telecare 24, no. 6 (April 13, 2017): 385–91. http://dx.doi.org/10.1177/1357633x17704346.
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Introduction There is a widening discrepancy between the increasing number of patients with diabetes mellitus and the health care resources available to manage these patients. Telemedicine has been used in a number of instances to improve and deliver health care where traditional care delivery methods may encounter difficulty. We conducted a cluster randomised controlled trial of telemedicine consultation to manage patients with diabetes mellitus. Methods Eleven primary care centres attached to one Veteran Administration tertiary care centre were randomised to provide patients with diabetes consultation referral either by usual consultation in diabetes clinic or telemedicine consultations via videoconference. Results Altogether, 199 patients were managed by telemedicine consultation and 83 by usual consultation. Patients in both groups showed a small decrease in haemoglobin A1c, with no statistical difference between the groups (telemedicine consultation −1.01% vs usual consultation −0.68%, p = 0.19). Surveys of patients and semi-structured interviews with primary care providers showed better response and satisfaction with telemedicine consultations. Discussion This study shows similar clinical outcomes as measured by glycaemic control for patients with diabetes mellitus having a specialist consultation using real-time telemedicine consultation as compared to in-clinic consultation. Telemedicine consultation was also associated with better patient and primary care provider satisfaction.
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Johnson, Laura S., Jason Lesandrini, and Grace S. Rozycki. "Use of the Medical Ethics Consultation Service in a Busy Level I Trauma Center: Impact on Decision-Making and Patient Care." American Surgeon 78, no. 7 (July 2012): 735–40. http://dx.doi.org/10.1177/000313481207800709.
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The purposes of this study were to assess reasons for consultation of the Ethics Consultation Service for trauma patients and how consultations impacted care. We conducted a review of ethics consultations at a Level I trauma center from 2001 to 2010. Data included patient demographics, etiology of injury, and timing/type of the consult, categorized as: shared decision-making, end-of-life, privacy and confidentiality, resource allocation, and professionalism. Consultations were requested on 108 patients (age mean, 46.5 ± 20 years; Injury Severity Score mean, 23 ± 14; length of stay [LOS] mean, 44 ± 44 days), 0.50 per cent of all trauma admissions. Seventy-seven per cent of consultations occurred in the intensive care unit. End of life was the most common consultation (44%) followed by shared decision-making (41%). Average time to consultation was 25 days. Shared decision-making consults occurred much earlier than end-of-life consults as evidenced by a lower consult day/LOS ratio (consult day/LOS = 0.36 ± 0.3 vs 0.77 ± 0.3, P = 0.0001). Conclusions consisted of: 1) ethics consultation on trauma patients are most commonly for end-of-life and shared decision-making issues; 2) most ethics consultations occur while patients are in the intensive care unit; and 3) earlier ethics consultations are likely to be for shared decision-making issues.
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Quiroz, Juan C., Liliana Laranjo, Ahmet Baki Kocaballi, Agustina Briatore, Shlomo Berkovsky, Dana Rezazadegan, and Enrico Coiera. "Identifying relevant information in medical conversations to summarize a clinician-patient encounter." Health Informatics Journal 26, no. 4 (August 29, 2020): 2906–14. http://dx.doi.org/10.1177/1460458220951719.
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To inform the development of automated summarization of clinical conversations, this study sought to estimate the proportion of doctor-patient communication in general practice (GP) consultations used for generating a consultation summary. Two researchers with a medical degree read the transcripts of 44 GP consultations and highlighted the phrases to be used for generating a summary of the consultation. For all consultations, less than 20% of all words in the transcripts were needed for inclusion in the summary. On average, 9.1% of all words in the transcripts, 26.6% of all medical terms, and 27.3% of all speaker turns were highlighted. The results indicate that communication content used for generating a consultation summary makes up a small portion of GP consultations, and automated summarization solutions—such as digital scribes—must focus on identifying the 20% relevant information for automatically generating consultation summaries.
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Rungby, Jeanne A., Frans Rømeling, and Peter Borum. "Tonsillectomy: assessment of quality by consultation rate after discharge." Journal of Laryngology & Otology 113, no. 2 (February 1999): 135–39. http://dx.doi.org/10.1017/s0022215100143385.
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AbstractThe aim of this prospective study was to establish a measure of short-term quality of treatment after tonsillectomy/adenotonsillectomy. One hundred and thirty-four questionnaires, returned after 14 days, from 41 children and 93 adults were analysed. Forty-seven per cent had one or more consultations with health-care professionals. Eighty-three consultations by telephone and 33 consultations in person were made. Two recent studies reported higher consultation rates in person to doctors compared to this study. The predominant reason for consulting health-care professionals was pain. Maximum pain scores were significantly higher among those with consultations vs. no consultations (p = 0.0001). Additionally, the intensity as well as the duration of maximal pain increased with the number of contacts per patient (p = 0.0001, p = 0.0045). Sixty-four per cent felt relieved after consultation by telephone and 83 per cent felt relieved after consultation in person. The present study suggests consultation rate as a parameter of quality of treatment and quality of information.
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Azam, Muhammad, and Raouf E. Nakhleh. "Surgical Pathology Extradepartmental Consultation Practices." Archives of Pathology & Laboratory Medicine 126, no. 4 (April 1, 2002): 405–12. http://dx.doi.org/10.5858/2002-126-0405-specp.
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Abstract Objectives.—To document the practice parameters and case characteristics associated with personal (expert) consultations. We also examine the value, level of participant (customer) satisfaction, turnaround time, and rate of personal consultations. Design.—We asked participants in the College of American Pathologists' Q-Probes program to document cases sent for consultation during 4 months or up to 20 cases. They documented patient and specimen characteristics, the turnaround times, and the participants' levels of satisfaction with the consultation experience. Participants.—One hundred eighty laboratories/surgical pathology practices. One hundred seventy-two (95.6%) were from the United States; the remainder were located in Canada and Australia. Main Outcome Measures.—Rate and turnaround time of consultations and participant level of satisfaction. Results.—A total of 2746 consultation cases were examined for an aggregate consultation rate of 0.5% (median, 0.7%). Institutions with a higher occupied bed size and a greater number of surgical pathology cases both had lower consultation rates (P ≤ .05). The median turnaround time (defined as the interval from the date on which the case was sent to the date on which the diagnosis was received) was 6 days. Twenty-nine percent and 68% of cases had a turnaround time within 3 and 7 days, respectively. Fifty-two percent of cases were sent to nationally known experts, and 32% were sent to local experts. Skin (18.0%), hematolymphoid (11.6%), and breast (9.6%) specimens were most commonly sent for consultation. In 70.5% of cases, the consultant confirmed the referring pathologist's original diagnosis, but in 15.9% of cases, the consultant also added significant information. Satisfaction rates were higher with faster turnaround times and verbal reporting. Satisfaction rates were lower for cases in which the patient or the clinician requested the consultation and in which the consultant's diagnosis was ambiguous. Conclusions.—This study establishes a multi-institutional consultation rate of 0.5%, defines the nature of surgical pathology consultations, and demonstrates that satisfaction with consultations is associated with a faster turnaround time and receipt of additional, clinically meaningful information.
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Chetty, Laran. "Client Satisfaction With Virtual Consultations During the COVID-19 Pandemic at an Occupational Health Physical Therapy Clinic." Workplace Health & Safety 70, no. 4 (February 3, 2022): 220–23. http://dx.doi.org/10.1177/21650799211061146.
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Background: The purpose of this project was to determine whether clients were satisfied with their occupational health physical therapy virtual consultations and whether or not they would have preferred a face-to-face consultation instead of a virtual consultation. Methods: Clients were mailed an adapted 10-item Telehealth Satisfaction Scale (TeSS) and asked to complete and return it in a prepaid envelope. Clients who returned the TeSS were then contacted by telephone and asked whether they would have preferred a face-to-face consultation instead of a virtual consultation. Findings: Overall, clients expressed a high degree of satisfaction with their virtual occupational health physical therapy consultation (96.9%). Most clients (82.1%) stated they would have chosen virtual consultations if given the choice. Conclusion/Application to Practice: The cumulative feedback from clients suggested that the benefits of virtual consultations can be sustained post COVID-19 pandemic as clients have accepted and adapted to this new approach within the occupational health physical therapy clinic.
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Zanaboni, Paolo, Trine S. Bergmo, and Eli Kristiansen. "Patients’ experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey." BMJ Open 14, no. 1 (January 2024): e075352. http://dx.doi.org/10.1136/bmjopen-2023-075352.
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ObjectivesTo explore patients’ experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text).DesignA nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway.SettingPrimary care.ParticipantsPatients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020.ResultsOf the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001).ConclusionsPatients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients’ and GPs’ use and experiences in a postpandemic setting.
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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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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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Billington, Emma O., A. Lynn Feasel, Jessica L. VanDyke, and Gregory A. Kline. "Group medical consultation for osteoporosis: a prospective pilot study of patient experience in Canadian tertiary care." British Journal of General Practice 70, no. 700 (October 5, 2020): e801-e808. http://dx.doi.org/10.3399/bjgp20x713081.
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BackgroundDelivery of patient-centred care is limited by physician time. Group medical consultations may save physician time without compromising patient experience.AimTo assess patient experience and specialist physician time commitment in a group consultation for osteoporosis.Design and settingProspective pilot study at a tertiary osteoporosis centre in Canada between May 2016 and June 2019.MethodThe authors evaluated women referred for osteoporosis who chose a 2-hour group consultation instead of a one-to-one consultation. Group consultations were led by an osteoporosis nurse and specialist physician, and consisted of individualised fracture risk assessment and education regarding osteoporosis therapies, followed by a decision-making exercise to choose a treatment plan. Patients then followed up with their GPs to implement this plan. Patient experience was assessed via a questionnaire immediately and 3 months post-consultation, at which time GP satisfaction and patient treatment status were also surveyed.ResultsOf 560 referrals received, 18 patients declined osteoporosis specialist assessment, 54 could not be contacted, 303 attended a one-to- one consultation, and 185 attended a group consultation. Mean participant age was 62.8 years (standard deviation [SD] 5.8) and the Fracture Risk Assessment Tool (FRAX) 10-year osteoporotic fracture risk was 13.0 (SD 7.0)%. Immediately post-consultation, 104 (97.2%) patients were satisfied and 102 (95.3%) felt included in decision making. Satisfaction was reported by 95/99 (96.0%) patients and 27/36 (75.0%) GPs. Treatment plans had been enacted by 90 (90.1%) patients. For a matched number of individual consultations, each group session conferred a specialist physician time savings of 5.5 hours.ConclusionGroup consultations represent a satisfactory and time-efficient alternative to one-to-one consultations for select patients with osteoporosis.
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Woods, Robert A., Renee Lee, Maria B. Ospina, Sandra Blitz, Harris Lari, Michael J. Bullard, and Brian H. Rowe. "Consultation outcomes in the emergency department: exploring rates and complexity." CJEM 10, no. 01 (January 2008): 25–31. http://dx.doi.org/10.1017/s1481803500009970.
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ABSTRACTObjective:Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals.Methods:Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms. Subsequent computer outcome data were extracted for each patient encounter, as well as demographic data from the ED during days in which there was a study shift.Results:During 105 clinical shifts, 1930 patients were managed by 21 EPs (median 17 patients per shift; interquartile range 14–23). Overall, at least 1 consultation was requested in 38% of patients. More than one-half of the patients (54.3%) who received a consultation were admitted to the hospital. Consultation proportions were similar between males and females (51% v. 49%,p= 0.03). Consultations occurred more frequently for patients who were older, had higher acuity presentations, arrived during daytime hours or arrived by ambulance. The proportion of agreement between the EP's and consultant's opinion on the need for admission was 89% (κ = 0.77, 95% confidence interval 0.72–0.83). Overall, 92% of patents received 1 consultation. Six percent of the consultations were perceived as “difficult” by the EPs (defined as the EP's subjective impression of difficulties with consultation times, accessibility and availability of consultants, and the interaction with consultants or disposition issues).Conclusion:Consultation is a common process in the ED. It often results in admission and is predictable based on simple patient factors. Because of perceived difficulty with consultations, strategies to improve the EP consultation process in the ED seem warranted.
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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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Hofmeyr, J. W. "’n Beraad te midde van berade: Die historiese konteks van die Cottesloe-Kerkeberaad herbeoordeel." Verbum et Ecclesia 12, no. 2 (July 18, 1991): 242–58. http://dx.doi.org/10.4102/ve.v12i2.1038.
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A consultation amongst consultations: The historical context of the Cottesloe Church Consultation reconsidered At the time of writing it happens to be thirty years since the well known Cottesloe Church Consultation took place. On the other hand the November 1990 consultation of a wide variety of South African churches appears strongly in the focal point. In this article the socio-political, ecclesiastical and theological context of the Cottesloe Consultation is reconsidered. Finally some conclusions are drawn as regards the relevance of the Cottesloe Consultation for our times.
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Peeters, Ken M. M., Loïs A. M. Reichel, Dennis M. J. Muris, and Jochen W. L. Cals. "Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care." JAMA Network Open 7, no. 1 (January 12, 2024): e2351623. http://dx.doi.org/10.1001/jamanetworkopen.2023.51623.
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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.
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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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Jiménez-Rodríguez, Diana, Diego Ruiz-Salvador, María del Mar Rodríguez Salvador, Mercedes Pérez-Heredia, Francisco José Muñoz Ronda, and Oscar Arrogante. "Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study." International Journal of Environmental Research and Public Health 17, no. 15 (July 27, 2020): 5396. http://dx.doi.org/10.3390/ijerph17155396.
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The use of telemedicine has greatly increased, largely derived from the COVID-19 pandemic, which has created the need for a guide aimed towards the adequate management of a modality of health care: the video consultation. A Delphi study composed of three rounds was conducted with 16 experts in holding video consultations and managing non-technical skills from different specialties and nationalities to conceive a consensus on the criteria needed for properly managing video consultations by healthcare professionals. The consensus criteria were defined by three dimensions (preparation of video consultation, video consultation process, and post-video consultation) and their corresponding items. Excellent consensus data was obtained; therefore, use is recommended by any healthcare professional who is going to utilize a video consultation, in order to manage it effectively.
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Botelho, Michael. "The communal consultation: video-recorded student consultations." Medical Education 50, no. 5 (April 13, 2016): 573–74. http://dx.doi.org/10.1111/medu.13047.
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Butcher, Paul, and Simona Pronckutė. "European Citizens’ Consultations: Consultation begins at home." European View 18, no. 1 (April 2019): 80–88. http://dx.doi.org/10.1177/1781685819847637.
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In 2018 the European Citizens’ Consultations took place throughout Europe. These events were organised by national governments and local actors, and thus represented a significantly increased role for the member states in communicating about Europe, a task which had previously been carried out chiefly by EU bodies. Thus, the Citizens’ Consultations hold great potential for the application of the principle of subsidiarity to citizens’ engagement and inclusion in decision-making. However, for the consultations to be successful, political leaders need to ensure that the results are reflected in the European Parliament election campaign and the agenda of the new leadership, demonstrating that citizens’ voices are being heard in Brussels. This article will give background information about the European Citizens’ Consultations, evaluate their potential and provide recommendations on how policymakers can ensure this new tool is used effectively.
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Assing Hvidt, Elisabeth, Anette Grønning, Elle Lüchau, Maja Nordtug, Martin Bavngaard, and Jens Søndergaard. "Video Consultations in General Practice: Tendencies and Lessons Learned From the First COVID-19 Lockdown Period." Iproceedings 8, no. 1 (August 23, 2022): e41530. http://dx.doi.org/10.2196/41530.
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Background Video consultation was urgently introduced in general practice in connection with the COVID-19 pandemic, where a rapid implementation ensured patients’ continued access to their general practitioner (GP). With the Danish lockdown in March 2020, the use of video consultations in general practice increased drastically and then declined significantly shortly after as society gradually reopened. Today, only a small proportion of the total number of consultations in general practice is made up of video consultations, and there is great variation in the scope and use of video consultation among GPs and practice staff. Objective The aim of this paper is to present research findings from a qualitative, interdisciplinary project, investigating GP and patient experiences with video consultations during the first lockdown period in 2020, which might help explain the abovementioned tendencies in relation to scope and implementation variances. Methods The data corpus includes data generated through semistructured interviews with 27 patients and 15 GPs, as well as 8 video recordings of video consultations between GP and patient. Results The patients reported positive experiences with consulting their GP through video, valuing increased convenience and spatial flexibility and wishing for future use of video consultation as either a supplement or an alternative to physical consultation. Video consultation furthermore presented a new communicative context in which both patients and GPs enacted distinct forms of technologically facilitated participation. Conclusions To further the best use of video consultation in future general practice, organizational and individual factors such as renumeration, task delegation, time pressure, and professional identity need to be considered.
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Etgen, Thorleif. "Case series of introducing palliative care consultation in psychiatry." Palliative Medicine 34, no. 5 (February 17, 2020): 680–83. http://dx.doi.org/10.1177/0269216319901241.
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Background: The significance of palliative care consultation in psychiatry is unclear. Actual case series: Analysis of the introduction of palliative care consultation in a large psychiatric hospital. Possible courses of action: Continue without offering, survey the need for or offer palliative care consultation, and analyse its introduction. Formulation of a plan: Palliative care consultation was established and details including patient age, department, diagnosis, main problem, solution and discharge were analysed during the first 2 years. Outcome: Two consultations in the first year and 18 consultations in the second year were requested (18 geriatric, 2 addiction, 0 general, clinical social and forensic psychiatry) involving two domains: delirium associated with dementia or another condition (75%) and mental illness (e.g. alcoholic psycho-syndrome, psychosis, suicidal tendency, schizophrenia, depression) and cancer (25%). Recommendations of consultations were realized in 95%. Lessons from the case series: Implementation of palliative care consultation in psychiatry is one possible method of how to introduce palliative care in a field of medicine with lack of palliative care. View: Future research should focus on reasons for reservations about palliative care in psychiatry, include more patients with severe persistent mental illness and assess the value of palliative care consultation in resolving this problem.
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Atalay, Fatma, and K. Topal. "A Restrospective Evaluation of Otorhinolaryngology Consultations Requested from the Emergency Department." Annals of Medical Research 29, no. 11 (2022): 1. http://dx.doi.org/10.5455/annalsmedres.2022.06.186.
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Aim: In this study, it was aimed to examine the emergency service consultations requested from the otorhinolaryngology outpatient clinic and to discuss the results in the light of the literature. Material and Methods: In our study, 376 emergency department consultations requested from the otorhinolaryngology outpatient clinic of Kastamonu Training and Research Hospital between the dates 01.10.2019 and 01.10.2021 were examined retrospectively. Age and gender of patients, date of consultation, reasons for consultation, diagnoses made as a result of consultation and interventions were recorded. Results: 142 (37.8%) of the patients who requested consultations were female and 234 (62.2%) of them were male. The mean total age was 38.43. The most common reason for consultation was nasal fracture, infectious causes, foreign body in the ear and foreign body in the nose, respectively (n=77, 20.47%; n=51, 13.56%; n=39, 10.37%; n=36, 9.57%). The most frequently consultation requested months are July (n=62, 16.48%), August (n=45, 11.96%) and September (n=44, 11.70%), respectively. As a result of the consultations, the most common interventions were foreign body removal and nasal fracture repositioning (n=64, 17.02%; n=58, 15.42%). No otorhinolaryngology pathology was found in 79 patients (21.01%). Conclusion: The fact that emergency physicians have sufficient knowledge and experience in otorhinolaryngology emergencies will both reduce the mortality and morbidity of patients and prevent the loss of time and internal power by preventing unnecessary consultation requests
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Luntz, Jennifer J. "Mental health consultation: Stages in the consultation process." Children Australia 25, no. 1 (2000): 21–26. http://dx.doi.org/10.1017/s1035077200009573.
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This is the second of two articles that present theoretical issues concerning mental health consultation. The first article looked at the question of what consultation is and how it differs from related processes such as supervision, therapy and staff development (Luntz 1999). This paper uses Kadushin’s six stage framework for social work consultation to look at some common issues which confront consultants in the process of mental health consultation as they establish, maintain and terminate consultative relationships with agencies and workers, giving an account of some of the complex issues which bedevil each of the stages.
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Garcia Hernandez, I., D. V. Mendoza Mendoza, P. Muñoz Reinoso, and J. J. Pérez Venegas. "POS1480-HPR IMPLEMENTATION OF TELEMEDICINE IN RHEUMATOLOGY: VIRTUAL CONSULTATION AS A TOOL FOR DIRECT COMMUNICATION WITH PRIMARY CARE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1024.3–1025. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1443.
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Background:Virtual consultation is defined as the provision of a healthcare service when there is a distance between the subjects and information and communication technologies are used to carry out the consultation. This tool has been successfully implemented in different specialties. It is useful for providing quick solutions, improving the overload of the medical care and for the early detection of inflammatory diseases1. In our centre, virtual consultation from Primary Care (PC) to Hospital Care (HC) has been implemented.Objectives:The main objective is to describe our experience with the use of virtual consultation and its value as a new modality of specialised medical care. The second aim is to identify the most frequent reasons for consultation and diagnoses, to assess the concordance between the two and to analyse the trend over time of the number of virtual consultations and their relationship with the different waves of the COVID 19 pandemic.Methods:Retrospective observational study. The virtual consultations made from PC (47 centres) to Rheumatology during 2020 were analysed. They were carried out through a computer programme, using the “Andalusian Health Service Virtual Consultation Platform” tool. A specific agenda was established for virtual consultations. The reason for the referral and the rheumatologist’s diagnosis were collected. The response given to the PC was divided into four models: NON-TRIBUTARY (not related to the speciality), DISCHARGE (a diagnosis and therapeutic response is concluded), APPOINTMENT FOR CONSULTATION and FOLLOW-UP (new contact is requested, completing the information). The reasons for consultation, diagnoses, time and type of response were analysed.Results:47 virtual consultations were carried out. 54.5% (n 298) were closed as DISCHARGE. 27.4% (n 150) were APPOINTMENT FOR CONSULTATION, and 17.7% (n 97) indicated FOLLOW-UP. Only 0.4% (n 2) were NOT TRIBUTARY.The average response time was 2 days 15 hours and 56 min.The most frequent reason for consultation was polyarthralgias (26.7%, n 146) and after the rheumatologist’s assessment a diagnosis was established in 89% of them. Inflammatory arthropathy accounted for 30.8% (n 45), osteoarthritis for 19.9% (n 29), fibromyalgia for 12.3% (n 18), polymyalgia rheumatica (PMR) for 6.9% (n 10), osteoporosis for 2.7% (n 4) and connective tissue disease for 2.1% (n 3).Another frequent reason for consultation was osteoporosis (13.5% n 74), of which 85.1% (n 63) had a confirmed diagnosis and/or need for revision.A diagnosis could be made via telematics in 89.6% of the consultations. 15.5% were osteoporosis (n 85), 14.9% osteoarthritis (n 81), 10.5% soft tissue injuries, 8.8% mechanical/nonspecific pain (n 47), 7.1% rheumatoid arthritis (n 39), 6.5% fibromyalgia (n 34), 6.2% connective tissue disease (n 34), 5.7% PMR (n 31), 4.9% suspected spondyloarthritis (n 26), 4.2% psoriatic arthritis (n 23) and 4.2% microcrystalline arthritis (n 23).27.4% (n 150) of the virtual consultations were required for assessment in a face-to-face appointment. We analysed the distribution over time (Figure 1). In the COVID 19 confinement phase (14 March - 21 June), the number of consultations increased, peaking in June, a behaviour that has persisted in the other mobility phases (October/November).Conclusion:More than half of the virtual consultations carried out were resolved without face-to-face assessment, with a diagnosis being established in almost 90%. It is an effective tool for rapid access to Rheumatology, detecting pathology requiring preferential attention, with a face-to-face appointment, as well as for the early diagnosis of inflammatory arthropathy, which was detected in a quarter of the consultations, as well as for the diagnosis and follow-up of osteoporosis. Virtual consultation facilitates a quick response, playing an even more relevant role in the current SARS CoV-2 pandemic situation.References:[1]B. Tejera, S. Bustabad. A new form of communication between rheumatology and primary care: The virtual consultation. Reum Clin., 12 (2016), pp 11-14Disclosure of Interests:None declared
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Kachman, Marika, Keme Carter, Vineet M. Arora, Andre Flores, David O. Meltzer, and Shannon K. Martin. "Describing Variability of Inpatient Consultation Practices: Physician, Patient, and Admission Factors." Journal of Hospital Medicine, Volume 15, Issue 03 (February 19, 2020): 164–68. http://dx.doi.org/10.12788/jhm.3355.
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Appropriate use of consultation can improve patient outcomes, but inappropriate use may cause harm. Factors affecting the variability of inpatient consultation are poorly understood. We aimed to describe physician-, patient-, and admission-level factors influencing the variability of inpatient consultations on general medicine services. We conducted a retrospective study of patients hospitalized from 2011 to 2016 and enrolled in the University of Chicago Hospitalist Project, which included 6,153 admissions of 4,772 patients under 69 attendings. Consultation use varied widely; a 5.7-fold difference existed between the lowest (mean, 0.613) and highest (mean, 3.47) quartiles of use (P <.01). In mixed-effect Poisson regression, consultations decreased over time, with 45% fewer consultations for admissions in 2015 than in 2011 (P <.01). Patients on nonteaching hospitalist teams received 9% more consultations than did those on teaching services (P =.02). Significant variability exists in inpatient consultation use. Further understanding may help to identify groups at high-risk for underuse/overuse and aid in the development of interventions to improve high-value care.
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Kummer, Benjamin R., Joshua Z. Willey, Michael J. Zelenetz, Yiping Hu, Soumitra Sengupta, Mitchell S. V. Elkind, and George Hripcsak. "Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center." Applied Clinical Informatics 10, no. 05 (October 2019): 849–58. http://dx.doi.org/10.1055/s-0039-1698465.
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Abstract Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.
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Taylor, Michael J., Dell Horey, Charles Livingstone, Siew-Pang Chan, and Hal Swerissen. "General practitioners and consultation drift: the effects of supply-side changes and reforms on service delivery patterns." Australian Health Review 37, no. 5 (2013): 574. http://dx.doi.org/10.1071/ah12160.
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Objectives To determine what types of supply-side change underpinned the recent decline in longer (Level C and D) consultation provision and to evaluate the impact of the May 2010 reforms in realigning Medicare with long-term health policy objectives. Methods Retrospective analysis of Level C and D consultation provision by general practitioners (GPs) across Australia. Outcome measures were extent (number of consultations per providing GP) and participation (proportion of GPs providing these consultations). Results The proportion of GPs participating in Level C consultation provision is substantial (96%) and constant; however, extent of provision per GP decreased by 21% between 2006 and 2010. Level D participation decreased from 72% during 2006 to a nadir of 62% in 2009, and extent of provision decreased by 26% between 2006 and 2010. Conclusion Two distinct types of change underpinned the overall decline in Level C and D consultation provision. GPs appear to be providing Level C consultations less often, but the overwhelming majority still provide these consultations to some extent. The extent of provision of Level D consultations and the proportion of GPs providing them has decreased; an appreciable number of GPs simply stopped providing Level D consultations. Medicare reforms appear ineffective in realigning Medicare with long-term policy objectives. What is known about the topic? Previous research has demonstrated that GP consultation delivery patterns under Medicare have changed profoundly in recent years, with provision of Level C and D GP consultations having declined substantially. What does this paper add? This research shows that the overall decline in longer consultations is underpinned by distinct supply-side changes: (1) a decrease in average consultation provision per GP (for Levels C and D) and (2) the effective abandonment of Level D consultations by GPs. Medicare reforms do not appear to be entirely effective in addressing these supply changes. What are the implications for practitioners? Despite their centrality to health policy objectives of improved preventive care, chronic disease management and mental healthcare, longer GP consultations are declining in very distinct ways. The ability of the current Medicare model to achieve these health policy objectives appears increasingly questionable.
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McCusker, Sarah, Aoife Daly, Natalie King, Manrup Hunjan, Lea Solman, Esther Burden-Teh, Susannah George, and Gordon Hale. "P17 A Multisite Service Evaluation of Paediatric Teleconsultations." British Journal of Dermatology 190, Supplement_1 (January 2024): i10. http://dx.doi.org/10.1093/bjd/ljad483.026.
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Abstract Paediatric dermatology teleconsultations have become familiar territory since the Covid-19 pandemic. There is a continued drive to provide teleconsultations, with efficiency and cost-saving cited as benefits. Yet, this is not supported by a recent UK-wide survey of health professionals.1 We evaluated practice across two paediatric dermatology centres, to assess time required for teleconsultations. Data were collected prospectively from paediatric dermatology outpatient consultations for patients <16 years over 2 weeks in March and 4 weeks in September 2022. Consultation type (face-to-face/telephone/video), patient demographics, diagnosis and consultation length were reviewed. Caldicott approval was obtained. A total of 173 consultations were included. There was a range of diagnoses including eczema (n=60), skin lesions (n=22), vascular lesions (n=28) and other inflammatory skin conditions (n=63). Most consultations were face-to-face (n=108, 62%), while 38% (n=65) were teleconsultations. Median consultation duration was 13 minutes, 45 seconds (range: 2.5min–1hour 5min 2s). Comparison of consultation duration across 3 modalities (face-to-face vs telephone vs video) demonstrated no statistical significance between groups. (H(2)=5.76, P=0.056). There was a trend toward significance, likely due to 3 face-to-face consultations with duration of >50 minutes. Limitations include relatively small sample size and consultations carried out by few clinicians. Consultation modality is often influenced by case complexity, i.e., more complex consultations are likely to be held face-to-face. Future work includes a health-economic analysis of teleconsultations to determine if these are cost-effective.
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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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Shuman, Andrew G., Sacha M. Montas, Andrew R. Barnosky, Lauren B. Smith, David W. Kissane, Joseph J. Fins, and Mary S. McCabe. "Clinical ethics consultation in oncology." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 9121. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.9121.
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9121 Background: There is limited empirical research exploring the nature of clinical ethical consultations within the oncology population. Our objective is to review, describe and compare clinical ethics consultations at two NCI-designated comprehensive cancer centers, in order to identify opportunities for systems improvement in clinical care. Methods: This case series is derived from prospectively-maintained clinical ethics consultation databases at each institution. All adult oncology patients receiving ethics consultation from 2007 through 2011 were included as eligible cases. Both qualitative and quantitative analyses were undertaken. Demographic and clinical information were obtained from the databases for all patients, and verified via chart abstraction. Additional variables studied included the reason for and context of the ethical consultation, the patient’s code status before and after consultation, and involvement of palliative care or other adjuvant services. Opportunities for systems-level improvements and/or educational initiatives were identified. Results: A total of 207 eligible cases were identified. The most common primary issues leading to ethics consultation were code status and advance directives (25%), surrogate decision-making (17%), and medical futility (13%). Communication lapses were identified in 41%, and interpersonal conflict arose in 51%. Prior to ethics consultation, 26% of patients were DNR; 60% were DNR after ethics consultation. Palliative care consultation occurred in 41% of cases. Opportunities for systems improvement and professional education related to goals of care at the end of life, the role of palliative care involvement, and improved communication. Conclusions: Ethics consultations among cancer patients reflect the realities inherent to their clinical management. Appropriately addressing advance directives within the context of overall goals of care is crucial. Thoughtful consideration of communication barriers, sources of interpersonal conflict, symptom control, and end-of-life care are paramount to optimal management strategies in this patient population.
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Ciechanowicz, Dawid, Maria Wójtowicz, Barbara Ufnalska, Paweł Głodek, Hanna Ruszkowska, and Łukasz Kołodziej. "The impact of preoperative cardiology consultation on the surgical treatment of patients with proximal femur fractures." Chirurgia Narządów Ruchu i Ortopedia Polska 87, no. 3 (September 22, 2022): 99–104. http://dx.doi.org/10.31139/chnriop.2022.87.3.2.
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Introduction. Proximal femur fractures are a common problem in the geriatric population. Moreover, due to numerous comorbidities, the choice of the appropriate form of treatment requires a cardiology consultation. Aim. Therefore, the aim of this study is to analyze whether these consultations have a significant impact on the treatment of patients with proximal femoral fractures. Materials and methods. A total number of 158 patients with a mean age of 81.3 (range, 56-98), treated for femoral neck and trochanteric fractures were enrolled in a retrospective study. Data from the patient’s treatment history were used for the study, such as: age, hospital admission date, cardiological consultation date, surgery date, discharge date or date of death. Results. Patients without cardiology consultation stayed in hospital on average 3.97 days shorter (p = 0.0011) and had surgery on average 2.89 days earlier (p = 0.000001) than patients with an arranged consultation. The percentage of deaths in both groups was similar: 6.1% and 7.1% (p = 0.70068). Spinal anesthesia was mainly performed by anesthesiologists in the group with consultation (64.3%) and without consultation (83.8%) (p = 0.442). More cases with a consultation were disqualified from surgery: 18.8% vs. 2.9% (p = 0.00357). Among the patients with an ordered cardiological consultation, 53.6% had surgery > 48 hours after admission compared to 26.2% patients without consultation (p = 0.0002). Conclusions. Cardiological consultations extend the length of stay in hospital and delay surgical treatment, but do not affect the choice of anesthesia. However, consultation in some cases may help in the proper qualification and disqualification from surgery.
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KAPUR, N., I. HUNT, M. LUNT, J. McBETH, F. CREED, and G. MACFARLANE. "Psychosocial and illness related predictors of consultation rates in primary care – a cohort study." Psychological Medicine 34, no. 4 (April 21, 2004): 719–28. http://dx.doi.org/10.1017/s0033291703001223.
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Background. Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over a 5-year period.Method. We carried out a prospective, population-based cohort study with three waves of data collection by postal questionnaire in one general practice in Greater Manchester (UK). Consultation data were sought from primary care records on a random subsample of 800 adult patients. The main outcome measure was the number of consultations (including surgery and home visits) over the 5 years of the study as determined by raters blind to questionnaire responses. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, a functional assessment of disability.Results. Consultation data were obtained on 738 patients (92% of selected subjects), who accounted for 12182 consultations. Negative illness attitudes, the presence of physical and psychiatric disorder, health anxiety, changes in psychological distress, reported physical symptoms and demographic factors such as age and sex were independently associated with consultation over a 5-year period. These variables together accounted for a difference of ten consultations per year between groups.Conclusion. Consultation in primary care is a complex behaviour with a complex aetiology. Terms such as ‘frequent attenders’ may be less helpful than recognizing a number of dimensions that operate across the whole spectrum of consultation frequency. Future research should consider the wider context of consultation.