Showing papers on "Referral published in 1980"

Assault, suicide, and mental illness.

Abstract: • The characteristics of 9,365 patients admitted to public hospitals in a one-year period were analyzed in relation to the presence of assaultive or suicidal problems prior to admission. There were definite differences in the occurrence of assaultive or suicidal problems in relation to sex, age, primary diagnosis, education, race, marital status, prior private care, and source of referral to the hospital. There were no significant differences in regard to the history of previous psychiatric admissions, veteran status, or history of seizures. These findings demonstrate the usefulness of a large, routinely collected data base in the study of specific psychiatric problems and offer directions for intervention and future research in the field of life-threatening behavior.

Communication Failure in Primary Care: Failure of Consultants to Provide Follow-up Information

Abstract: In a two-physician general practice within 80 km of two university medical centers, there were 4,367 patient visits in six months, from which 233 referrals (5.3%) were made to consultants. All referred patients were accompanied by referral material and a request for follow-up information. The overall rate of receiving follow-up information was 62%. Private specialists provided substantially more follow-up information (78%) than either university-affiliated emergency rooms (48%) or university-affiliated specialty clinics (59%). Patients requiring continuing medical supervision from the referring physician also fared poorly: follow-up information for them was provided only 54% of the time. The timeliness and method of providing follow-up information were examined and believed to be satisfactory when follow-up information was returned. ( JAMA 243:1650-1652, 1980)

Sample Selection and the Natural History of Disease: Studies of Febrile Seizures

Abstract: We have compared published reports on the frequency of unfavorable sequelae in a common disorder of childhood, febrile seizures, as ascertained from hospital clinics or referral units, with the frequency as reported from population-based studies. Studies on defined populations, in which the attempt was made to recognize and follow up all affected persons regardless of medical care sought for the condition, are in close agreement and indicate relatively low rates of unfavorable sequelae. Clinic-based studies of febrile seizures have reported disparate results, including high frequencies of adverse outcomes. A possible explanation is that patients in clinic-based studies may not be representative of persons with the disorder in the general population.

The 'iceberg' of illness and 'trivial' consultations.

Abstract: The medical symptom 'iceberg' and 'trivia' were defined in terms of people's own perceptions of their symptoms and their subsequent referral behaviour. The data were collected by household interviews of patients registered at a health centre and included information on personal and environmental characteristics. Bivariate and multivariate analysis was used to explore associations between those who were part of the symptom 'iceberg' or 'trivia', and factors which might have caused such incongruous referral behaviour.

The Effect of Referral Procedures on Aftercare Compliance

Abstract: A study of four referral procedures involving 400 patients discharged consecutively from a geographically distant state hospital and referred to a community mental health center for aftercare suggests that simple changes in hospital discharge systems can increase compliance of patients and reduce recidivism. The scheduling of a specific follow-up appointment for the patient increased aftercare compliance significantly. Compliance was furtber increased, and the recidivism rate was cut in half, when the patient was seen by the community mental health aftercare nurse before discharge and was also given a specific follow-up appointment with that nurse.

Decision Makers’ Prediction of Students’ Academic Difficulties as a Function of Referral Information

Abstract: Educators and psychologists who had previously participated in at least two placement team meetings individually completed a computer-simulated decision-making program on a referred child. The 224 participants were randomly assigned to sixteen different referral conditions varying on the basis of the sex, socioeconomic status, physical attractiveness, and nature of the referral difficulty demonstrated by the referred child. Participants assessed test scores and qualitative information; all scores and information indicated performance within the average range for the referred student’s age and grade. A multivariate analysis of variance and follow-up univariate tests revealed that the nature of referral information significantly affected decision makers’ prognoses for academic success. When decision makers were told the student was referred for academic problems, they predicted difficulties in math, but not in reading or speech. Decision makers predicted that girls referred because of academic probl...

The Memphis Diabetes Continuing Care Program

Abstract: Since 1963 a network of nurse-operated, physician-backed decentralized clinics has provided continuing care for more than 5000 diabetic patients referred from the medical center clinics. Protocols that provide therapy goals and management details are used by the nurses and nutritionists in this network. To reduce fragmentation of care, intercurrent illnesses as well as other chronic diseases are treated using protocols in these clinics or in the home. This study examines certain outcome data in a subset of 556 diabetic patients under continuing care over a 7-yr period in this network, with comparisons being made to care before referral. Blood glucose is maintained at comparable levels in both decentralized and hospital clinics. Blood pressure levels in hypertensive patients are maintained in a satisfactory range. Total hospitalization rates are reduced by 47%. For ketoacidosis and amputation, hospitalization is decreased by 69% compared with the experience before referral. The maintenance care costs are decreased substantially compared with costs before referral due to the less expensive ambulatory services and the reduced need for hospitalization. The data support the concept that decentralization is an effective means of providing continuing care to patients with diabetes mellitus.

Referrals to a psychiatric service from old people's homes.

Abstract: One hundred consecutive referrals have been surveyed, the diagnostic and behavioural problems leading to referral considered and follow-up information obtained one year later. For most admission to hospital as in- or day-patients was unnecessary. Old people's homes do not make excessive demands on the psychiatric services, but deserve support, including help in developing a more tolerant and flexible approach to less confirming residents. This is becoming imperative now that old people's homes are dealing with increased numbers of disturbed residents.

When do pregnant women attend for antenatal care

Abstract: The case records of a representative sample of 313 women from four health districts in the North-east Thames Health Region were reviewed to determine the stage of pregnancy at which they contact antenatal services. Patients seeking care (when a blood specimen was obtained) after 20 weeks' gestation ranged from 6% to 26%. These women were more likely to be of higher parity and immigrants. Appreciable delays in obtaining an early blood specimen, or in referral to a hospital antenatal clinic, were due to delay by hospitals in giving appointments and, to a lesser extent, to slowness of general practitioners in referring patients or taking blood.

The Outcome of Forensic Psychiatric Assessment A Study of Remands in Six Canadian Cities

Abstract: This article summarizes data collected from 248 pretrial cases assessed by forensic psychiatrists for the criminal courts in six Canadian cities during July 1978. The discussion focuses upon purposes for court referrals, statutes employed for psychiatric remands, characteristics of forensic patients, diagnoses and recommendations rendered by clinicians, and the relationship between psychiatric recommendation and judicial outcome. It is suggested that legal and policy analysis of the court-ordered forensic assessment to date is lacking in detail and comprehensiveness, and that research needs to be directed more toward the decision-making and referral practices of the courts.

Influence of obstetricians' attitudes on their use of prenatal diagnosis for the detection of Down's syndrome.

Abstract: Practising obstetricians were surveyed to determine the relation between their referral patterns and their knowledge and attitudes concerning prenatal diagnosis by amniocentesis for women aged 35 years and over. Although 82% had referred at least one eligible patient for prenatal diagnosis during the past year, almost none had used the available services for all appropriate patients. There was a statistically significant trend for increased referral as correct knowledge of the risks and accuracy of prenatal diagnosis increased. Moreover, a discriminant function combining risk and accuracy estimates, type and size of practice, and language distinguished the referrers from the nonreferrers (P = 0.0002), although there was considerable overlap between the physicians classified according to a high, moderate or low rate of referral. The data suggest that while knowledge and practice characteristics can distinguish obstetricians who refer patients for prenatal diagnosis from those who never do so, the frequency of referral may involve other factors, such as how physicians accept innovation and perceive risks.

Perceptions of the family physician by patients and family physicians.

Abstract: The professional definition of the family physician is not based on research that considers both patient and family physician perceptions. Questionnaire responses from 86 family physicians and 287 patients from ten family practices in Los Angeles were analyzed to compare their attitudes, perceptions, and expectations of the family physician. Both groups agreed the family physician could handle most medical problems (including hospital care), should provide continuity, should emphasize preventive medicine, and should be caring. The physician's manner and skill were felt equally important. Family physician and patient expectations conflicted in four major areas: referral, the handling of emotional problems, concern with and care of family, and the issue of autonomy. Such research may help the development of family practice and improve the patient-family physician relationship through improved graduate and continuing medical education for family physicians.

A Study Of Psychiatric Referrals In A General Hospital

Abstract: In-patient as well as out-patient psychiatric referrals at Safdarjang Hospital, New Delhi were studied during a short period of 2½ months. The data were analysed with respect to referral rate, sources of referral and psychiatric diagnosis as made by the referring unit, compared with the diagnosis arrived at the department of Psychiatry. The results have been discussed in the study.

Parent‐Child separations during childhood: their relation to adult psychiatric morbidity and to psychiatric referral: preliminary findings

Abstract: A large body of literature suggests that parental loss in childhood bears a causal relation to adult psychiatric morbidity. As previous studies have used identified psychiatric patients, from psychiatric hospitals, it is unclear whether childhood parental loss causes psychiatric impairment (severity of symptomatology) in adult life or is in fact merely associated with psychiatric referral (illness behaviour). The present study of psychiatric outpatients, and “cases” and non-cases from a community survey, allows these two factors, impairment (severity of symptomatology) and illness behaviour (psychiatric referral) to be clearly distinguished. Parent-child separations bear no significant relation to psychiatric symptomatology in adult life, but are associated with referral to psychiatric services.

The referral process: a study of one method for improving communication between rural practitioners and consultants.

Abstract: Communication between referring physicians and consultants, essential for successful completion of the consultative-referral process, was inadequate in a rural clinic. This finding prompted the authors to conduct a randomized prospective trial of a referral form and return mailer in three rural primary care clinics associated with a university medical center. The use of a return mailer increased the percentage of consultant feedback from 39 percent to 60 percent, a highly significant increase. An added benefit was a decrease in the median time interval between a patient's contact with a consultant and receipt of that consultant's report by the rural clinics. The positive effect of the return mailer was consistent among various consultant categories, with the greatest improvement coming from a teaching hospital Emergency Room. The type of referring provider or the emergency status of the patient did not affect the percentage of communications returned. The use of a referral form accompanied by a request for feedback and a return mailer is an inexpensive method of increasing communication between primary care providers and consultants, thereby enhancing the value of the consultative-referral process.

Patterns of discussion and decision-making amongst abortion patients.

Abstract: PIP: Discussion and decision making among 308 of 338 Wessex women who obtained an induced abortion at one of 2 centers are studied. The most important discussants were found to be family doctors, boy and girl friends, husbands, mothers, and pregnancy counselors. In the majority of key discussions the patient had been able to discuss the pregnancy fully, had a sympathetic reception and met a discussant who was favorable to her having an abortion. However, younger patients were less likely to have such an experience and were later at arriving at their abortion decision and were more prone to uncertainty. It is argued that alternative counseling and referral systems should be developed for younger patients with unplanned pregnancies who may request abortion.

Obstetric emergency referrals to Kenyatta National Hospital.

Abstract: A study was undertaken of the incidence of maternal and child mortality during 1977 at the Kenyatta National Hospital in Kenya. It was noted that while obstetric emergency referrals to the hospital from district and provincial hospitals in the country accounted for 3% of the total Kenyatta Hospital deliveries they constituted 59% of the total maternal mortality cases. A table presents the reasons for obstetric referral. More than 1/3 of these were due to obstructed labor. Of the 10 deaths which occurred among the referral patients 7 were due to puerperal sepsis and 1 each were due to thrombosis severe anemia and heart failure and ruptured uterus. In 41% of the referral cases the patients were at fault i.e. they had neglected to attend the antenatal clinic. The other 59% were due to hospital negligence. Of the babies born to these referral cases approximately 60% were either born in poor condition or died at birth. Health education to publicize the antenatal clinics is recommended. Furthermore it is felt that outlying hospitals should be well staffed and equipped to handle all obstetric emergencies.

Evaluation of a decentralized system for chronic disease care: seven years of observation.

Abstract: Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over seven years. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After seven years in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the seventh year, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean serum glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1000/year were 74% of the rate during the year before referral to the program and out-patient visits/1000/year were approximately the same as before referral. However, two-thirds of the visits, formerly made to a public hospital, were now being made to neighborhood ...

Training for team care

Abstract: The aim of this paper is to highlight some of the findings of a research study concerned with the perception of general practitioner trainees, health visitor, district nurse and social work students towards the primary health care team. Areas of role understanding; role restriction/role euphoria and high referral of problems to others are illustrated. The results suggest a need for role learning experiences during training which are subsequently extended and reinforced by interdisciplinary participation in simulated patient management experiences. The idea of team care in the United Kingdom was first mooted as early as 1920 when a committee under the chairmanship of Dawson proposed that doctors should work in teams from health centres. This suggestion was destined to lie dormant until the 1960s, when due to a more favourable political, social and economic climate, the idea was rejuvenated. District nurses and health visitors became associated with doctors in general practice and such terms as 'attached', 'aligned', 'linked' and 'in liaison with' were in vogue (C.E.T.H.V. 1977). However, the bringing together of personnel was only the first small step in what should have been a dynamic drive to progress from an individualistic effort to that of a concerted team approach. In recent years however, there has been increasing controversy about the effectiveness of the team as a unit.

Medicine and literature in the medical curriculum.

Abstract: United States' medical education is a laboratory experience. During the first two years of the curriculum, students are exposed to medical sciences that are taught from a research laboratory perspective; during the final two years of their medical education, students learn the protocols of the referral hospital, a clinical "laboratory." Postgraduate medical training also occurs within this same clinical laboratory: the tertiary care facility. The result of this laboratory-oriented educational program is that physicians who complete it frequently lack familiarity with basic, everyday human problems. Many medical students and physicians with this training are naive in their understanding of the human condition. This problem has been accentuated by the stultifying influence of modern medical schools on the so-called liberal arts education of college undergraduates. Competition for admission to medical schools and the scientific rigors of medical education have produced a generation of medical students who almost universally major in biology

Diagnostic Decision Making in Individuals Susceptible to Biasing Information Presented in the Referral Case Folder.

Abstract: Teacher-student interactions and, to some extent, educational decision making have been shown to be influenced by naturally-occurring student characteristics. The extent to which computer simulated classification decisions within special education were differentially affected by information presented at the time of the referral was investigated. Decisions about 16 different cases were evaluated and found to be a function of referral information rather than child performance data. The outcomes are discussed with regard to implications for the practice of psychoeducational assessment. Diagnostic Decision Making in Individuals Susceptible to Biasing Information Presented in the Referral Case Folder Assessment of children in educational settings has become a common practice (Salvia & Ysseldyke, 1978; Ysseldyke & Algozzine, 1979); many issues have resulted from the decision-making activities in America's schools (Ysseldyke, 1979). For example, definitions of special education categories often are arbitrarily derived and/or prognostically useless (Algozzine & Sutherland, 1977; Hallahan & Kauffman, 1977; Ysseldyke & Algozzine, 1979). Additionally, it has been argued that the entire decision-making process is biased (Ysseldyke, 1979; Ysseldyke & Algozzine, 1979). This research addresses one aspect of bias in assessment: the extent to which individuals, who find a hypothetical child eligible for special placement, are influenced by data presented at time of referral. Teachers exert considerable influence upon the intellectual, academic, and personal-social development of the children in their classrooms; differences in characteristics and behaviors of children have been shown to produce differential teacher expectations and interactions (Algozzine, 1975; Brophy & Good, 1974; Foster, 1976; Sutherland, 1976). Brophy and Good (1974) suggested that susceptibility to "teacher expectation effects" was an individual difference variable which required research so that more productive teacher-pupil matching might be possible. Teacher expectancy effects and bias on a'number of factors have been demonstrated in a variety of settings. For example, Palardy (1969) showed that reading performance was related to teachers' expectations for a child's ability to learn to read; Algozzine (1977) found that teacher

Care of the diabetic child in the community.

Abstract: Brief admission of the new diabetic child and of a parent to an enlightened hospital for stabilisation, preliminary education, and familiarisation with hospital and community staff is well worth while. The greater the demand for constant control of the highest quality, the greater the need for a close understanding of the psychosocial factors concerned and for clinical skill. The nature of the home and the family relationships should in theory be available from the child's general practitioner at the time of the first referral since he has so much information about the whole family. With the virtual disappearance, however, of mutual consultation in the patient's home in many places, the opportunity for oral communication has declined, and availability on the telephone is not always easy. The busy general practitioner (far less an unknown physician from a deputising service without access to the records) has little time to write a comprehensive letter. In practice a relatively small hospital-based mobile team of specially experienced sisters who are keen to communicate in the home, the GP's surgery, and the school makes a major contribution to the diabetic care of a young population vulnerable to major handicap in what should be the prime of life. Their cost effectiveness may be difficult to prove but it is not at all in doubt--especially when the sisters as in this area deal in the community with a wider range of chronic illnesses and handicaps in children.

Selection Criteria for Outpatient Group Psychotherapy

Abstract: A tentative set of selection criteria for referral to outpatient group psychotherapy is outlined. The criteria do not distinguish between different schools of therapy but are organized around indications for referral to heterogeneous and homogeneous groups. Noting that the most common and difficult differential therapeutic decision is choosing between heterogeneous group treatment an individual therapy, or selecting some combination of both, the authors also discuss factors to be considered in making that determination.