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At least 19 recordsLinked to original sources

PubMed1998

Why patients consult when they cough: a comparison of consulting and non-consulting patients.

BACKGROUND: Although it is the commonest symptom presented to general practitioners (GPs), little is known about why someone decides to consult with a cough. AIM: To describe the illness behaviour of patients with a cough. METHOD: Patients who had consulted a GP because of a cough, and a group of subjects who had recently had a cough but had not consulted, were interviewed in a qualitative study that investigated how they made sense of their illness. RESULTS: Consulting patients understood their cough to be abnormally severe, whereas non-consulting subjects regarded their cough as 'normal' and mild. Consulting patients thought the cough would interfere with social roles and non-consulting subjects did not. The consulting patients were much more likely to be worried about the cough than the non-consulting subjects. In particular, half of the consulting patients were worried about their hearts, whereas the non-consulting subjects were not. The two groups did not distinguish bacteria from viruses, and did not differ in beliefs about the role of antibiotics that they thought were needed for severe coughs. Both groups had concerns about pollution. CONCLUSIONS: For consulting patients, cough breached the taken for granted property' of health that the non-consulting subjects with a cough were able to maintain. Cough, for the consulting patients, was not a trivial illness.

Adolescent↗

PubMed2000

Health care ethics consultation: nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation.

Patients, families, and health care providers have a right to expect that ethics consultants can deal competently with the complex issues that they are asked to address. The Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation explored core competencies and related issues in ethics consultation. This position paper summarizes the content of the resulting Task Force Report, which included nine general conclusions: 1) U.S. societal context makes "ethics facilitation" an appropriate approach to ethics consultation; 2) ethics facilitation requires certain core competencies; 3) core competencies can be acquired in various ways; 4) individual consultants, teams, or committees should have the core competencies for ethics consultation; 5) consult services should have policies that address access, patient notification, documentation, and case review; 6) abuse of power and conflicts of interest must be avoided; 7) ethics consultation must have institutional support; 8) evaluation of process, outcomes, and competencies is needed; and 9) certification of individuals and accreditation of programs are rejected.

Bioethics↗

PubMed1989

Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters.

To identify factors associated with the decision to consult with dyspepsia, patients with dyspepsia were identified from a postal survey in the community. A random sample of 69 patients who had consulted their general practitioner and 66 patients with dyspepsia who had not consulted were interviewed in their homes. Differences in consultation behaviour were not explained by differences in self-reported severity or frequency of symptoms or by the presence of associated symptoms. The most striking difference between the two groups was concern among the consulters about the possible seriousness of symptoms. Consulters were also more likely to be worried about cancer and heart disease and to have experienced more disruptive or threatening life events than the non-consulters. These results emphasize the importance of looking beyond the presentation of common symptoms in general practice to patients' fears about the significance of the symptoms and to non-physical determinants of consultation behaviour.

Anxiety↗

PubMed2001

Consulting about consulting: challenges to effective consulting about public health research.

OBJECTIVE: To understand barriers to obtaining input from consumers in developing public health research. METHODS: Documentation of a failed attempt at consumer consultation supplies information on barriers to effective involvement and conditions that must prevail to improve consultation. RESULTS: People are keen to be heard in the formulation of health research. However, competing demands and limited resources make it difficult for community groups to allocate scarce resources to consultation. Sometimes research issues may seem 'academic' and thus remote from the urgent priorities of the people with whom researchers wish to consult. Consultation may require more time than researchers on limited budgets can afford. CONCLUSIONS: Despite a general public health commitment to involving consumers in research development, obstacles to consultation make it difficult to incorporate it into the research agenda. IMPLICATIONS: Researchers and funding bodies will need to allocate resources to consumer consultation if it is to become the rule rather than the exception in public health research.

Australia↗

PubMed2002

Consultation length, patient-estimated consultation length, and satisfaction with the consultation.

Lack of time is a frequently expressed patient concern, but actual measured consultation length is often not associated with patient satisfaction. Correlational analysis of patients from nine GP practices was used to test the hypothesis that patients' perceptions of consultation length are influenced not just by actual consultation length, but by other aspects of their experience of consultations. The consultations of 160 patients were timed, and patients in subsequent interviews gave estimates of consultation duration and completed a satisfaction questionnaire. Consultations where patients were more satisfied appeared to patients to have lasted longer (partial correlation r = 0.26), but were not actually longer. Patient concerns about time may be as much about quality time as about actual time.

Adolescent↗

PubMed1990

Is the Friday afternoon consult frequent? Timing of consultation requests on a psychiatric consultation service.

Two hundred psychiatric consultations were reviewed to determine if there was a pattern regarding the time of day and day of the week that consultations were requested. Consultations were found to be requested on a random basis although a survey of consultation psychiatrists perceived that consultations were more often requested late in the day. The implications of such misperceptions are discussed as they relate to negative attitudes towards consultative psychiatry by psychiatric physicians.

Child Psychiatry↗

PubMed1992

Non-consulters and high consulters in general practice: cardio-respiratory health and risk factors.

The 1990 General Practitioner contract requires that health promotion and illness prevention services should be provided to all patients aged 16-74 years. Consultation rates over a period of three years were examined in 7010 middle-aged men in Great Britain to compare the cardio-respiratory health and risk factor status of non-consulters (men who did not consult in three years) with those of average consulters (men who consulted 3-5 times in three years) and high consulters (men who consulted 24 or more times in three years) to assess their relative need for health promotion and illness prevention services. The non-consulters (n = 1025) were remarkably similar to the average consulters (n = 1585) in health and lifestyle characteristics. The high consulters (n = 306) had a greater burden of ill-health and a less healthy lifestyle. Chest pain on exertion, chronic bronchitis, breathlessness or wheeze were present in 23 per cent of non-consulters, 27 per cent of average consulters and over 50 per cent of high consulters. Similarly, 48 per cent of the non-consulters smoked, drank heavily or were obese compared with 47 per cent of the average consulters and 61 per cent of the high consulters. The prevalence of recall of high blood pressure which had been diagnosed by a doctor rose from 6 per cent in non-consulters and 10 per cent in average consulters to 29 per cent in high consulters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Quality of consultation and the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN).

OBJECTIVE: Consultation of another physician is one of the requirements for prudent practice. The project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN) is aimed at professionalizing consultation. The objective of this study is to assess whether the quality of consultation was improved through SCEN. METHOD: In four districts all general practitioners (GPs) received a pre-test questionnaire approximately six weeks before the start of the project in the period (n=1224, response 71%). In the period from April 2000 to December 2002, all GPs in districts in which SCEN had been implemented received a written post-test questionnaire one and a half years after the start of the project. This post-test questionnaire was returned by 60% of the GPs (n=3614). RESULTS: In SCEN consultations the attending physicians has no specific relation to the attending physician in 85% of consultations, while this is the case for 31% of other consultations. While before the start of SCEN in 71% of consultations six or seven of the seven criteria for good consultation were met, in SCEN consultations 83% of cases six or seven of these requirements were met. GPS who had consulted a SCEN physician generally were more positive about different aspects than those who consulted another consultant, such as considering the consultant to be able to make an independent judgement (totally agree 74% versus 59%). CONCLUSION: Although the quality of consultation appears to be high for both SCEN physicians and other consultants, the SCEN project further contributed to the quality of consultation. Since GPs attach importance to judgement of SCEN physician and have the intention to use it in future, and the quality of consultation stays high over time, this project is expected to maintain its value.

Euthanasia↗

PubMed1986

Timer: a new objective measure of consultation content and its application to computer assisted consultations.

As part of the research into the effect in the consultation of the use of a computer to prompt opportunistic preventive care a valid, objective, and practical measure of the consultation process was required. After a review of the alternative methods the Time Interval Medical Event Recorder (Timer) was developed, its reliability tested, and applied to 93 control consultations and 49 computer assisted consultations. Timer records, every five seconds, four consultation events: the problems being dealt with, the physical activity, the verbal activity, and the secondary tasks being attempted. Timer showed that control consultations lasted an average of 6 minutes 58 seconds. The doctors spent 35% of their time on administration, and patients and doctors were both conversational for just 33% of the consultation. Giving information was the most common verbal activity (48% of the duration of the consultation) with silence accounting for 21% of the time. When the computer was used the average consultation was longer, at 7 minutes and 46 seconds. The doctor's contribution to the consultation appeared to have increased. Patient centred speech fell from 36% in controls to 28% of the duration of the consultation when the computer was used, while doctor centred speech rose from 30% to 34.5%. Secondary tasks (exploring patient concepts, education, management sharing, and prevention) were attempted during 28% of the control consultations and 40% of the computer consultations. This was accounted for by the increase in prevention (p less than 0.001). Timer is a reliable and practical tool for researching the consultation, and though it has shown validity in detecting differences between consultations that use a computer and those that do not, further applications are required to establish its full value.

Diagnosis, Computer-Assisted↗

PubMed1991

How well do nurse-run telephone consultations and consultations in the surgery agree? Experience in Swedish primary health care.

The telephone consultation service is an important part of Swedish primary health care. However, few studies have compared telephone consultations managed by nurses with surgery consultations managed by both doctors and nurses in terms of information obtained from the patient regarding his or her symptoms, and the management decisions made. In this study, the information obtained from a patient during a telephone consultation with a health centre nurse and the management decisions made, were compared with those obtained at a subsequent surgery consultation with the same nurse, and then with a doctor. Of 200 telephone consultations at a health centre (50 in each of the following four categories as defined by the management decision of the nurse: acute case, semi-acute case, referral case and self-care case), 193 patients were included in the study. The information given to the nurse during the telephone consultation was recorded. The patient was then asked to come for a surgery consultation on the same day, first with the same nurse and then with a general practitioner. A comparison was made between the information obtained and the decisions taken in these three situations. In 185 of the 193 cases (96%) the information led to the same management decision by the nurse, in both the telephone consultation and later in the surgery consultation. In all cases the same history was recorded by the nurse during the telephone and surgery consultations as by the general practitioner. This indicates that in most cases little or no information is missed in a telephone consultation with a nurse as compared with a surgery consultation with a nurse or doctor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Modelling consultation rates in infancy: influence of maternal and infant characteristics, feeding type and consultation history.

BACKGROUND: Severity of illness, sociodemographic factors, and breastfeeding have been identified as predictors of consultation rates in infants, and prescriptions for antibiotics have been found to increase future consultation rates in older children. The Baby Check trial (1996-1998) provided detailed information about consultations for 935 babies during their first 6 months. AIMS: To investigate potential predictors of consultation rates in babies. DESIGN OF STUDY: A 6-month cohort study of newborn babies originally enrolled into a randomised controlled trial. Maternal and infant characteristics were collected from hospital discharge records. Primary care consultation data for each baby were collected by case note review. SETTING: Thirteen general practices in Glasgow. METHOD: Multilevel models were used to analyse the number of consultations for each baby during its first 26 weeks, dependent upon the baby's age, the calendar month, maternal and infant characteristics, and previous consultations. RESULTS: The strongest predictors of consultation rates were previous consultations, particularly during the preceding week. Breastfed babies and those with older mothers consulted less often. A multilevel model was better than a fixed effects model, with considerable variation in consultation rates between babies. CONCLUSION: Infants' consultation rates over time can be analysed using multilevel models, if details of primary care consultations are available. These models can incorporate the effects of fixed variables and those that change during the follow-up period. Our findings add to previous research linking breastfeeding with reduced morbidity in infancy, and for that reason breastfeeding should continue to be promoted in primary care.

Adult↗

PubMed2000

Recordings or summaries of consultations for people with cancer.

OBJECTIVES: Many people find it difficult to remember information provided during medical consultations. One way of improving this may be to provide a record of the conversation. This review examined the effects of providing recordings or summaries of their consultations to people with cancer and their families. SEARCH STRATEGY: The following sources were searched: Cochrane Library (to issue 1 of 1999); and MEDLINE; CINAHL; Sociofile; Cancerlit; Dissertation Abstracts; EMBASE; IAC Health & Wellness; JICST; Pascal; ERIC; ASSIA; PsycINFO; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; CAB Health; DHSS-Data; MANTIS (to mid 1998). SELECTION CRITERIA: Randomised and non-randomised controlled trials that evaluate the effects of providing recordings (e.g. audiotapes) or summaries (e.g. letter with reminders of key points) of consultations to people with cancer or their families. Two reviewers assessed studies for inclusion. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by another reviewer. The quality of studies was assessed on six criteria. MAIN RESULTS: Eight studies satisfied the selection criteria. All involved adult participants. The studies did not all measure similar outcomes. In seven studies, between 83% and 96% of participants found recordings or summaries of their consultations valuable. Four out of six studies reported better recall of information for those receiving recordings or summaries. Two out of four studies found that participants provided with a recording or summary were more satisfied with the information received. No studies (out of six) found any statistically significant effect on anxiety or depression. No study evaluated the effects on survival or quality of life. REVIEWER'S CONCLUSIONS: The provision of recordings or summaries of key consultations may benefit most adults with cancer. Although more research is needed to improve our understanding of these interventions, most patients find them very useful. Practitioners should consider offering people tape recordings or written summaries of their consultations.

Humans↗

PubMed2005

A comparison between telephone and bedside consultations given by palliative care consultation teams in the Netherlands: results from a two-year nationwide registration.

Palliative Care Consultation (PCC) teams in The Netherlands give support to professional caregivers in palliative care. In contrast to many other countries, consultants only give advice. They do not give prescriptions. Most consultations are given by phone; in some, the consultant also visits the patient. For two years, the PCC teams registered all consultations prospectively on a standard registration form in a nationwide database. The aim of this study was to obtain more insight into the possible differences between telephone and bedsides consultations with regard to characteristics of consultants, requesting caregivers, and the patients, as well as the number and kind of problems discussed. The data demonstrate that bedside consultations show more variety in requesting caregivers and are conducted more often for patients. Bedside consultations also addressed a higher number of problems and a wider range of domains (e.g., psychological, spiritual, daily functioning, and support for informal caregivers). These results suggest that bedside consultations have a surplus value compared to telephone consultations. More rigorous study is needed to compare the relative merits of different methods of consultations in palliative care.

Adolescent↗

PubMed1999

Do better quality consultations result in better health? Relationship between quality of consultations and health status of patients with non-acute abdominal complaints in general practice.

BACKGROUND: In theory, a positive relationship is expected between the quality of a consultation and a patient's subsequent health status. However, such a relationship has not yet been firmly established in daily practice. OBJECTIVE: We aimed to study the relationship between the quality of the first consultation in a new episode of non-acute abdominal complaints and subsequent health status of patients in general practice. METHODS: Quality scores for 743 consultations were calculated on the basis of review criteria developed by expert panels. Functional health status was measured by the SIP (Sickness Impact Profile) at baseline, and at 1 and 6 months after the consultation. Multilevel regression analysis was used to examine the relationship between the quality of consultations and health status, and to identify factors of influence on this relationship. RESULTS: In the majority of these patients (97%) health status improved regardless of consultation quality. In patients with malignant disease, and chronic colitis, however, an association between consultation quality and subsequent health status was found: in those with a high consultation quality score (>66-percentile) the health status deteriorated in the first month but improved over the following 5 months; in those with a low consultation quality score (<33-percentile) it deteriorated continuously. CONCLUSION: For the great majority of patients we found no relation between the quality of consultation and health status. However, for a very small subgroup of patients there is proof of benefit from better quality consultations.

Abdominal Pain↗

PubMed1999

Are women more ready to consult than men? Gender differences in family practitioner consultation for common chronic conditions.

BACKGROUND: When consultations for all reasons are combined, women are seen to consult their general practitioners more than men through most of adult life. It is, therefore, often assumed that women are more likely to consult for every condition. OBJECTIVES: To examine whether women report being more likely to consult a general practitioner than men when taking account of the underlying condition and various aspects of the experience of the condition consulted for. METHODS: Home-based nurse-interviews with 852 people in early middle age (39 years) and 858 in late middle age (58 years) sampled from the general population in the West of Scotland. Detailed information about current chronic conditions included general practitioner consultation and reported experience of pain frequency, pain severity, limitation to normal activities and restricted activity in the previous four weeks. RESULTS: Women were no more likely than men to consult a general practitioner in the previous year when experiencing the five most common groups of conditions; in addition, women were no more likely than men to consult at a given level of severity for a given condition type, except in the case of one aspect of reported experience of mental health problems. CONCLUSIONS: The results argue against the most widely accepted explanation for gender differences in consulting, namely, that women are simply more likely to consult a general practitioner than men irrespective of underlying morbidity. Reasons for the higher rates of women consulting observed in general practice-based studies are discussed in relation to these data.

Adolescent↗

PubMed1998

Seasonal affective disorder among primary care consulters in January: prevalence and month by month consultation patterns.

BACKGROUND: Little is known about the prevalence or the consultation patterns of patients with seasonal affective disorder (SAD) in primary care settings. METHODS: Patients aged 16-64 years consulting a general practitioner (G.P.) during a three week period in January were screened with the Seasonal Pattern Assessment Questionnaire (SPAQ). Interview-confirmed cases of SAD (N = 33) were matched by age and sex to controls without seasonal morbidity and primary care consultation patterns were compared over a 5 year period. RESULTS: Of 692 patients screened, 64 (9.3%) satisfied SPAQ criteria for winter SAD. Patients with SAD showed no winter excess of consultations but were high year round consulters, averaging 1.8 times more consultations than controls. CONCLUSIONS: High levels of SAD caseness on the SPAQ were found among patients consulting in primary care during January. Possible explanations for the high non-seasonal consultation patterns among SAD patients include somatisation and diagnostic inaccuracies. LIMITATIONS: Diagnostic criteria for SAD, and the SPAQ in particular, may be over-inclusive. The SPAQ completion rate (about 39% of eligible patients consulting a G.P.) was relatively low. CLINICAL RELEVANCE: Patients with SAD (using SPAQ criteria) commonly consult their G.P.s in winter but frequency, rather than seasonality, of consultation may be a better guide to diagnosing SAD in primary care.

Adolescent↗

PubMed2006

The inpatient consultation approach to osteoporosis treatment in patients with a fracture. Is automatic consultation needed?

BACKGROUND: Osteoporosis has been described as a "silent epidemic." We describe an osteoporosis consultation program to facilitate the evaluation and treatment of inpatients with fragility fractures. METHODS: The inpatient orthopaedic team voluntarily requested an osteoporosis consultation on all patients with a fragility fracture. The osteoporosis consultant evaluated patients for secondary causes and started treatment with calcium, vitamin D, and bisphosphonates unless contraindicated. From November 2001 to December 2003, fifty-three osteoporosis consultations were performed. A retrospective review of the charts of all patients with a hip fracture treated during this twenty-six-month period revealed that only 47% were actually seen by the osteoporosis consultants, creating an unintentional "nonintervention" cohort of thirty-one patients with a hip fracture. Treatment for osteoporosis was assessed by a review of the inpatient charts and by a telephone interview after discharge. RESULTS: The study group consisted of eighty-four patients, which included fifty-three in the intervention cohort (twenty-eight hip and twenty-five other fractures) and thirty-one in the nonintervention cohort (all patients with a hip fracture). In the intervention cohort, most patients were vitamin-D deficient. Calcium and vitamin-D treatment was recommended for all fifty-three patients, and bisphosphonates were recommended for forty-one of the fifty-three patients in the intervention cohort. In the nonintervention cohort, two patients received calcium and vitamin D and one received a bisphosphonate; the difference between the cohorts was significant (p < 0.0001). In the intervention cohort, twenty-seven of the thirty-four patients who were available for a telephone interview after discharge (at a mean of eighteen months) remained on calcium and vitamin D; twenty-two of the thirty-four patients remained on bisphosphonates. In the nonintervention cohort, only one of the twelve patients who were available for follow-up (at a mean of thirty-nine months) was receiving calcium and vitamin D and none were on bisphosphonate treatment. CONCLUSIONS: This consultation program cannot be considered an outright success since only half of all patients with a hip fracture actually received a consultation. However, osteoporosis consultation, when provided, facilitated the recognition of secondary causes and the generic treatment of osteoporosis, and inpatients started on treatment generally continued the medication after discharge. The results of this study strongly support the need for a mechanism of automatic osteoporosis consultation for inpatients with a fragility fracture and suggest that, if consultation is reliably obtained, this approach can be effective in improving patient care. LEVEL OF EVIDENCE: Therapeutic Level III.

Aged↗

PubMed2002

Effects of genetic consultation on perception of a family risk of breast/ovarian cancer and determinants of inaccurate perception after the consultation.

The aim of this study was to assess the effects of cancer genetic consultations on women's perception of their family risk of breast/ovarian cancer, and to determine which factors were associated with an inaccurate perception after the consultation. A multicenter prospective survey was carried out on women (n = 397) attending cancer genetic clinics in France for the first time, in which the perceived family risk was measured both before and after the consultation, using self-administered questionnaires. The effects of the consultation on risk perception were significant among low (P <.001) and moderate risk women (P <.05). However, after the consultation, 76.3% of the "low"-risk women did not perceive their family as "low"-risk families, and 21.9% of the moderate-risk women were still definitely sure there was a genetic risk running in their family. The consultation did not affect the family risk perception of the high risk women (n = 171): the risk was thought to be very high both before (87.7%) and after (89.5%) the consultation (NS); however 10.5% of this group still perceived their family as being unlikely to be at risk after the consultation. In the low- and moderate-risk groups after multivariate adjustment, the inaccurate perceptions varied, depending on the clinics and on the psychosocial context of the consultation: they increased when the consultee was personally affected by cancer, and decreased when the consultee had a health occupation. Cancer genetic consultations had only marginal effects on the perception of family risk on the whole, although they were significant in the case of low- and moderate-risk women. The question arises as to whether a more comprehensive approach should be implemented and how to go about providing efficient cancer risk information in the context of health care systems.

Adult↗