Business, Management and Accounting › Organizational Behavior and Human Resource Management

Healthcare Systems and Technology

Works Count: 57725

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This cluster of papers focuses on improving communication and coordination in the referral process between primary care and specialist healthcare providers. It explores topics such as electronic consultations, patient sharing among physicians, physician collaboration, healthcare networks, and the impact of communication on healthcare quality.

Keywords

Referral; Communication; Primary Care; Specialist; Healthcare Networks; Electronic Consultations; Patient Sharing; Physician Collaboration; Healthcare Quality; Social Network Analysis

Handbook of health communication

2008-01-01

Teresa L. Thompson

Contents: Preface. T.L. Thompson, Introduction. Part I: Introduction. (Edited and With Introduction by K.I. Miller). B.F. Sharf, M.L. Vanderford, Illness Narratives and the Social Construction of Health. A.S. Babrow, M. … Contents: Preface. T.L. Thompson, Introduction. Part I: Introduction. (Edited and With Introduction by K.I. Miller). B.F. Sharf, M.L. Vanderford, Illness Narratives and the Social Construction of Health. A.S. Babrow, M. Mattson, Theorizing About Health Communication. R.L. Street, Jr., Communication in Medical Encounters: An Ecological Perspective. Part II: Provider-Patient Interaction Issues (Edited and With Introduction by T.L. Thompson). D.J. Cegala, S.L. Broz, Provider and Patient Communication Skills Training. D. Roter, K.S. McNeilis, The Nature of the Therapeutic Relationship and the Assessment of Its Discourse in Routine Medical Visits. J.B. Brown, M. Stewart, B.L. Ryan, Outcomes of Patient-Provider Interaction. C.M. Gillotti, Medical Disclosure and Decision-Making: Excavating the Complexities of Physician-Patient Information Exchange. J.F. Nussbaum, S. Reagan, B. Whaley, Children, Older Adults, and Women: Impact on Provider-Patient Interaction. Part III: Social and Community Health Issues (Edited and With Introduction by A. Dorsey). J.W. Dearing, The State of the Art and the State of the Science of Community Organizing. C.W. Scherer, N.K. Juanillo, Jr., The Continuing Challenge of Community Health Risk Management and Communication. L.A. Ford, G.A. Yep, Working Along the Margins: Developing Community-Based Strategies for Communicating About Health With Marginalized Groups. T.L. Albrecht, D.J. Goldsmith, Social Support, Social Networks, and Health. R.J.W. Cline, Everyday Interpersonal Communication and Health. Part IV: Organizational Issues (Edited and With Introduction by K.I. Miller). J.C. Lammers, A.P. Duggan, J.B. Barbour, Organizational Forms and the Provision of Health Care. J. Apker, E.B. Ray, Stress and Social Support in Health Care Organizations. M.S. Poole, K. Real, Groups and Teams in Health Care: Communication and Effectiveness. C. Conrad, H.G. McIntush, Organizational Rhetoric and Healthcare Policymaking. P. Geist-Martin, K. Horsley, A. Farrell, Working Well: Communicating Individual and Collective Wellness Initiatives. Part V: Media Issues. (Edited and With Introduction by R. Parrott). C. Salmon, C. Atkins, Using Media Campaigns for Health Promotion. L. Murray-Johnson, K. Witte, Looking Toward the Future: Health Message Design Strategies. R.N. Rimal, A.D. Adkins, Using Computers to Narrowcast Health Messages: The Role of Audience Segmentation, Targeting, and Tailoring in Health Promotion. J.W. Turner, Telemedicine: Expanding Health Care Into Virtual Environments. J.K. Springston, R.A.W. Lariscy, Health as Profit: Public Relations in Health Communication. K.N. Kline, Popular Media and Health: Images, Effects, and Institutions. J.M. Bernhardt, K.A. Cameron, Accessing, Understanding, and Applying Health Communication Messages: The Challenge of Health Literacy. Part VI: Lessons and Challenges From the Field. (Edited and With Introduction by A. Dorsey). G.L. Kreps, Opportunities for Health Communication Scholarship to Shape Public Health Policy and Practice: Examples From the National Cancer Institute. T. Edgar, V. Freimuth, S.L. Hammond, Lessons Learned From the Field on Prevention and Health Campaigns. R. Parrott, C. Steiner, Lessons Learned About Academic and Public Health Collaborations in the Conduct of Community-Based Research. N. Guttman, Ethics in Health Communication Interventions.

Costing psychiatric interventions.

1992-01-01

Jennifer Beecham , Martín Knapp

The demands and needs for cost information in psychiatric contexts have multiplied considerably in recent years, but have often been frustrated by inadequate data. The typical costs data available to … The demands and needs for cost information in psychiatric contexts have multiplied considerably in recent years, but have often been frustrated by inadequate data. The typical costs data available to the policy maker, manager, clinical professional or researcher have been dominated until recently by age-old accounting practices and line management arrangements, and constrained by fragmentation of responsibility. Most limiting of all, costs data have rarely been used in taking decisions about individual cases. In considering the demands and needs for costs in psychiatry, this chapter describes a research instrument - the Client Service Receipt Inventory (CSRI) - which has been developed and extensively applied in order to meet some of these needs. The chapter includes illustrations of applications of data recorded using the CSRI.

Methods for the Design and Administration of Web-based Surveys

2000-07-01

Titus Schleyer , Jane L. Forrest

This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles … This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.

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Communication loads on clinical staff in the emergency department

2002-05-01

Enrico Coiera , Rohan Jayasuriya , Jennifer Hardy +2 more

Objective: To measure communication loads on clinical staff in an acute clinical setting, and to describe the pattern of informal and formal communication events. Design: Observational study. Setting: Two emergency … Objective: To measure communication loads on clinical staff in an acute clinical setting, and to describe the pattern of informal and formal communication events. Design: Observational study. Setting: Two emergency departments, one rural and one urban, in New South Wales hospitals, between June and July 1999. Participants: Twelve clinical staff members, comprising six nurses and six doctors. Main outcome measures: Time involved in communication; number of communication events, interruptions, and overlapping communications; choice of communication channel; purpose of communication. Results: 35 hours and 13 minutes were observed, and 1286 distinct communication events were identified, representing 36.5 events per person per hour (95% CI, 34.5–38.5). A third of communication events (30.6%) were classified as interruptions, giving a rate of 11.15 interruptions per hour for all subjects; 10% of communication time involved two or more concurrent conversations; and 12.7% of all events involved formal information sources such as patients' medical records. Face-to-face conversation accounted for 82%. While medical staff asked for information slightly less frequently than nursing staff (25.4% v 30.9%), they received information much less frequently (6.6% v 16.2%). Conclusion: Our results support the need for communication training in emergency departments and other similar workplaces. The combination of interruptions and multiple concurrent tasks may produce clinical errors by disrupting memory processes. About 90% of the information transactions observed involved interpersonal exchanges rather than interaction with formal information sources. This may put a low upper limit on the potential for improving information processes by introducing electronic medical records.

Interventions to improve outpatient referrals from primary care to secondary care

2008-10-08

Ayub Akbari , Alain Mayhew , Manal Alawi Al-Alawi +6 more

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Client-centred rehabilitation: client perspectives

2004-01-01

Cheryl Cott

Purpose: The purpose of this research is to understand the important components of client-centred rehabilitation from the perspective of adult clients with long-term physical disabilities. Method: Focus groups were conducted … Purpose: The purpose of this research is to understand the important components of client-centred rehabilitation from the perspective of adult clients with long-term physical disabilities. Method: Focus groups were conducted with adult clients who had completed at least one course of rehabilitation in the publicly-funded rehabilitation system in Ontario. Data were analysed using an iterative inductive approach. Results: The major theme underlying all of the participants' comments was the need for better transitions between rehabilitation programs and the community. Participants felt ill-prepared for community living and the emotional challenges of living with a long-term condition and, once discharged from rehabilitation, felt isolated and had difficulty finding out about and accessing community services. Conclusions: The findings demonstrate that client-centred rehabilitation encompasses much more than goal-setting and decision-making between individual clients and professionals. It refers to a philosophy or approach to the delivery of rehabilitation services that reflects the needs of individuals and groups of clients. This entails a shift from an acute-illness, curative model to one that acknowledges the long-term nature of the career of chronic illness or disability. Definitions of evidence that is deemed credible need to be broadened beyond expert, 'scientific' evidence to include multiple dimensions of evidence including the expertise of the client.

A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97

2001-02-03

Elizabeth Mitchell

Objectives: To appraise findings from studies examining the impact of computers on primary care consultations. Objectives: To appraise findings from studies examining the impact of computers on primary care consultations.

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Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another’s Data

2008-05-27

Jeana Frost , Michael P. Massagli

This project investigates the ways in which patients respond to the shared use of what is often considered private information: personal health data. There is a growing demand for patient … This project investigates the ways in which patients respond to the shared use of what is often considered private information: personal health data. There is a growing demand for patient access to personal health records. The predominant model for this record is a repository of all clinically relevant health information kept securely and viewed privately by patients and their health care providers. While this type of record does seem to have beneficial effects for the patient-physician relationship, the complexity and novelty of these data coupled with the lack of research in this area means the utility of personal health information for the primary stakeholders-the patients-is not well documented or understood.PatientsLikeMe is an online community built to support information exchange between patients. The site provides customized disease-specific outcome and visualization tools to help patients understand and share information about their condition. We begin this paper by describing the components and design of the online community. We then identify and analyze how users of this platform reference personal health information within patient-to-patient dialogues.Patients diagnosed with amyotrophic lateral sclerosis (ALS) post data on their current treatments, symptoms, and outcomes. These data are displayed graphically within personal health profiles and are reflected in composite community-level symptom and treatment reports. Users review and discuss these data within the Forum, private messaging, and comments posted on each other's profiles. We analyzed member communications that referenced individual-level personal health data to determine how patient peers use personal health information within patient-to-patient exchanges.Qualitative analysis of a sample of 123 comments (about 2% of the total) posted within the community revealed a variety of commenting and questioning behaviors by patient members. Members referenced data to locate others with particular experiences to answer specific health-related questions, to proffer personally acquired disease-management knowledge to those most likely to benefit from it, and to foster and solidify relationships based on shared concerns.Few studies examine the use of personal health information by patients themselves. This project suggests how patients who choose to explicitly share health data within a community may benefit from the process, helping them engage in dialogues that may inform disease self-management. We recommend that future designs make each patient's health information as clear as possible, automate matching of people with similar conditions and using similar treatments, and integrate data into online platforms for health conversations.

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Influence of Cardiac-Surgery Performance Reports on Referral Practices and Access to Care — A Survey of Cardiovascular Specialists

1996-07-25

Eric C. Schneider , Arnold M. Epstein

Reports on the comparative performance of physicians are becoming increasingly common. Little is known, however, about the credibility of these reports with target audiences or their influence on the delivery … Reports on the comparative performance of physicians are becoming increasingly common. Little is known, however, about the credibility of these reports with target audiences or their influence on the delivery of medical services.

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Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians

2007-02-27

Sunil Kripalani , F. Lefèvre , Christopher O. Phillips +3 more

Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events.To characterize the prevalence of deficits in … Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events.To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process.MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Observational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18).Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents.Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.

Big Data And New Knowledge In Medicine: The Thinking, Training, And Tools Needed For A Learning Health System

2014-07-01

Harlan M. Krumholz

Big data in medicine—massive quantities of health care data accumulating from patients and populations and the advanced analytics that can give those data meaning—hold the prospect of becoming an engine … Big data in medicine—massive quantities of health care data accumulating from patients and populations and the advanced analytics that can give those data meaning—hold the prospect of becoming an engine for the knowledge generation that is necessary to address the extensive unmet information needs of patients, clinicians, administrators, researchers, and health policy makers. This article explores the ways in which big data can be harnessed to advance prediction, performance, discovery, and comparative effectiveness research to address the complexity of patients, populations, and organizations. Incorporating big data and next-generation analytics into clinical and population health research and practice will require not only new data sources but also new thinking, training, and tools. Adequately utilized, these reservoirs of data can be a practically inexhaustible source of knowledge to fuel a learning health care system.

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Tailoring: what's in a name?

2000-02-01

Matthew W. Kreuter

Communication breakdown in the outpatient referral process

2000-09-01

Tejal K. Gandhi , Dean F. Sittig , Michael J. Franklin +3 more

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Telemedicine Technology and Clinical Applications

1995-02-08

Douglas A. Perednia

TELEMEDICINE can be broadly defined as the use of telecommunications technologies to provide medical information and services. Although this definition includes medical uses of the telephone, facsimile, and distance education,<i>telemedicine</i>is … TELEMEDICINE can be broadly defined as the use of telecommunications technologies to provide medical information and services. Although this definition includes medical uses of the telephone, facsimile, and distance education,<i>telemedicine</i>is increasingly being used as shorthand for remote electronic clinical consultation. Interest in the field has increased dramatically in the 1990s. State and federal allocations for telemedicine and related technologies are likely to exceed $100 million in fiscal 1994-1995.<sup>1</sup>At least 13 federal agencies, including the US Department of Commerce, Health Care Financing Administration (HCFA), Office of Rural Health Policy, and US Department of Defense, have begun telemedicine research and demonstration programs. Many states are using their own resources to build state-of-the-art telemedicine systems, some with capital investments exceeding $50 million. Faith in this technology is not universal, however. Depending on one's viewpoint, telemedicine may be seen as a valuable tool for providing badly needed specialty care services

Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace

2010-11-16

Trisha Greenhalgh , Susan Hinder , K. Stramer +2 more

<b>Objective</b> To evaluate the policy making process, implementation by NHS organisations, and patients’ and carers’ experiences of efforts to introduce an internet accessible personal electronic health record (HealthSpace) in a … <b>Objective</b> To evaluate the policy making process, implementation by NHS organisations, and patients’ and carers’ experiences of efforts to introduce an internet accessible personal electronic health record (HealthSpace) in a public sector healthcare system. <b>Design</b> Mixed method, multilevel case study. <b>Setting</b> English National Health Service; the basic HealthSpace technology (available throughout England) and the advanced version (available in a few localities where this option had been introduced) were considered. <b>Main outcome measures</b> National statistics on invitations sent, HealthSpace accounts created, and interviews and ethnographic observation of patients and carers. Data analysis was informed by a socio-technical approach which considered macro and micro influences on both adoption and non-adoption of innovations, and by the principles of critical discourse analysis. <b>Participants</b> 56 patients and carers (of whom 21 opened a basic HealthSpace account, 20 had diabetes but were not initially using HealthSpace, and 15 used advanced HealthSpace accounts to exchange messages with their general practitioner), 3000 pages of documents (policies, strategies, business plans, minutes of meetings, correspondence), observational field notes, and 160 interviews with policy makers, project managers, and clinical staff. <b>Results</b> Between 2007 and October 2010, 172 950 people opened a basic HealthSpace account. 2913 (0.13% of those invited) opened an advanced account, compared with 5-10% of the population anticipated in the original business case. Overall, patients perceived HealthSpace as neither useful nor easy to use and its functionality aligned poorly with their expectations and self management practices. Those who used email-style messaging were positive about its benefits, but enthusiasm beyond three early adopter clinicians was low, and fewer than 100 of 30 000 patients expressed interest. Policy makers’ hopes that “deploying” HealthSpace would lead to empowered patients, personalised care, lower NHS costs, better data quality, and improved health literacy were not realised over the three year evaluation period. <b>Conclusion</b> Unless personal electronic health records align closely with people’s attitudes, self management practices, identified information needs, and the wider care package (including organisational routines and incentive structures for clinicians), the risk that they will be abandoned or not adopted at all is substantial. Conceptualising such records dynamically (as components of a socio-technical network) rather than statically (as containers for data) and employing user centred design techniques might improve their chances of adoption and use. The findings raise questions about how eHealth programmes in England are developed and approved at policy level.

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The Indiana Network For Patient Care: A Working Local Health Information Infrastructure

2005-09-01

Clement J. McDonald , J. Marc Overhage , Michael Barnes +4 more

The Indiana Network for Patient Care (INPC) is a local health information infrastructure (LHII) that includes information from the five major hospital systems (fifteen separate hospitals), the county and state … The Indiana Network for Patient Care (INPC) is a local health information infrastructure (LHII) that includes information from the five major hospital systems (fifteen separate hospitals), the county and state public health departments, and Indiana Medicaid and RxHub and that carries 660 million separate results. It provides cross-institutional access to physicians in emergency rooms and hospitals based on patient-physician proximity or on hospital credentialing. The network includes and delivers laboratory, radiology, dictation, and other documents to a majority of Indianapolis office practices. The INPC began operation seven years ago and is one of the first and best examples of an LHII.

Implementing Antibiotic Practice Guidelines through Computer-Assisted Decision Support: Clinical and Financial Outcomes

1996-05-15

Stanley L. Pestotnik

Objective: To determine the clinical and financial outcomes of antibiotic practice guidelines implemented through computer-assisted decision support. Design: Descriptive epidemiologic study and financial analysis. Setting: 520-bed community teaching hospital in … Objective: To determine the clinical and financial outcomes of antibiotic practice guidelines implemented through computer-assisted decision support. Design: Descriptive epidemiologic study and financial analysis. Setting: 520-bed community teaching hospital in Salt Lake City, Utah. Patients: All 162 196 patients discharged from LDS Hospital between 1 January 1988 and 31 December 1994. Intervention: An antibiotic management program that used local clinician-derived consensus guidelines embedded in computer-assisted decision support programs. Prescribing guidelines were developed for inpatient prophylactic, empiric, and therapeutic uses of antibiotics. Measurements: Measures of antibiotic use included timing of preoperative antibiotic administration and duration of postoperative antibiotic use. Clinical outcomes included rates of adverse drug events, patterns of antimicrobial resistance, mortality, and length of hospital stay. Financial and use outcomes were expressed as yearly expenditures for antibiotics and defined daily doses per 100 occupied bed-days. Results: During the 7-year study period, 63 759 hospitalized patients (39.3%) received antibiotics. The proportion of the hospitalized patients who received antibiotics increased each year, from 31.8% in 1988 to 53.1% in 1994. Use of broad-spectrum antibiotics increased from 24% of all antibiotic use in 1988 to 47% in 1994. The annual Medicare case-mix index increased from 1.7481 in 1988 to 2.0520 in 1993. Total acquisition costs of antibiotics (adjusted for inflation) decreased from 24.8% ($987 547) of the pharmacy drug expenditure budget in 1988 to 12.9% ($612 500) in 1994. Antibiotic costs per treated patient (adjusted for inflation) decreased from $122.66 per patient in 1988 to $51.90 per patient in 1994. Analysis using a standardized method (defined daily doses) to compare antibiotic use showed that antibiotic use decreased by 22.8% overall. Measures of antibiotic use and clinical outcomes improved during the study period. The percentage of patients having surgery who received appropriately timed preoperative antibiotics increased from 40% in 1988 to 99.1% in 1994. The average number of antibiotic doses administered for surgical prophylaxis was reduced from 19 doses in the base year to 5.3 doses in 1994. Antibiotic-associated adverse drug events decreased by 30%. During the study, antimicrobial resistance patterns were stable, and length of stay remained the same. Mortality rates decreased from 3.65% in 1988 to 2.65% in 1994 (P < 0.001). Conclusions: Computer-assisted decision support programs that use local clinician-derived practice guidelines can improve antibiotic use, reduce associated costs, and stabilize the emergence of antibiotic-resistant pathogens.

Client Control and Medical Practice

1960-01-01

Eliot Freidson

The interaction among colleague, practitioner, and patient is analyzed as a function of variable location in two sometimes conflicting systems-the lay referral system, which consists in a variable lay culture … The interaction among colleague, practitioner, and patient is analyzed as a function of variable location in two sometimes conflicting systems-the lay referral system, which consists in a variable lay culture and a network of personal influence along which the patient travels on his way to the physician, and the professional referral system of medical culture and institutions. Two analytically extreme types of practice are distinguished on the basis of their location in each of these systems. Independent practice is located in the lay referral system and is primarily subject to client controls. Dependent practice is located well within the professional referral system and is primarily subject to colleague controls.

Communicating with patients.

1992-11-21

Jason Bennett , P. Bridger

took a median of 30 minutes to arrive at the patient's home and 20 minutes to reach the hospital.When the same variables were analysed in the patients subsequently confirmed to … took a median of 30 minutes to arrive at the patient's home and 20 minutes to reach the hospital.When the same variables were analysed in the patients subsequently confirmed to have definite or probable acute myocardial infarction it was found that the decision time was shorter if relatives were with the patient at the onset of symptoms.The interval between admission to hospital and administration of streptokinase in those given the drug was the longest single delay (median 102 minutes).No factors were identified that significantly influenced the time of administration of streptokinase.Thus most elderly patients reach hospital in time to benefit from thrombolytic treatment but many elderly patients are not admitted to coronary care units.Not only must attention be given to shorten- ing the time to administration of thrombolytic treatment but elderly patients with suspected acute myocardial infarction should have the potential benefit of specialised coronary care.

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Collaborative Care for Depression

2006-11-27

Simon Gilbody

<h3>Background</h3> Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged … <h3>Background</h3> Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged as a potentially effective candidate intervention to improve quality of primary care and patient outcomes. <h3>Methods</h3> To quantify the short-term and longer-term effectiveness of collaborative care compared with standard care and to understand mechanisms of action by exploring between-study heterogeneity, we conducted a systematic review of randomized controlled trials that compared collaborative care with usual primary care in patients with depression. We searched MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980), CINAHL (from the beginning of 1980), PsycINFO (from the beginning of 1980), the Cochrane Library (from the beginning of 1966), and DARE (Database of Abstracts of Reviews of Effectiveness) (from the beginning of 1985) databases from study inception to February 6, 2006. <h3>Results</h3> We found 37 randomized studies including 12 355 patients with depression receiving primary care. Random effects meta-analysis showed that depression outcomes were improved at 6 months (standardized mean difference, 0.25; 95% confidence interval, 0.18-0.32), and evidence of longer-term benefit was found for up to 5 years (standardized mean difference, 0.15; 95% confidence interval, 0.001-0.31). When exploring determinants of effectiveness, effect size was directly related to medication compliance and to the professional background and method of supervision of case managers. The addition of brief psychotherapy did not substantially improve outcome, nor did increased numbers of sessions. Cumulative meta-analysis showed that sufficient evidence had emerged by 2000 to demonstrate the statistically significant benefit of collaborative care. <h3>Conclusions</h3> Collaborative care is more effective than standard care in improving depression outcomes in the short and longer terms. Future research needs to address the implementation of collaborative care, particularly in settings other than the United States.

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Meetings Between Experts: An Approach to Sharing Ideas in Medical Consultations

1987-11-01

Phil Brown , David Tuckett , Mary Boulton +2 more

The Doctor-Nurse Game

1967-06-01

Leonard I. Stein

THE relationship between the doctor and the nurse is a very special one. There are few professions where the degree of mutual respect and cooperation between co-workers is as intense … THE relationship between the doctor and the nurse is a very special one. There are few professions where the degree of mutual respect and cooperation between co-workers is as intense as that between the doctor and nurse. Superficially, the stereotype of this relationship has been dramatized in many novels and television serials. When, however, it is observed carefully in an interactional framework, the relationship takes on a new dimension and has a special quality which fits a game model. The underlying attitudes which demand that this game be played are unfortunate. These attitudes create serious obstacles in the path of meaningful communications between physicians and nonmedical professional groups. The physician traditionally and appropriately has total responsibility for making the decisions regarding the management of his patients' treatment. To guide his decisions he considers data gleaned from several sources. He acquires a complete medical history,

Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review

2004-06-18

Delanyo Dovlo

BACKGROUND: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who … BACKGROUND: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. METHODS: A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. RESULTS: The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. CONCLUSIONS: The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.

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The Danish National Patient Register

2011-07-01

Elsebeth Lynge , Jakob Lynge Sandegaard , Matejka Rebolj

The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally.At the onset the register included information on inpatient … The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally.At the onset the register included information on inpatient in somatic wards. The content of the register has gradually been expanded, and since 2007 the register has included information on all patients in Danish hospitals.Although the NPR is overall a sound data source, both the content and the definitions of single variables have changed over time. Changes in the organisation and provision of health services may affect both the type and the completeness of registrations.The NPR is a unique data source. Researchers using the data should carefully consider potential fallacies in the data before drawing conclusions.

Missing Clinical Information During Primary Care Visits

2005-02-01

Peter Smith

ContextThe coordinating function of primary care is information-intensive and may be impeded by missing clinical information. However, missing clinical information has not been explicitly investigated in the primary care setting.ObjectiveTo … ContextThe coordinating function of primary care is information-intensive and may be impeded by missing clinical information. However, missing clinical information has not been explicitly investigated in the primary care setting.ObjectiveTo describe primary care clinicians’ reports of missing clinical information.Design, Setting, and ParticipantsCross-sectional survey conducted in 32 primary care clinics within State Networks of Colorado Ambulatory Practices and Partners (SNOCAP), a consortium of practice-based research networks participating in the Applied Strategies for Improving Patient Safety medical error reporting study. Two hundred fifty-three clinicians were surveyed about 1614 patient visits between May and December 2003. For every visit during 1 half-day session, each clinician completed a questionnaire about patient and visit characteristics and stated whether important clinical information had been missing. Clinician characteristics were also recorded.Main Outcome MeasuresReports of missing clinical information frequency, type, and presumed location; perceived likelihood of adverse effects, delays in care, and additional services; and time spent looking for missing information. Multivariate analysis was conducted to assess the relationship of missing information to patient, visit, or clinician characteristics, adjusting for potential confounders and effects of clustering.ResultsClinicians reported missing clinical information in 13.6% of visits; missing information included laboratory results (6.1% of all visits), letters/dictation (5.4%), radiology results (3.8%), history and physical examination (3.7%), and medications (3.2%). Missing clinical information was frequently reported to be located outside their clinical system but within the United States (52.3%), to be at least somewhat likely to adversely affect patients (44%), and to potentially result in delayed care or additional services (59.5%). Significant time was reportedly spent unsuccessfully searching for missing clinical information (5-10 minutes, 25.6%; >10 minutes, 10.4%). After adjustment, reported missing clinical information was more likely when patients were recent immigrants (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.06-2.99), new patients (OR, 2.39; 95% CI, 1.70-3.35), or had multiple medical problems compared with no problems (1 problem: OR, 1.09; 95% CI, 0.69-1.73; 2-5 problems: OR, 1.87; 95% CI, 1.21-2.89; >5 problems: OR, 2.78; 95% CI, 1.61-4.80). Missing clinical information was less likely in rural practices (OR, 0.52; 95% CI, 0.29-0.92) and when individual clinicians reported having full electronic records (OR, 0.40; 95% CI, 0.17-0.94).ConclusionsPrimary care clinicians report that missing clinical information is common, multifaceted, likely to consume time and other resources, and may adversely affect patients. Additional research on missing information is needed to focus on validating clinicians’ perceptions and on conducting prospective studies of its causes and sequelae.

How and why are communities of practice established in the healthcare sector? A systematic review of the literature

2011-10-14

Geetha Ranmuthugala , Jennifer Plumb , Frances Cunningham +3 more

Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they … Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date. To this end, a systematic review of the literature on CoPs was conducted, to examine how and why CoPs have been established and whether they have been shown to improve healthcare practice. Peer-reviewed empirical research papers on CoPs in the healthcare sector were identified by searching electronic health-databases. Information on the purpose of establishing CoPs, their composition, methods by which members communicate and share information or knowledge, and research methods used to examine effectiveness was extracted and reviewed. Also examined was evidence of whether or not CoPs led to a change in healthcare practice. Thirty-one primary research papers and two systematic reviews were identified and reviewed in detail. There was a trend from descriptive to evaluative research. The focus of CoPs in earlier publications was on learning and exchanging information and knowledge, whereas in more recently published research, CoPs were used more as a tool to improve clinical practice and to facilitate the implementation of evidence-based practice. Means by which members communicated with each other varied, but in none of the primary research studies was the method of communication examined in terms of the CoP achieving its objectives. Researchers are increasing their efforts to assess the effectiveness of CoPs in healthcare, however the interventions have been complex and multifaceted, making it difficult to directly attribute the change to the CoP. In keeping with Wenger and colleagues' description, CoPs in the healthcare sector vary in form and purpose. While researchers are increasing their efforts to examine the impact of CoPs in healthcare, cultivating CoPs to improve healthcare performance requires a greater understanding of how to establish and support CoPs to maximise their potential to improve healthcare.

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National Ambulatory Medical Care Survey: 2002 summary.

2004-08-26

David A. Woodwell , Donald K. Cherry

This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. This … This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. This report also highlights visits to primary care specialties.The data presented in this report were collected from the 2002 National Ambulatory Medical Care Survey (NAMCS). NAMCS is a part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from 1992, 1993, 1995, and 1997 are also presented.During 2002, an estimated 890 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. The visit rate to physician offices in metropolitan statistical areas (MSAs) (337.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (221.9 visits per 100 persons). For one-half of all office visits, regardless of specialty, physicians indicated they were the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (31.1 percent) were referrals. New patients, representing 12.1 percent of the visits in 2002, are down 18% since 1992. Primary care specialists provided 90 percent of all preventive care visits. Essential hypertension, acute upper respiratory infection, diabetes mellitus, and arthropathies were the leading illness-related primary diagnoses. There were an estimated 104.0 million injury-related visits in 2002, or 36.7 visits per 100 persons. On average, 2.3 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included nonsteroidal anti-inflammatory drugs (NSAIDs) (4.9 mentions per 100 visits) and antidepressants (4.5 mentions per 100 visits). Of primary care specialists, 25.8 percent reported not accepting new patients who are Medicaid enrollees.

Computer-Based Medical Consultations: MYCIN.

1976-12-01

Edward H. Shortliffe

Dropping the Baton: Specialty Referrals in the United States

2011-03-01

Ateev Mehrotra , Christopher B. Forrest , Caroline Y. Lin

Context: In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the … Context: In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines. Methods: This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care. Findings: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist's role during the referral episode (e.g., single consultation or continuing co-management). Conclusions: There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed.

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Guidelines for the Clinical Use of Electronic Mail with Patients

1998-01-01

Bryan G Kane , Daniel Z. Sands

Guidelines regarding patient–provider electronic mail are presented. The intent is to provide guidance concerning computer-based communications between clinicians and patients within a contractual relationship in which the health-care provider has … Guidelines regarding patient–provider electronic mail are presented. The intent is to provide guidance concerning computer-based communications between clinicians and patients within a contractual relationship in which the health-care provider has taken on an explicit measure of responsibility for the client's care. The guidelines address two interrelated aspects: effective interaction between the clinician and patient, and observance of medicolegal prudence. Recommendations for site-specific policy formulation are included.

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Electronic medical record use and physician–patient communication: An observational study of Israeli primary care encounters

2005-04-16

Ruth Margalit , Debra Roter , Mary Ann Dunevant +2 more

Consultation length in general practice: cross sectional study in six European countries

2002-08-29

Myriam Deveugele

<h3>Abstract</h3> <b>Objectives</b>: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation … <h3>Abstract</h3> <b>Objectives</b>: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors9 and patients9 perceptions of psychosocial aspects. <b>Design</b>: Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients. <b>Setting</b>: General practices in six European countries. <b>Participants</b>: 190 general practitioners and 3674 patients. <b>Results</b>: In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors9 variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor9s perception had more influence in this situation than the patient9s. Consultation length is influenced by the patients9 sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient9s age (the older the patient the longer the consultation). As a doctor9s workload increased, the length of consultations decreased. The general practitioner9s sex or age and patient9s level of education were not related to the length of consultation. <b>Conclusion</b>: Consultation length is determined by variables related to the doctor and the doctor9s country as well as by those related to patients. Women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.

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Using the Internet to conduct surveys of health professionals: a valid alternative?

2003-09-24

Dejana Braithwaite , Jon Emery , Simon de Lusignan +1 more

Objective. The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods. Objective. The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods.

Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis

2015-05-20

Varsha G. Vimalananda , Gouri Gupte , Siamak M. Seraj +4 more

Background We define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise … Background We define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults. Methods We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based. Results Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers. Discussion E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.

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Validation of information recorded on general practitioner based computerised data resource in the United Kingdom.

1991-03-30

Hershel Jick , Susan S. Jick , L E Derby

OBJECTIVE--To determine the extent of agreement between clinical information recorded on surgery computers of selected general practitioners and similar information in manual records of letters received from hospital consultants and … OBJECTIVE--To determine the extent of agreement between clinical information recorded on surgery computers of selected general practitioners and similar information in manual records of letters received from hospital consultants and kept in the general practitioners9 files. DESIGN--Hospital consultants9 letters in the manual records of selected general practitioners were photocopied and the consultants9 clinical diagnoses were compared with diagnoses recorded on computer. SETTING--General practices in the United Kingdom using computers provided by VAMP Health for recording clinical information. SUBJECTS--2491 patients who received one of three non-steroidal anti-inflammatory drugs and who attended 58 practices whose computer recorded data were considered after a preliminary review to be of satisfactory quality. RESULTS--Among 1191 patients for whom consultants9 letters were forwarded a clinical diagnosis reflecting the diagnosis noted on a consultant letter was present on the computer record for 1038 (87%). CONCLUSION--Clinical information available on the computer records of the general practitioners who participated in this study is satisfactory for many clinical studies.

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Virtual online consultations: advantages and limitations (VOCAL) study

2016-01-01

Trisha Greenhalgh , Shanti Vijayaraghavan , Joseph Wherton +7 more

Introduction Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. Methods … Introduction Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. Methods To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel—audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel—interviews, ethnographic observations and analysis of documents within the trust; macrolevel—key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. Ethics approval City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. Planned outputs We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: ‘what to expect in your virtual consultation’. Discussion The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We anticipate that this study will contribute to a balanced assessment of when, how and in what circumstances this model might be introduced.

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Letter: The consultants' contract.

1974-12-21

Plumley Pf

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties

2016-09-05

Christine A. Sinsky , Lacey Colligan , Ling Li +6 more

Little is known about how physician time is allocated in ambulatory care.To describe how physician time is spent in ambulatory practice.Quantitative direct observational time and motion study (during office hours) … Little is known about how physician time is allocated in ambulatory care.To describe how physician time is spent in ambulatory practice.Quantitative direct observational time and motion study (during office hours) and self-reported diary (after hours).U.S. ambulatory care in 4 specialties in 4 states (Illinois, New Hampshire, Virginia, and Washington).57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours, 21 of whom also completed after-hours diaries.Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.Data were gathered in self-selected, high-performing practices and may not be generalizable to other settings. The descriptive study design did not support formal statistical comparisons by physician and practice characteristics.For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work.American Medical Association.

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

2017-04-01

Ming Tai-Seale , Cliff Olson , Jinnan Li +5 more

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to … Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011–14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician’s office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.

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National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data.

2005-03-01

Lola Jean Kozak , Maria Owings , Margaret Jean Hall

This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, … This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes.The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2002, data were collected for approximately 327,000 discharges. Of the 474 eligible non-Federal short-stay hospitals in the sample, 445 (94 percent) responded to the survey.An estimated 33.7 million inpatients were discharged from non-Federal short-stay hospitals in 2002. They used 164.2 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, ischemic heart disease, psychoses, pneumonia, and malignant neoplasms. Inpatients had 6.8 million cardiovascular procedures and 6.6 million obstetric procedures. Males had higher rates for cardiac procedures such as cardiac catheterization and coronary artery bypass graft, but males and females had similar rates of pacemaker procedures. The number and rate of all cesarean deliveries, primary and repeat, rose from 1995 to 2002; the rate of vaginal birth after cesarean delivery dropped from 35.5 in 1995 to 15.8 in 2002.

National hospital discharge survey: annual summary, 1994.

1997-05-01

Graves Ej , Gillum Bs

This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1994. Estimates are provided by demographic characteristics of patients discharged, geographic region of … This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1994. Estimates are provided by demographic characteristics of patients discharged, geographic region of hospitals, conditions diagnosed, and surgical and nonsurgical procedures performed. Measurements of hospital use include number and rate of discharges and days of care, and the average length of stay.The estimates are based on data collected through the National Hospital Discharge Survey for 1994. The survey has been conducted annually by the National Center for Health Statistics since 1965. In the 1994, data were collected for approximately 277,000 discharges. Of the 512 eligible non-Federal short-stay hospitals, 478 (93 percent) responded to the survey. Diagnoses and procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.In 1994 there were an estimated 30.8 million discharges from non-Federal short-stay hospitals. These patients used a total of 177.2 million days of care and had an average length of stay of 5.7 days. Other data summarized in this report include estimates for diagnoses, procedures, expected source of payment, hospital deaths, and newborn infants.

National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.

2006-05-01

Lola Jean Kozak , Karen A Lees , Carol J. DeFrances

This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and … This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes.The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2003, data were collected for approximately 320,000 discharges. Of the 479 eligible non-Federal short-stay hospitals in the sample, 426 (89 percent) responded to the survey.An estimated 34.7 million inpatients were discharged from non-Federal short-stay hospitals in 2003. They used 167.3 million days of care and had an average length of stay of 4.8 days. Females used almost one-third more days of hospital care than males. Patients with five or more diagnoses rose from 29 percent of discharges in 1990 to 57 percent in 2003. The leading diagnostic category was respiratory diseases for children under 15 years, childbirth for 15-44 year olds, and circulatory diseases for patients 45 years of age and over. Only surgical procedures were performed for 27 percent of discharges, 18 percent had surgical and nonsurgical procedures, and 16 percent had only nonsurgical procedures. A total of 664,000 coronary angioplasties were performed, and stents were inserted during 86 percent of these procedures with drug-eluting stents used in 28 percent. The number and rate of total and primary cesarean deliveries rose from 1995 to 2003. The rate of vaginal birth after cesarean delivery dropped 58 percent, from 35.5 in 1995 to 14.8 in 2003.

Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019-07-01

Vicky Hammersley , Eddie Donaghy , Richard A. Parker +5 more

Background Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice. Aim To explore the content, quality, … Background Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice. Aim To explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice. Design and setting Comparison of audio-recordings of follow-up consultations in UK primary care. Method Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use. Results Of the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items. Conclusion VC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

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Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review

2019-12-15

Hassan Khader Y. Almathami , Khin Than Win , Elena Vlahu‐Gjorgievska

Health care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to … Health care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to communicate with health care professionals; in this case, the patient communicates with the health care professional for a follow-up or for a consultation about his or her health condition. This communication process is referred to as an e-consultation. In this paper, telemedicine services refer to health care services that use ICTs, which enable patients to share, transfer, and communicate data or information in real time (ie, synchronous) from their home with a care provider-normally a physician-at a clinical site. However, the use of e-consultation services can be positively or negatively influenced by external or internal factors. External factors refer to the environment surrounding the system as well as the system itself, while internal factors refer to user behavior and motivation.This review aims to investigate the barriers and the facilitators that influence the use of home consultation systems in the health care context. This review also aims to identify the effectiveness of Home Online Health Consultation (HOHC) systems in improving patients' health as well as their satisfaction with the systems.We conducted a systematic literature review to search for articles-empirical studies-about online health consultation in four digital libraries: Scopus, Association for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 45. A qualitative content analysis was performed to identify barriers and facilitators to HOHC systems, their effectiveness, and patients' satisfaction with them.The systematic literature review identified several external and internal facilitators and barriers to HOHC systems that were used in the creation of a HOHC framework. The framework consists of four requirements; the framework also consists of 17 facilitators and eight barriers, which were further categorized as internal and external influencers on HOHC.Patients from different age groups and with different health conditions benefited from remote health services. HOHC via video conferencing was effective in delivering online treatment and was well-accepted by patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as a result of online consultation facilitators that promoted effective and convenient remote treatment. However, some patients preferred face-to-face consultation and showed resistance to online consultation. Resistance to online consultation was influenced by some of the identified barriers. Overall, the framework identified the facilitators and barriers that positively and negatively influenced the uptake of HOHC systems, respectively.

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COVID-19 and telehealth, education, and research adaptations

2020-06-18

N. Romesh Wijesooriya , Vimal Mishra , Paul L.P. Brand +1 more

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Disparities in Health Care and the Digital Divide

2021-07-23

Sy Atezaz Saeed , Ross MacRae Masters

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Special Communication

1962-03-03

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

Current Surgical Therapy

2009-10-13

Daniel J. Kacey

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E.H.Shortliffe 著, "Computer-Based Medical Consultations : MYCIN", American Elsevier, A4判, 264ぺージ, \10,080, 1976

1978-02-15

穂積田中

The Consultation: An Approach to Learning and Teaching.

1984-10-01

David Pendleton

'the research which Pendleton and his colleagues have done is high class and relevant. The results are coherent, and on the whole easy to read and absorb.' The Lancet 'the research which Pendleton and his colleagues have done is high class and relevant. The results are coherent, and on the whole easy to read and absorb.' The Lancet

Patient communication during the emergency department visit: is text messaging preferred?

2025-06-24

Shaveta Khosla , Alejandro Escobar , David Chestek +1 more | European Journal of Emergency Medicine

Procalcitonina sérica para el diagnóstico de colangitis aguda grave

2025-06-24

Álvaro J. Montiel‐Jarquín , Angélica Porras-Juárez , Arturo García-Galicia +6 more | Anales Médicos de la Asociación Médica del Centro Médico ABC

Correction: How do undergraduate medical students use the annotation option of a video feedback system when recording consultations with real patients; a qualitative document analysis

2025-06-24

Ellemieke Maria Cornelia Rasenberg , Guus Maria Brand , Bart Thoonen | BMC Medical Education

Military Maxillofacial Trauma Referrals to the Royal Centre for Defence Medicine, UK: Benefits of a Telemedicine Referral Pathway

2025-06-24

Jennifer Hon , Reanne Booker , John Breeze | International Journal of Oral and Maxillofacial Surgery

Patient-Centered Innovation Must Include People With Disabilities—Reply

2025-06-23

Dimitri Christakis | JAMA Pediatrics

Patient-Centered Innovation Must Include People With Disabilities

2025-06-23

Serena Barello , Michela Monaci | JAMA Pediatrics

Characterizing the impact of a novel electronic consultation platform on access to Hepatitis C treatment in a Manitoba context

2025-06-23

Lauren J. MacKenzie , Laurie Ireland , Javier Mignone +2 more | Healthcare Management Forum

Access to Hepatitis C (HCV) treatment requires a specialist referral in Manitoba, Canada, with specialist availability posing barriers to HCV care. This work assessed the impact of eConsult, an electronic … Access to Hepatitis C (HCV) treatment requires a specialist referral in Manitoba, Canada, with specialist availability posing barriers to HCV care. This work assessed the impact of eConsult, an electronic platform that enables Primary Care Providers (PCPs) to access specialist advice, potentially reducing face-to-face patient visits. This single case study was conducted at Nine Circles Community Health Centre in Winnipeg. Charts of individuals referred via traditional pathways (Dec 2016-Dec 2017) and eConsult (Dec. 2017 - Dec. 2019) were reviewed, and stakeholder interviews were conducted with PCPs and an HCV specialist. Compared to traditional referrals, eConsult patients were more likely to link to specialist care (100% vs. 69%, P = 0.026) and complete HCV treatment (79% vs. 36%, P = 0.049). The use of eConsult may improve access to HCV care in Manitoba, with outcomes shaped by system agility, adaptability across contexts, and the altruism of healthcare providers who support its use.

Improving Mental Health Care Access with Technology: Addressing the Screening-to-Referral Bottleneck

2025-06-18

Aaron J. Gorelik , Arielle Radin , Ryan Bogdan +1 more | NEJM AI

P46 The learning curve of PCNL- single surgeon experience

2025-06-16

A. Freimanis , V. Paradnieks , V. Lietuvietis | European Urology Open Science

The Benefits and Evolutions of Shared Research Cores

2025-06-13

Brandon Kappy , Bobbe Thomas , Monika K. Goyal +1 more | Pediatric Emergency Care

Shared research cores are centralized facilities that provide investigators with advanced equipment and services under fee-for-service arrangements. By pooling costs among investigators, cores offer access to otherwise cost-prohibitive technology and … Shared research cores are centralized facilities that provide investigators with advanced equipment and services under fee-for-service arrangements. By pooling costs among investigators, cores offer access to otherwise cost-prohibitive technology and allow researchers to utilize specialized staff without taking on retraining costs. The structure of shared cores promotes a team-based approach to research where users can learn technical skills and collaborate with investigators from different fields. Research cores have become an essential part of universities and academic healthcare centers, providing the infrastructure for some of the most important scientific innovations of the past decade. Recently, shared cores have expanded to include clinical research programs that offer investigators improved access to translational services and study scalability, with some cores specializing in unique patient populations and disease processes. Yet, as most clinical cores are embedded in outpatient facilities, they often exclude patients who experience trauma and acute illnesses. This article discusses a novel pediatric emergency department research core-like program and the value that such a program brings to investigators studying emergent symptoms, underserved populations, and acute presentations of chronic diseases. As emergency departments are always open, they offer expanded recruitment windows and can embed interventions into existing patient flow processes. Housing a research core or core-like program within the department of emergency medicine also allows the program to subsidize internal projects and collaborate with other divisions across the institution.

The Sessions and Post-Consultation Patient Feedback

2025-06-12

Windy Dryden | Routledge eBooks

Optimising referrals

2025-06-09

| BDJ In Practice

Improving Awareness of Doctor Availability Within a Community Learning Disability Team

2025-06-01

Chris Wilson | BJPsych Open

Aims: To improve multidisciplinary team awareness of doctor availability within the East-North-East Leeds Community Learning Disability Team. To create and implement a resource listing accurate availability per half-day, contact details, … Aims: To improve multidisciplinary team awareness of doctor availability within the East-North-East Leeds Community Learning Disability Team. To create and implement a resource listing accurate availability per half-day, contact details, and named cover in cases of absence. To improve team communication, reduce uncertainty, and streamline contact and escalation processes. To utilise baseline and post-intervention outcome measures to assess improvements in practice. Methods: This project was formulated following reports of uncertainty around doctor availability, inefficient methods of contact attempts, and with no current effective rota system in place. A Plan-Do-Study-Act (PDSA) approach was taken to assess and adopt continuous improvement throughout. Baseline questionnaires were distributed to staff to assess current levels of awareness of doctor availability, escalation pathways, and perceived usefulness of a planned resource. Key stakeholders (consultants, resident doctors, managers, senior administrators) were engaged to adapt and expand a current limited senior doctor rota, to include all doctors, named cover, enhanced contact methods, and a wider audience. This utilised Outlook calendars, was displayed in the team office, and was updated weekly. Post-intervention questionnaires were circulated to assess the impact of the intervention. Further procedures were implemented to sustain this change, including commitments from permanent staff to take responsibility in maintaining the resource, standard operating procedures formulated for administrative and medical teams, and safeguards created to identify future issues encountered. Results: Response rates from staff were 32% and 36% pre- and post-intervention respectively. Staff confidence in knowing which doctors were available and when rose from 22% to 91%. Staff knowledge of how to immediately contact an available doctor rose from 44% to 91%. Staff knowledge of how to further escalate concerns rose from 67% to 91%. 91% of staff reported using the resource, 91% found it useful, and 82% found it accurate. Further adaptations were made as the project progressed and in response to feedback and issues encountered. Conclusion: This project successfully resulted in improving awareness of doctor availability in all domains measured, and was well received. By developing a clear, accessible rota and engaging staff in its use, staff confidence and team communication improved. This project led to lasting changes in practice, ensuring ongoing effectiveness sustained beyond the project’s conclusion. Key points of discussion include engagement of key stakeholders in planning, implementing, and sustaining improvement, ensuring feasibility and longevity. Furthermore, reflecting on the effective use of PDSA principles with simple, measurable changes, and implementing ongoing review processes.

Comprehensive Evaluation of Referral Practices From General Practitioners to Balbriggan CMHT, Dublin: Audit Cycle Overview

2025-06-01

Umer Saeed Haroon , Saad Maqsood , Eimear Kelly | BJPsych Open

Aims: The aim of this audit was to evaluate and enhance referral practices from general practitioners (GPs) to the Balbriggan Community Mental Health Team (CMHT), Dublin. Appropriate referrals are crucial … Aims: The aim of this audit was to evaluate and enhance referral practices from general practitioners (GPs) to the Balbriggan Community Mental Health Team (CMHT), Dublin. Appropriate referrals are crucial for effective mental health care. The initial audit, conducted in mid-2024, sought to identify barriers to successful referrals, particularly regarding psychotherapy initiation and medication management. Following these findings, guidelines were developed and disseminated to GPs to improve the referral process. A follow-up audit was then conducted to assess the impact of these interventions on referral practices and identify any remaining challenges. Methods: An audit cycle was conducted, comprising a retrospective initial audit followed by a prospective follow-up audit. The initial audit reviewed 110 referrals from 1 May to 1 August 2024, while the follow-up audit analysed 77 referrals from 1 September to 30 November 2024. Following the initial audit, local guidelines were created and shared with GPs on 19 August 2024, focusing on appropriate referral procedures, psychotherapy initiation, and medication management. Data collection focused on referral acceptance rates, reasons for rejection, and the initiation of psychotherapy and psychotropic medication. The effectiveness of the guidelines was also evaluated. Results: The results of the audits showed significant improvements in referral practices. In the initial audit, 110 referrals were reviewed, resulting in 60 accepted (54.5%) and 50 rejected (45.5%). Key barriers included 16% of patients not receiving psychotherapy and 11% receiving suboptimal medication dosages. Additionally, 9% of referrals were declined due to non-initiation of psychotropic medications, indicating GPs’ hesitancy to refer patients without prior treatment. In contrast, the follow-up audit, which reviewed 77 referrals, showed a marked increase in acceptance rates, with 71 accepted (92.2%) and only 6 rejected (7.8%). However, 14% of patients still did not receive psychotherapy, suggesting persistent hesitancy among GPs. Notably, the percentage of rejected referrals for ADHD/ASD assessments increased from 21% to 33%, indicating that misalignment between GP expectations and CMHT services remains a challenge. Conclusion: This audit demonstrates the importance of effective communication and collaboration between GPs and the CMHT in enhancing referral practices. The implementation of guidelines led to improved referral acceptance rates. However, challenges still exist regarding psychotherapy initiation and specific service offerings, particularly for ADHD/ASD assessments. Ongoing monitoring and education for GPs are essential to sustain these improvements and ensure optimal patient access to mental health care.

Enhancing Email Responsiveness in Mental Health Services: A Quality Improvement Initiative

2025-06-01

Rakesh Sharma | BJPsych Open

Aims: Effective communication is essential in mental health services, where timely decisions can significantly impact patient outcomes. Studies have shown that delayed responses to clinical communications can compromise patient safety, … Aims: Effective communication is essential in mental health services, where timely decisions can significantly impact patient outcomes. Studies have shown that delayed responses to clinical communications can compromise patient safety, lead to treatment delays, and increase stress among professionals. The absence of standardized email response protocols within the North London Mental Health Trust has resulted in varying practices, with some professionals responding promptly while others may neglect emails, particularly those concerning patient care. This project seeks to address this inconsistency and improve the overall communication framework within the Trust. Aims were to to develop and implement an email response protocol for mental health professionals in the North London Mental Health Trust, ensuring timely and consistent communication regarding patient care. Methods: Co-Production: Engage stakeholders, including clients/carers, mental health professionals, managers, and admin representatives, to co-design the email response guidelines. Conduct surveys to gather insights on current practices and barriers to timely responses. Identify and Understand: Conduct a baseline assessment of current email response times and practices using a survey distributed to all mental health professionals. Analyse the collected data to identify patterns of non-responsiveness and the reasons behind them (e.g. workload, lack of awareness of the importance of timely responses). Develop Change Strategy: Based on stakeholder feedback and data analysis, draft clear email response guidelines that outline expected response times, prioritize urgent communications, and provide examples of acceptable email etiquette. Incorporate exceptions for individuals on leave, out of office, or in emergency situations. Results: 1. Work-Related Email Volume: The majority of mental health professionals receive between 20–50 emails per day, with a significant portion being patient-care related. 2. Response Time for Patient-Care Emails: Around 60% of professionals respond to patient-related emails within 24 hours. This increases to 80% when measured within 48 hours, indicating that while delays exist, the majority eventually respond within two days. 3. Factors Influencing Response Time: High workload, email volume, and urgent clinical duties were cited as the most common barriers to quick responses. Some professionals also noted a lack of standardized email response guidelines, leading to inconsistency in practices. 4. Challenges in Email Management: Professionals expressed difficulty in managing high email volumes, particularly when dealing with urgent clinical responsibilities. Lack of training on email prioritization was another reported challenge. 5. Recommendations from Professionals for Improvement: Implementation of standardized email response guidelines. Training on email management strategies and prioritization of urgent vs. non-urgent communications. 6. Impact on Patient Care and Communication: A consensus among professionals was that delayed email responses negatively impact patient care, as they can lead to delayed decision-making and increased stress among teams. 7. Willingness to Engage in Further Training: A majority of professionals were willing to participate in training related to improving email response times, indicating strong support for a structured intervention. Conclusion: The implementation of a standardized email response protocol is vital for improving communication practices among mental health professionals in the North London Mental Health Trust. By addressing the current gaps in communication, we aim to enhance patient care and streamline inter-professional collaboration.

Improving Trainee Engagement in Trainee Council Meetings at Birmingham and Solihull Mental Health Foundation Trust

2025-06-01

Sarah Brennan , Vicki Ibbett , Ruth Scally | BJPsych Open

Aims: Trainee Council Meetings (TCMs) offer a dedicated time and place for trainees working in the Trust to highlight issues and raise concerns relating to their rotations. Trainee engagement in … Aims: Trainee Council Meetings (TCMs) offer a dedicated time and place for trainees working in the Trust to highlight issues and raise concerns relating to their rotations. Trainee engagement in these meetings has historically been variable. This project was developed with the aim of improving trainee engagement with TCMs. It is part of a larger ‘Raising Concerns’ Quality Improvement Project within the Trust. Increase attendance at Trainee Council Meetings (TCMs) by Foundation, GP and Core Psychiatry Trainees. Improve structure and organisation of Trainee Council Meetings. Improve trainee access to records of meeting minutes. Methods: Retrospective TCM attendance data was collected in Summer 2023. The only data available were numbers of attendees, not trainee grade. The following issues were identified: TCMs sometimes took place in person and sometimes took place online (via Microsoft Teams). Attendance tended to be poorer for in-person meetings than those online. There was no clear leadership structure within the Trainee Council. There was lack of clarity over which representatives were responsible for planning and facilitating TCMs. This led to an unfair and unequal distribution of TCM workload. The following change ideas were implemented from the respective dates: July 2023 – It was agreed that TCMs would always take place online. August 2023 – Development of two leadership roles within the Trainee Council: ‘Trainee Representative and Induction Co-ordinators’ and ‘SHO Inclusion Co-ordinators’. Planning and facilitation of TCMs was agreed as a responsibility to be shared amongst these representatives. Development of a Meeting Proforma (see Appendix), clarifying actions to be taken by council leads before, during and after TCMs. Attendance data were collected prospectively between September 2023 and March 2024. Data included numbers of trainees attending and trainee grade. Results: Trainee attendances before change ideas: December 2022 – 20 March 2023 – 9 June 2023 – 22 Trainee attendances after change ideas: September 2023 – 38 November 2024 – 34 March 2024 – 36 Conclusion: Attendance data show that there has been an improvement in numbers of trainees attending Trainee Council Meetings following implementation of change ideas. Attendance of trainees by grade was unknown prior to June 2023. The majority of attendees between September 2023 and March 2024 were Core Psychiatry trainees. Attendance by Foundation and GP trainees is low.

POS1455-HPR DEVELOPMENT OF ELECTRONIC HEALTH RECORDS AND DASHBOARDS TO ENHANCE A RHEUMATOLOGY CARE TEAM IN A LOWER-MIDDLE-INCOME COUNTRY

2025-06-01

D. Fonseca , A. Rojas-Villarraga , Jairo Cajamarca-Barón +2 more | Annals of the Rheumatic Diseases

A case of a pacemaker follow-up: Too little, too late, part 2

2025-06-01

Nyree Sencion-Akhtar , Tracey Shannon , Daniel Frenkel | HeartRhythm Case Reports

ABS1258-PARE FROM BENCH TO VOICE: EMBEDDING PATIENT INVOLVEMENT IN RHEUMATOLOGY RESEARCH

2025-06-01

S. Grealis , F. J. B. Quinlan , Sarah Bender +5 more | Annals of the Rheumatic Diseases

POS0398 CHARACTERIZING THE PRIMARY CARE MUSCULOSKELETAL TRAJECTORY AND PREDICTING REFERRAL TO THE RHEUMATOLOGIST

2025-06-01

Georgy Gomon , Saskia le Cessie , Rachel Knevel | Annals of the Rheumatic Diseases

POS0433 COMPARISON OF MUSCULOSKELETAL REFERRAL PATHWAYS ACROSS EUROPE

2025-06-01

Georgy Gomon , Maxime Raffray , I. Pérez - Sancristóbal +7 more | Annals of the Rheumatic Diseases

ABS1001 ANALYSIS OF THE ACTIVITY OF A MULTIDISCIPLINARY COMMITTEE ON SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES IN A TERTIARY CARE HOSPITAL

2025-06-01

Esther Panadero , G. Moral García , Jorge L. Flores +3 more | Annals of the Rheumatic Diseases

POS1017-PARE DEVELOPMENT OF AN EXPERT PATIENT PROGRAM TO TRAIN AND EMPOWER PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: OUTCOMES AND FUTURE IMPACT

2025-06-01

Tarek Carlos Salman-Monte , I. Castrejon , Helena García Llana +5 more | Annals of the Rheumatic Diseases

POS0347-PARE A NATIONAL SURVEY OF RHEUMATOLOGY TELEPHONE ADVICE LINE SUPPORT IN THE UNITED KINGDOM: USER PERSPECTIVES

2025-06-01

Ailsa Bosworth , Sarah Ryan , Samantha Hider +1 more | Annals of the Rheumatic Diseases

OP0115-HPR PERSPECTIVES OF PATIENTS WITH INFLAMMATORY ARTHRITIS AND THEIR PARTNERS ON PARTNER PARTICIPATION IN RHEUMATOLOGY CONSULTATIONS: A (DANISH) QUALITATIVE STUDY

2025-06-01

Conny Wang Hansen , Julie Midtgaard , A. de Thurah +2 more | Annals of the Rheumatic Diseases

OP0027 The journey of patients from primary care practices to a diagnosis of rheumatoid arthritis in rheumatology

2025-06-01

Maxime Raffray , Thomas Frisell , D. Di Giuseppe +2 more | Annals of the Rheumatic Diseases

Improving Quality and Appropriateness of Referrals to a Drug and Alcohol Outreach Service in a General Psychiatric Hospital

2025-06-01

E. Dempsey , Rebecca Lawrence | BJPsych Open

Aims: By March 2025, 90% of referrals to the Ritson Outreach Service in the Royal Edinburgh Hospital will be appropriate and contain relevant details. Methods: Members of the Ritson Outreach … Aims: By March 2025, 90% of referrals to the Ritson Outreach Service in the Royal Edinburgh Hospital will be appropriate and contain relevant details. Methods: Members of the Ritson Outreach team agreed the following referral criteria for inpatients on general psychiatric wards: Prescribing for alcohol withdrawal and relapse prevention. Prescribing in opioid dependence. Prescribing in benzodiazepine dependence. Advice on linking to community services. Standards for referral details were also agreed: ward, referrer, contact number, reason for admission, specific request, community addictions input, patient’s awareness and views on referral, drug screen results, estimated discharge date, appropriateness according to referral criteria. A baseline audit of referrals to the Ritson Outreach inbox from 19 March–28 August 2024 was conducted. Surveys about barriers to making appropriate referrals were gathered from the ward with the highest referral rate. A referral form including criteria and prompts for relevant details was devised. This was made available via an automatic reply from the referral email address. Referrals made following implementation of the form were re-audited for a four-week period from 8 January 2025. Results: 20 referrals were included in the baseline audit.Adherence to standards: Ward 100%; Referrer 100%; Contact number 55%; Reason for admission 60%; Specific request 55%; Community addictions input 30%; Patient aware of referral 20%; Patient’s views 40%; Drug screen results 5%; Estimated discharge date 5%; Appropriate 55%. 10 surveys from the ward with the highest referral rate revealed only 10% of staff felt confident about the referral criteria and relevant details to include prior to implementation of the referral form. In the four-week period following implementation of the referral form, 5 referrals were received via the referral mailbox. Adherence to standards: Ward 100%; Referrer 100%; Contact number 100%; Reason for admission 80%; Specific request 100%; Community addictions input 80%; Patient aware of referral 60%; Patient’s views 60%; Drug screen results 20%; Estimated discharge date 40%; Appropriate 80%. Conclusion: Implementation of a referral form has begun to improve quality and appropriateness of referrals to the Ritson Outreach Service, although not yet reaching the target of 90% appropriate referrals. Further data collection is ongoing, along with measures to increase staff awareness of the referral criteria and process, such as posters in handover rooms and inclusion in resident doctor inductions.

Improving the Quality and Efficiency of Internal Referrals to Child and Adolescent Psychiatry: An Audit of Referral Standards in CAMHS

2025-06-01

Tammam Obeid , Rachel Edwards | BJPsych Open

Aims: Efficient and comprehensive referral processes are essential for the timely and appropriate delivery of psychiatric care within Child and Adolescent Mental Health Services (CAMHS). Incomplete or inconsistent referral documentation … Aims: Efficient and comprehensive referral processes are essential for the timely and appropriate delivery of psychiatric care within Child and Adolescent Mental Health Services (CAMHS). Incomplete or inconsistent referral documentation can lead to delays in care, increased administrative burden, and potential risks to patient safety. This audit evaluates the quality of internal referrals to CAMHS psychiatry, focusing on the inclusion of key demographic details, documentation of consent, evidence of prior therapeutic interventions, and risk assessment. Methods: This retrospective audit examined referral quality within Marsden House CAMHS in Cheshire and Wirral Partnership NHS Foundation Trust (CWP). The focus was on internal referrals made by therapists and other CAMHS clinicians to the Psychiatry team. Data were collected from referral emails sent to the Marsden House Doctors’ email inbox between January and March 2024.The audit assessed 23 referrals against key quality indicators, including:Completeness of demographic details (name, age, gender, date of birth, NHS number).Documentation of patient consent within the referral.Evidence of prior therapy interventions (partnership work) before referral to psychiatry.Inclusion of risk assessment details.The number of emails exchanged per referral, indicating inefficiencies in the process.To ensure consistency in data extraction, a structured proforma was used to record key variables. The findings were then analysed to identify gaps in referral quality and inefficiencies in the process, with a focus on areas for improvement. Results: The audit identified significant gaps in referral completeness, particularly in demographic documentation, consent recording, and risk assessment. The absence of a structured referral form contributes to inconsistencies and inefficiencies, increasing administrative workload and delaying access to psychiatric care. Additionally, a lack of documented prior therapy interventions suggests that referrals may not always align with NICE guidelines, which recommend therapy as the first-line treatment before psychiatric escalation.Key Findings: The mean number of demographic details included per referral was 2.7 out of 5 key identifiers. Consent was documented in only 43% (10/23) of referrals. 65% (15/23) of referrals documented prior therapy interventions, whereas 35% did not include this information. Risk was explicitly mentioned in only 39% (9/23) of referrals.On average, 2.43 emails were required per referral, highlighting inefficiencies in the process.The lack of a standardised referral form is a major contributing factor to these inefficiencies, leading to incomplete information, delays, and increased administrative workload. The findings also indicate that referrals do not always adhere to NICE guidelines, potentially leading to inappropriate psychiatric escalations when therapy should be the first-line intervention. Conclusion: This audit highlights the need for a structured, standardised referral process to enhance efficiency, completeness, and patient safety in CAMHS psychiatry referrals. Implementing these recommendations will improve the quality of referrals, reduce delays, and ensure young people receive the most appropriate and timely psychiatric care.Recommendations: Implementation of a Standardised Referral Form with mandatory fields for demographics, consent, risk assessment, and prior therapy interventions.Training for Referrers to improve the quality and completeness of referrals in line with best clinical practice.Ensuring Compliance with NICE Guidelines by requiring documentation of prior therapy interventions before psychiatry referrals, unless clinically justified.Streamlining the referral process to improve efficiency and reduce unnecessary email correspondence.

Editor's view-tailoring care.

2025-05-31

Nathalie van der Velde | PubMed

The nature of inquiries and responses in clinical pharmacy teleconsultation service: a retrospective study from Türkiye

2025-05-30

Aysel Pehlivanlı , Hilal Akyel , Beril Kadıoğlu Yaman +1 more | Journal of Pharmaceutical Policy and Practice