Showing papers on "Referral published in 1974"
TL;DR: While referral was related to severity of psychiatric illness and previous psychiatric illness, the degree to which the psychiatric illness obtruded or created problems in management appeared more crucial in determining referral.
Abstract: Psychiatric morbidity among 230 medical inpatients was determined by a two-stage screening procedure, using the General Health Questionnaire and Standardized Psychiatric Interview. Of these patients, 23% were considered psychiatrically ill, affective disorders being the commonest illnesses encountered; and 27 (12%) were psychiatrically referred. While referral was related to severity of psychiatric illness and previous psychiatric illness, the degree to which the psychiatric illness obtruded or created problems in management appeared more crucial in determining referral. In half of those with psychiatric illness the problems did not appear to have been detected or dealt with. It is suggested that medical clerking should routinely include questions about mood and psychological responses to illness.
256 citations
TL;DR: Variations in this general result between diagnostic groups and, to some extent, by sex and age suggest interaction between intrapersonal motivation for treatment and administrative barriers erected by treatment facilities.
Abstract: Analysis of the flow of patients from an inner city hospital psychiatric emergency service to three separate outpatient clinics disclosed the effects of structural barriers on the rate of completion of referral. Generally, giving the patient, at the time of emergency room contact, an appointment for follow-up within one week produced a threefold increase in completion over more traditional modes of referral. Variations in this general result between diagnostic groups and, to some extent, by sex and age suggest interaction between intrapersonal motivation for treatment and administrative barriers erected by treatment facilities.
60 citations
48 citations
TL;DR: The hypothesis that a single person when developing symptoms of mental illness is more likely to be admitted to mental hospital, whereas a married person is morelikely to be treated in the community, was proved true.
Abstract: The relationship between marital status and the risk of psychiatric referral was examined among all new patients from the North-East Scottish Region entering psychiatric care for the first time in their lives between 1963 and 1967, a total of 9,776 cases. A comparison of referral rates by marital status, sex and age showed that the main marital groups with high risks of referral to psychiatric services were the divorced of both sexes, widowed males, widowed females aged 20-54, married females aged 16-24 and single males older than 25. These findings differ from those of previous studies based only on hospital admission data.
A comparison of diagnostic groups by marital status, sex and age revealed important differences in the marital status distribution in different diagnostic groups. Single males had higher rates of referral than married males for the psychoses and alcoholism, but for the neuroses and personality disorders rates were similar for the two groups. Single females had increased risks of referral in comparison with married females only for schizophrenia.
The hypothesis that a single person when developing symptoms of mental illness is more likely to be admitted to mental hospital, whereas a married person is more likely to be treated in the community, was proved true. Proportionately more single persons of both sexes were admitted directly to hospital than were referred to extra-mural psychiatric services. Results are discussed in relation to previous studies and the hypotheses regarding marital status and mental illness are reappraised in the light of the present findings.
47 citations
TL;DR: A model of physician referral behavior based on exchange theory is developed and tested using data collected from 127 internists in private practice in the northern suburbs of Chicago and findings are discussed in terms of policy issues.
Abstract: The physician's important decision-making role in the allocation of medical resources is well recognized. An important part of this role is one physician's decision to refer a patient to another physician for care. Existing research, largely descriptive in nature, has been limited by lack of a clear theoretical and conceptual framework for analysis. The current paper develops and tests a model of physician referral behavior based on exchange theory. Differences in rates of referral among physicians are viewed as a function of the different rewards and costs perceived by physicians occupying different levels of status within a given medical community. The model is tested using data collected from 127 internists in private practice in the northern suburbs of Chicago. Findings are discussed in terms of policy issues and suggestions for further research are indicated.
44 citations
TL;DR: A program of brief group therapy, conducted in Spanish by a bilingual social work assistant, that helped patients with their presenting problems and helped prepare them to accept referral to the longer term treatment facilities of the center.
Abstract: Barriers of culture and language have tended to keep poor Spanish-speaking people from using community mental health center treatment facilities. This paper describes a program of brief group therapy, conducted in Spanish by a bilingual social work assistant, that helped patients with their presenting problems and helped prepare them to accept referral to the longer term treatment facilities of the center.
24 citations
Journal Article•
24 citations
TL;DR: The sharply falling birth rate, the steep decline in infectious disease, the persistently rising cost of care, the referral of many difficult but interesting cases to specialists, the consequences of increasing medical manpower, and the growth of family medicine and allied health personnel are all factors influencing the shape of Pediatrics.
18 citations
TL;DR: Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, issues involving the extent to which internists see psychiatric conditions in their practice and the extent of referral to and from psychiatrists are investigated.
Abstract: Increased demand for mental health services has focused increased attention on the nature of referral relationships between primary care physicians and psychiatrists in the delivery of psychiatric care. Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, this paper focuses on issues involving the extent to which internists see psychiatric conditions in their practice; the extent of referral to and from psychiatrists; the most common conditions referred to psychiatrists; the most common treatment modalities used by psychiatrists; the most common reasons psychiatrists refer to internists; and internists ratings of satisfaction with various aspects of their psychiatric referral relationships. A contingency model is proposed as a framework for further understanding the process. Specific propositions to be tested in future research are presented.
18 citations
18 citations
TL;DR: In this article, the authors studied the effect of appearance on the referral rate for psychological assessment, speech, reading, and learning disability in third-grade children and found that boys were referred more than girls and the children judged as physically attractive by ratings of photographs received significantly more referrals than their less attractive classmates.
Abstract: Rates of referrals for psychological assessment, speech, reading, and learning disability were studied in third-grade children. Over-all, boys were referred more than girls and the children judged as physically attractive by ratings of photographs received significantly more referrals than their less attractive classmates. Differential consequences of appearance on interpersonal responsiveness are discussed with particular emphasis upon access to intervention programs as a function of appearance.
TL;DR: This article explored the referral pattern of a group of clergy in a large midwestern city, and examined the type of problems being seen in counseling by clergy, and found that the problems were related to substance abuse.
Abstract: The purpose of this research was to explore the referral pattern of a group of clergy in a large midwestern city; to examine the type of problems being seen in counseling by clergy; and, to determi...
TL;DR: The author describes the evolution and current functioning of a menial health service in an HMO that serves more than 175,000 members in the Seattle metropolitan area and investigates referral patterns, categories of presenting problems, diagnostic impressions, treatment modalities, and patterns of utilization.
Abstract: The author describes the evolution and current functioning of a menial health service in an HMO that serves more than 175,000 members in the Seattle metropolitan area. A cohort of 159 patients was followed for 18 months to investigate referral patterns, categories of presenting problems, diagnostic impressions, treatment modalities, and patterns of utilization. The advantages and problems of the prepayment system vis-a-vis psychiatric care are discussed.
TL;DR: A handsome appearance is greatly prized in contemporary society and persistently portrayed by the advertising media as a sure road to happiness and success, but physical attractiveness may indeed often be associated with a sense of confidence and self-esteem, but these personal qualities are not invariable accompaniments of good looks.
Abstract: A handsome appearance is greatly prized in our contemporary society and persistently portrayed by the advertising media as a sure road to happiness and success. Physical attractiveness may indeed often be associated with a sense of confidence and self-esteem, but, as Marilyn Munroe's tragic life and death so clearly illustrate, these personal qualities are not invariable accompaniments of good looks. In the animal world a damaged or deformed member of the species tends to be ostracized or actively persecuted by the rest of the group. Likewise in human society a person whose appearance falls below the contemporary aesthetic standard for the culture runs the risk of being the target for prejudice and discrimination. There are widely held erroneous beliefs, firmly rooted in folk-lore, connecting appearance with personality traits. For instance, it is falsely claimed that a receding chin denotes weakness of character, a squint implies deceitfulness, and misshapen features are linked with criminality. As a result many disfigured individuals feel they are rarely judged by others on their real abilities or personal qualities but are stereotyped unfavourably from the first encounter.
TL;DR: This paper considers the data derived from 266 consecutive admissions to the day hospital using information obtained in each case discussed by the staff group and noted on a standard form according to agreed principles.
Abstract: In a previous paper (Morrice, 1973a) an account was given of a day hospital run as a therapeutic community. Emphasis was laid upon the way staff had learned to diagnose and treat patients not only according to conventional labels but also in terms of their disturbed social relationships—so-called social diagnosis and social prescription. At that time also an attempt was begun to identify life events which appeared to have precipitated the patients’ referral to psychiatric care. This paper considers the data derived from 266 consecutive admissions to the day hospital. Information obtained in each case was discussed by the staff group and noted on a standard form (Fig. 1) according to agreed principles.
TL;DR: This four-part report focuses on the construction of a conceptual model for measuring referral outcomes, a system for classifying health problems and services, a systems for tracking referrals, and factors related to outcomes.
Abstract: A computerized network of Health Education and Referral Centers is being developed in Los Angeles County. To assist in evaluating this network, a method for assessing the effectiveness of referrals was needed. This four-part report focuses on the construction of a conceptual model for measuring referral outcomes, a system for classifying health problems and services, a system for tracking referrals, and factors related to outcomes.
TL;DR: The referral of patients with acute confusional states and dementia to psychiatric hospitals may indeed be preferable to their management in general hospitals, where their disturbed behaviour presents a variety of problems with which these hospitals are not usually equipped to cope.
Abstract: One hundred and seven patients with neurosurgical disease treated in a combined neurosurgical, neurological, and psychiatric unit within a psychiatric service were reviewed retrospectively. Most patients had acute confusional states or dementia without gross localizing signs and in only three cases did the neurosurgical illness closely resemble a non-organic psychiatric syndrome. The great majority showed abnormalities on physical examination and simple investigations. A past history of alcoholism and/or other psychiatric illness was common. Many apparently had been referred to psychiatric hospitals simply because they presented problems of management. Consequently, the staff of the psychiatric hospitals must be aware of neurosurgical disease and have free access to facilities for its investigation and management. If these requirements are fulfilled, the referral of patients with acute confusional states and dementia to psychiatric hospitals may indeed be preferable to their management in general hospitals, where their disturbed behaviour presents a variety of problems with which these hospitals are not usually equipped to cope.
TL;DR: The 6 “admission” variables were found to be of no value as early predictors, but the ancillary variable (length of stay) proved to be importantly related to the overall need for Social Service.
Abstract: A study was made of the possible usefulness of certain sociodemo-graphic characteristics as early indicators of the need for referral of elderly hospital patients to Social Service. The study population covered the 5,312 elderly patients accommodated in the private, semiprivate and teaching wards of the hospital's medical and surgical services during the year 1967. Of these patients, 520 were referred to Social Service. The data on 6 items (age, sex, marital status, religion, color, and medical service location) routinely recorded on each admission sheet were collected to determine whether they would prove predictive of the need for referral to Social Service; if so, they would constitute an inexpensive automated screening device for this purpose. At present, most elderly patients who need the services of social workers are referred only late in the course of hospitalization. Incidental to the original plan of study was the collection of data on the length of hospital stay. The 6 “admission” variables were found to be of no value as early predictors, but the ancillary variable (length of stay) proved to be importantly related to the overall need for Social Service. However, since the data on this variable can be obtained only at the time of discharge, they cannot be used as a screening device for early identification of the need. Further studies may reveal a means of early prediction of the length of hospital stay.
TL;DR: This report deals with the use of psychiatric care by diagnosed schizophrenics in the Kansas City area, one of several reports issuing from a large and detailed survey designed to ascertain the extent and utilization of psychiatric services.
Abstract: This report deals with the use of psychiatric care by diagnosed schizophrenics in the Kansas City area. It is one of several reports issuing from a large and detailed survey designed to ascertain the extent and utilization of psychiatric services, public and private, inpatient and outpatient Of central concern here are not only schizophrenics as a major diagnostic group per se but, more specifically, that particular group's fate in its encounter and interactions with the psychiatric care system. Accordingly, mental health facilities are examined with respect to available resources and various treatment modes. The characteristics of the patients are then explored, including their life space or social milieus. Such social dimensions as marital status, living arrangements, socioeconomic status, referral source, and urban/ rural residence are also examined.
Journal Article•
TL;DR: From this paper based on the opinions of hospital patients, a representative group of Dutch family doctors and of specialists, as well as on the results of an investigation in three practices of the Nijmegen University Department of General Practice, two conclusions can be drawn.
Abstract: From this paper based on the opinions of hospital patients, a representative group of Dutch family doctors and of specialists, as well as on the results of an investigation in three practices of the Nijmegen University Department of General Practice, two conclusions can be drawn.(1) The family doctor can fulfil an important role for his patients in hospital. This role arises from his function as a doctor to the family and is complementary to the technical specialist's work in hospital. The family doctor can therefore bridge the gap between hospital and home and between the patient and his family.(2) A strict referral and hospital admission policy by the family doctor has important consequences and gives him a key position in health care. He can promote the shift from hospital-centred care to domiciliary-centred care which is now generally considered to be necessary.It seems likely that such a strict referral system means a better quality of medical care for patients.This is a priority of the first order, greater than that of perfecting hospital medical care, which will require an ever-increasing effort and cost for a decreasing group of patients.
Journal Article•
TL;DR: Long-term follow-up study of this group of children with myelodysplasia may indicate that transfer of custody can be a positive therapeutic alternative for the child and his family.
Abstract: Of 173 patients with myelodysplasia followed in the Birth Defects Center at University Hospital between 1968 and 1972, 30 (17%) have been placed outside their natural families for temporary or long-term care. Only one has been adopted and five have been institutionalized; the remainder have been in foster home care. High level paralysis, mental retardation, and lower socioeconomic status correlate positively with placement. In this series, gender was not a contributory factor. An initial "hopeless" prognosis and/or selection for "no treatment" were decisions often made prior to referral to this center but were highly correlated to placement. Considering the multiple medical, emotional, and economic problems facing these families, relinquishment of custody should be anticipated in a significant percentage of cases. To date, placement outside the natural family has been viewed primarily as abandonment or as an emergency solution to a crisis. Long-term follow-up study of this group of children may indicate that transfer of custody can be a positive therapeutic alternative for the child and his family.
TL;DR: An analysis of the types and numbers of x-ray films requested in the first year of a health centrex-ray unit showed that chest films represented the largest proportion of these.
Abstract: An analysis of the types and numbers of x-ray films requested in the first year of a health centre x-ray unit showed that chest films represented the largest proportion of these. The unit is most valuable when it is inmediately available to the patient and general practitioner at the time of consultation, and thus it should be open for at least five sessions per week. The likely referral rate for the health centre x-ray unit is 84 patients per 1,000 at risk, and a unit functioning for five sessions a week can examine 60 patients during that time. This minimum of five sessions would be fully used by a population of 30,000 patients. The running costs were found to be about the same as those of a hospital x-ray unit.
Journal Article•
TL;DR: The training and function of speechpathology are discussed, with emphasis placed on classification, proper time of referral, etiology, and treatment techniques of common speech disorders.
Abstract: Summary The training and function of speechpathology are discussed, with emphasis placed on classification, proper time of referral, etiology, and treatment techniques of common speech disorders.
Journal Article•
01 Jan 1974
TL;DR: In 1971 a proposal for a new emergency care system for Greater Copenhagen was submitted to the local authorities in the area by a committee of experts, which would contain emergency wards with beds, centers for traumatic surgery, coronary units, modern emergency ambulances, and a central referral office with wireless connections to all ambulances.
Abstract: In 1971 a proposal for a new emergency care system for Greater Copenhagen (1·3 million inhabitants) was submitted to the local authorities in the area by a committee of experts. The proposed system would contain emergency wards with beds, centers for traumatic surgery, coronary units, modern emergency ambulances, a central referral office with wireless connections to all ambulances for the purpose of giving medical advice, and clinics for light casualties.
01 Jan 1974
TL;DR: Outpatient methadone maintenance programs located within community mental health centers are discussed and it is concluded that such programs do not belong in mental health center.
Abstract: Some of the problems and issues associated with outpatient methadone maintenance programs located within community mental health centers are discussed. It is concluded that, in general, such programs do not belong in mental health centers. The role of the mental health center should he that of a backup service for referral of those addicts who have emotional problems and who are motivated for the services provided by the center.
TL;DR: The general and ocular signs and symptoms of diabetes are reviewed, together with the pathogenesis of diabetic retinopathy.
Abstract: Diabetes Is the second most common cause of blindness in adults and the first signs of the disease may frequently be detected during routine optometric examination. There is a need to extend family and general health history taking to include specific questions relating to diabetes. The general and ocular signs and symptoms of diabetes are reviewed, together with the pathogenesis of diabetic retinopathy. The progression of diabetic retinopathy is illustrated by fundus photographs of diabetics presenting at the author's practice. Referral criteria are suggested for patients presenting with suspected ocular signs of diabetes.
TL;DR: Variation between Aberdeen general practitioners in referral rates for home and surgery nursing care is shown to be substantial and is related to the proportion of elderly patients in the practice, inversely to list size.
Abstract: Variation between Aberdeen general practitioners in referral rates for home and surgery nursing care is shown to be substantial and is related to the proportion of elderly patients in the practice, inversely to list size, to the doctor's experience, and to practice attachment of nurses. There is, however, a large unexplained variation which, it is suggested, reflects differing general practitioner perception of nursing need and nursing skill, a situation that could be improved by joint training.