Showing papers on "Referral published in 1969"

Psychiatric Referral from a General Practice

Abstract: A study was undertaken of the results of psychiatric referral from one metropolitan practice over a five-year period. Information was obtained from the patients' medical records and from the responses to a postal questionnaire sent to all the consultant psychiatrists concerned. The practice referral rate was consistently high (on average, 118 per 10,000 at risk), and some possible reasons are indicated. The clinical and social characteristics of the referral sample are outlined. The outcome of referral was somewhat disappointing: of 115 patients referred wholly under the National Health Service, 18 per cent. were not seen, 29 per cent. subsequently lapsed from treatment and altogether 57 per cent. were rated unimproved at the end of the spell of hospital care. The results were most favourable for those patients referred because of acute symptoms, social crises or other reasons imparting some degree of urgency; least so for those with chronic problems who had been referred for psychotherapy and long-term readjustment. A number of suggestions for improvement of the specialist service are briefly outlined, and an experimental approach is advocated.

Referral, Utilization, and Staffing Patterns of a Mental Health Service in a Prepaid Group Practice Program in New York

Abstract: The authors describe a psychiatric demonstration program in a prepaid group practice plan. Among adults aged 15 and older, the average annual consultation rate was 11 per 1,000 enrollees and the treatment rate 7.5 per 1,000. Treatment visits in one year averaged 14.2 services; patients treated by psychiatrists had fewer average visits than those of social workers. It was noted that family doctors in the medical group altered their referral practices following two years of contact with the mental health service.

The role of family planning in the primary prevention of mental illness.

Abstract: After reviewing the mental health implications of unregulated fertility in the areas of illegitimacy, premarital pregnancy, poverty, postpartum psychosis, and overpopulation, the author concludes that family planning services can be an important addition to preventive psychiatry techniques. Psychiatric centers might feasibly offer case-finding, education, and referral services and, in some instances, direct contraceptive advice to their clients. At the level of community action, psychiatrists can also help to educate community leaders and the public about the need for expanded family planning services.

Oral contraception and other factors in relation to hospital referral for menstrual problems without known underlying cause: findings in a large cohort study.

Abstract: Data on women referred to a hospital for menstrual problems were compared with data on women who had not been referred in order to examine the pattern of referral to hospitals for menstrual problems. Women with a diagnosis of fibroids uterine polyps endometriosis or uterine neoplasia were excluded from the study. These White English and Scottish women were 25-39 years old when they were recruited into a contraceptive study between 1968 and 1974. The closure date for the analysis was July 1994. For each type of menstrual disorder age (adjusted for parity) had a strong association with hospital referral (p < 0.001). Parity social class cigarette smoking height weight and Quetelet Index (weight kg/height sq m) were associated with some menstruation disorders but not with others. For example cigarette smoking was associated with hospital referral for painful periods and other or unspecified periods but not other disorders. Total duration of oral contraceptive (OC) use was associated with hospital referral for absent or scanty periods (p < 0.01) and for excessive periods (p < 0.05). Hospital referral for absent or scanty periods was 2-5 times more prevalent among women who had discontinued OCs 13-24 months earlier than among women in any other group (1.69 vs. 0.32-0.81/1000 woman-years; p < 0.001). Current OC users or women who discontinued OC use within the previous 12 months were less likely than nonusers to be referred to a hospital for excessive periods (2.67 vs. 6.11) painful periods (0.26 vs. 0.5) irregular periods (2.18 vs. 3.28) and other menstrual disorders (1.16 vs. 1.57). Women who used OCs in the past tended to have higher rates of hospital referral for menstrual disorders than never users. These findings show that current OC use has beneficial effects on menstrual patterns in women without uterine fibroids or other known causes of menstrual disorders.

Emergency admissions to a general medical unit: A survey of the accompanying letters, with recommendations

Abstract: Letters of referral accompanied 166 out of 188 emergency admissions to a general medical unit over a four-month period. Of these, 129 contained useful information concerning past medical history, emergency treatment given, drugs taken, and provisional diagnosis. It is suggested that general practitioners should adopt some format based on essential criteria when writing letters of referral, so that important information is not overlooked.

Information technology and manpower productivity.

Abstract: Technology as an aid to medical care productivity cannot be treated as an isolated phenomenon, apart from its effect on all phases of our society. Thus, the major impact of technology on the health care system has not come from modifications in medical care activities, per se, but rather from the urbanization and industrialization of America, each a result of technological innovations. For example, changes in society's travel and communication habits have placed greater emphasis on central facilities and efforts to coordinate health care delivery. Major referral centers are clearly a product of the revolution in transportation and communication. In the near future, however, technology should begin to be a truly integral part of clinical practice, and its impact probably will be at least as significant as that of the highway and telephone. In this discussion we would like to suggest that radical changes in the use of health manpower

Primary glaucoma ‐ criteria for referral

Abstract: Although criteria for referral in mass screening for glaucoma are frequently debated, these criteria are not necessarily appropriate for an optometrist. He has the task of identifying patients requiring referral for ophthalmological investigation and he is dealing with an individual patient. In this paper, the signs and symptoms of primary glaucoma are discussed in some detail and in the light of some recent publications. As a result a schema is presented for determining when suspect glaucoma patients should be referred. It is intended that all ocular hypertensives will be referred and this may involve up to 6 percent of patients over 40 years of age. Some of these will be glaucomatous and the remainder may be in a preglaucomatous state.

Anxiety neuroses and phobic states. 3. Referral and prevention.

Abstract: a development to be forestalled at all costs. It was said earlier that, in general, normal anxiety is self-limiting, pathological anxiety self-exacerbating. Of no instance is this more true than of agoraphobia. Furthermore, social adjustment is severely disrupted, and the patient's demands that she is always accompanied when she goes out, her insistence in some cases that a schoolchild stays at home to keep her company, or her habit of ringing her husband up at work at all times throw a severe stress on family life. It follows from this that there is an even greater urgency about referring patients who are already developing an agoraphobic state which is not responding to treatment. One of the difficulties here is that agoraphobia may develop inconspicuously. The distinction between the housewife who goes out little because of lack of opportunity and the housewife who never goes out because she has agoraphobia may be difficult to detect, particularly if, as is often the case, she feels that her fears are foolish and unjustified and makes strenuous efforts to conceal them. For this reason it is worth making a point of establishing whether any anxious or depressed patient is also agoraphobic. Agoraphobia rapidly becomes entrenched, so that early diagnosis is likely to improve the prognosis. Another indication for referral is the patient who seems to be on the verge of doing irreparable damage to his social adjustment. The man who during a period of acute anxiety throws up his work or abruptly severs lifelong associations with his friends is likely to prove difficult to rehabilitate. In

Surgery and Irradiation in the Treatment of Esophageal Cancer

Abstract: Too often definitive diagnosis is delayed until treatment, by surgery, x-ray, or a combination of both, can offer relatively little; cure is not common and in many cases even the opportunity for palliation is minimal. A plea is made for earlier referral and more complete work-up of all patients over 40 who present with dysphagia. This would permit more effective use of the several modalities now available.

Immunizations. Comprehensive health care and changing professional roles.

Abstract: IN THIS PAPER, we describe how a few simple procedures coupled with the appropriate administrative decisions can combine to produce a significant improvement in our capacity to immunize children, as we know we should, but have never accomplished in practice. Our Children's Hospital outpatient department, with 80,000 visits in 1967, is geared to provide consultation services to a large area in central and southeastern Ohio, while providing total health care to a significant number of children who reside in Franklin County. It serves mainly children from low income families, but in its specialty and diagnostic clinics the hospital accepts some children of the upper socioeconomic classes on referral from their physician. The Children's Hospital is private and nonprofit, but serves as the main teaching facility of the Department of Pediatrics of the Ohio State University College of Medicine. The 32 general and specialty clinics operational during 1967 are all under

Urban challenges to psychiatry : the case history of a response

Abstract: Medical centers often function as though the phrase, "service to the community," belongs only in public health and preventive medicine textbooks. The problems of community mental health programs involve defining the characteristics and needs of a given community, and then devising methods for actual delivery of health care services. This edited volume collates research material from a 12-year study of the Columbia-Washington Heights Community Mental Health Project that began in 1957. The book describes successful attempts to improve mental health services offered by Columbia University's New York State Psychiatric Institute to the surrounding Washington Heights area. Major objectives of this social psychiatric research were to define a specific urban area "in terms of such questions as the prevalence of mental illness and emotional maladjustment, the availability and adequacy of mental health resources, and the attitudes within the community towards mental health and mental health programs." An additional goal was applying research findings to the actual delivery of community mental health services. Both methodology and content of this project are interesting because they illuminate the real nature of urban challenge to community psy¬ chiatry. Can middle class-oriented professionals effectively deal with overcrowded and shifting popula¬ tions who do not always share the same belief systems about mental illness or mental health? Columbia's project found the traditional deficits in emergency service referral and follow-up care of psychotic patients. Other facets like child, adolescent, and geriatric care, and drug abuse also demanded extensive revision in the light of population needs that

Quality of care in Estonian youth clinics.

Abstract: The first youth clinics in Estonia were established at the beginning of the 1990s by local enthusiasts and were without regular funding. Currently there a network of 17 clinics exists which offer sexual health services free of charge for young women and men up to the age of 25 years. Contraceptive counselling gynaecological and andrological examination STI/HIV testing pregnancy related counselling sexual counselling counselling after sexual violence and sexuality education lectures are offered in the clinics. Telephone and online counselling are also provided. If needed referral to a specialist or other health care institution (for example for termination of pregnancy) is provided.

Development of out-patient services in Psychiatric departments: A study of the activities of an after-care clinic

Abstract: The authors studied 214 patients who attended the aftercare clinics of the University of Helsinki Psychiatric Clinic. They found that the indiscriminating referral of nearly all discharged patients resulted in an accumulation of patients receiving long-term outpatient treatment, so that the numbers of new patients who could be accepted fell rapidly. There seemed to be two main kinds of patients, both needing careful selection while still in hospital but each needing rather different type of treatment. Both groups needed continuity of care and attention to interpersonal relationships within the family. Rehabilitation and social work services were insufficient.

Cues to stroke rehabilitation referral among family physicians

Abstract: The analyses in this study—from the Rehabilitation Center at Montebello State Hospital, Maryland—indicate that physicians have been slow to accept as a legitimate activity the rehabilitation of their stroke patients. The physicians who are more likely to send patients for such care tend to be more recent graduates, to belong to hospital staffs and medical societies, and possibly to graduate from schools in which the faculty has more interest in rehabilitation. From the experience with their first patients, physicians may learn how to refer more suitable patients. The situation is complex, however; the available data concerned only indirectly those factors which are probably most crucial to the degree of innovation. To avoid upsetting Montebello's program, this study did not include personal interviews with the 294 general practitioners involved, thus leaving some crucial questions dangling in mid-air, and possibly overlooking some valid reasons for nonreferral for rehabilitation during this period. The findings are tentative but they seem to indicate that the norms for physicians may not favor the use of outside sources of help nor encourage the energetic treatment of stroke patients. Cultural norms change only slowly, and this may partly explain the slow referral for rehabilitation. However, we should strive to ensure that the concepts and scientific basis of rehabilitation be as clear and as strong as possible, and that the concepts be communicated accurately, intensively and repeatedly. This will prepare a more fertile field for the seeds of change.