Biomedical subjects

P J Branger

Publications and source records attributed to P J Branger.

9 recordsLinked to original sources

PubMed1998

Communication between physicians and with patients suffering from breast cancer.

BACKGROUND: The communication between GP and specialists is vital for the patient suffering from breast cancer. OBJECTIVES: The aim of this study was to investigate (i) the speed and type of communication between GPs, specialists and patients with breast cancer, and (ii) the problems that GPs encounter in the communication with specialists concerning these patients. METHOD: In April 1995, 246 Dutch GPs from the Zwolle region (600 000 inhabitants) were invited to complete a questionnaire, using the information from the medical record and focusing on the last patient consulted with a confirmed diagnosis of breast cancer. RESULTS: Valid replies were received from 150 (61 %) GPs. The median period between initial referral date and receipt of the definite diagnosis from the surgeon was 4 weeks. After the patient's first appointment with the surgeon, the GPs received reports for 24% of the patients within 3 days; for 31% within 3-7 days; and for 16% of the patients after more than 2 weeks. After the first consultation between patient and surgeon, 68 (45%) of the 150 GPs reported that the patient contacted them; at this stage only 30 (20%) of these GPs had received a report from the surgeon. Thirty-one (21%) GPs did not contact the patient after receival of the definite diagnosis. GPs stated that the communication on patients with breast cancer is too slow (49%), or not frequent enough (25%); 25% of GPs found that the distribution of tasks between them and the specialists are not well described. CONCLUSION: In the diagnostic stage of breast cancer the communication between GPs, specialists and patients varies widely, is too slow and is incomplete. An effect of this unsatisfactory communication is that the patient herself is the messenger of the bad news.

Breast Neoplasms↗

PubMed1998

Shared care for diabetes: supporting communication between primary and secondary care.

As health care becomes more complex, interest in the benefits of coordination of care has increased. Especially patients that are being treated jointly by more than one physician (shared care), are vulnerable to adverse effects resulting from inadequate coordination and communication. We describe a study in which care providers support shared care by using computer-based patient records for data storage, and structured electronic data interchange (EDI) as a means of communication. The study showed that the electronic communication network for exchanging consultation outcomes significantly increased frequency of communication and the availability of data to the general practitioner on diagnostic procedures performed in the hospital, thus providing more complete information about the care that patients are receiving.

Computer Communication Networks↗

PubMed1995

Laboratory services utilization: a survey of repeat investigations in ambulatory care.

BACKGROUND: Earlier studies have shown that repeat investigations are a common cause of unnecessary duplication of laboratory test procedures. Most of the interventions aimed at reducing the number of repeat investigations have not resulted in long-term improvements. None of these studies, however, assessed utilization of laboratory services by physicians, simultaneously treating the same patient. METHODS: For a random sample of 1500 patients, we examined laboratory services utilization by physicians during an 8-month period. We counted the number of patients for whom more than one physician ordered laboratory test procedures simultaneously, and to what extent these procedures overlapped. RESULTS: For 28% of the patients more than one physician had ordered tests. Of all 41,655 tests, 5536 (13%) were repeated by a physician other than the physician who ordered the initial test: 1527 (4%) of the tests were repeated within 5 days. Patients between 70 and 90 years had the highest average number of tests, the highest number of involved physicians, and the smallest mean time between similar tests. CONCLUSIONS: There is a need for better coordination of care. Improved communication among physicians simultaneously treating a patient may lead to a reduction of repeat investigations.

Adolescent↗

PubMed1995

Communication in health care.

For routine communication, care providers still mainly rely on paper documents and paper mail. Evidence exists, however, that this communication can be improved, both by a better content of information exchange and by a more timely deliverance of this information. At present, several alternatives to paper-based communication are available, such as the Fax, the Smart Card, electronic mail, and electronic data interchange. This paper describes existing communication problems, and examines the current state of development and research aimed at improving this communication using electronic communication techniques that are gradually replacing paper-based communication. Applicability and shortcomings of these new techniques are also discussed.

Computer Communication Networks↗

PubMed1994

A standardized message for supporting shared care.

Computer Communication Networks↗

PubMed1992

Electronic communication between providers of primary and secondary care.

OBJECTIVE: To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. DESIGN: Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. SETTING: Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. OUTCOME MEASURES: Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors' satisfaction with electronic data interchange by questionnaire. RESULTS: Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. CONCLUSION: Electronic communication between primary and secondary care providers is a feasible option for improving communication.

Communication↗

PubMed1991

Electronic Data Interchange in medical care: an evaluation study.

This paper describes the evaluation of the first phase of the Communication Project Apeldoorn (COPA). The aim of COPA was to investigate the contribution of Electronic Data Interchange (EDI) to quality of care and practice efficiency. In this project over 33 general practitioners (GPs), 12 pharmacists and two hospitals (with one management) participated. In order to limit the number of variables for the evaluation study a limited number of messages was implemented: free-text messages between GPs; admission/discharge reports from hospitals to GPs, laboratory test reports from hospital to GP. The goal of the evaluation of the first phase of the project was to study message flow, the effect of integration with the Electronic Medical Record and the use of those data for patient care. In order to compare the use of EDI with the original situation (i.e. regular mail) a baseline study was performed. In this study the procedure for handling laboratory test reports and admission/discharge reports was also investigated. The results of the baseline study were compared with the evaluation of the use of EDI.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

Shared care for diabetes: supporting communication between primary and secondary care.

OBJECTIVE: To assess the effects on information exchange of electronic communication between physicians co-treating diabetic patients. DESIGN: Comparison of traditional paper-based communication for reporting and electronic communication. SETTING: General practitioners and an internal medicine outpatient clinic of an urban public hospital. SUBJECTS: A total of 275 diabetic patients, and the 32 general practitioners and one internal medicine consultant who cared for them. INTERVENTION: An electronic communication network, linking up the computer-based patient records of the physicians, thus enabling electronic data interchange. MAIN OUTCOME MEASURES: Number of letters sent and received per year by the general practitioners, the number of diabetes-related parameters (e.g. results of laboratory tests) in the patient records, and HBA1C levels. RESULTS: INTERVENTION GPs received more messages per year (1.6 per patient) than control GPs (0.5 per patient, P<0.05). Significant higher availability (P<0.05) was achieved for data on HBA1C levels, fructosamine levels, blood pressure measurements, cholesterol levels, triglyceride levels and weight measurements. INTERVENTION patients showed a slight but significant decrease of HBA1C levels in the second semester of 1994 (from 7.0 to 6.8, P = 0.03), control patients also showed a slightly decreased group mean, but this change was not significant (from 6.6 to 6.5, P = 0.52). The magnitudes of these mean differences, however, were not significantly different (intervention group: 0.21; control group: 0.12, P = 0.68). CONCLUSIONS: The electronic communication network for exchanging consultation outcomes significantly increased frequency of communication and the availability of data to the general practitioner on diagnostic procedures performed in the hospital, thus providing more complete information about the care that patients are receiving. A large-scale experiment over a longer period of time is needed to assess the effects of improved communication on quality of care.

Adult↗

PubMedDate not supplied

Electronic messaging between primary and secondary care: a four-year case report.

OBJECTIVE: To observe how electronic messaging between a hospital consultant and general practitioners (GPs) in 15 practices about patients suffering from diabetes evolved over a 3-year period after an initial 1-year study. DESIGN: Case report. Electronic messages between a hospital consultant and GPs were counted. The authors determined whether a message sent by the consultant was integrated into the receiving GP's electronic medical record system. After the observation period, the GPs answered a questionnaire. MEASUREMENTS: The number of electronic messages and the percentage of messages integrated into the electronic medical record. RESULTS: The volume of messages was maintained during the 3 years after the original study. In the original study, the percentage of the messages integrated by the GPs increased during the year. After that study, however, seven GPs stopped integrating data from messages. The extent to which received messages were integrated varied widely among practices. CONCLUSION: The authors conclude that extrapolation of the results of the original study would have led to incorrect conclusions. Although the volume of messages remained stable after the original study, GPs changed their method of handling messages. Initially, all GPs used the opportunity to copy data from the messages into their own records. At the end of the observation period (that is, the 3 years after completion of the original study), more than 50 percent of GPs had ceased copying data from the messages into their own records. The majority of GPs, however, wanted to expand the use of electronic messaging.

Attitude of Health Personnel↗