Showing papers on "Referral published in 1981"

Snowball Sampling: Problems and Techniques of Chain Referral Sampling

Abstract: In spite of the fact that chain referral sampling has been widely used in qualitative sociological research, especially in the study of deviant behavior, the problems and techniques involved in its...

Evaluation of neonatal-intensive-care program.

Abstract: Within the past 15 years, regional neonatal-intensive-care programs have been introduced and have expanded rapidly. The efficacy of some of the individual interventions that constitute neonatal intensive care has been validated in randomized, controlled clinical trials. It is therefore generally assumed that neonatal-intensive-care programs that incorporate these maneuvers are effective in reducing death and disability. However, the overall effectiveness of these programs has not been tested experimentally. Moreover, much of the non-experimental evidence supporting their value is based on the experience of referral units and does not measure the impact on the populations they serve. A definitive economic evaluation of neonatal intensive care has not yet been reported, despite the high cost of such programs. We conclude that neonatal-intensive care programs require further evaluation with rigorous scientific methods.

The use of Systematic Encouragement and Community Access Procedures to Increase Attendance at Alcoholic Anonymous and Al-Anon Meetings

Abstract: A difficulty in the treatment of alcoholism is that many alcoholics referred to treatment programs never reach the referral destination, or if they do, they seldom remain involved in those programs. The present study attempted to increase participation in Alcoholics Anonymous and Al-Anon meetings. Twenty clients were selected from an outpatient mental health alcoholism treatment program and randomly assigned to either a standard referral procedure which involved giving the client information about Alcoholics Anonymous or Al-Anon; encouraging the client to attend; and providing information concerning time, date, and location of weekly meetings; or to a systematic encouragement and community access procedure which involved a phone call being made in the counseling session to a local Alcoholics Anonymous or Al-Anon member in which the member briefly talked to the client about the meeting, offered to give a ride to the client and to meet the client before the meeting and having the Alcoholics Anonymous or Al-Anon member call the client the night of the meeting to remind them of it and to encourage them to come. The results of this study showed that 100% of the experimental group attended Alcoholics Anonymous or Al-Anon within 1 week of referral and continued to attend, whereas none of the control group ever attended. The results of this study suggest that the systematic encouragement and community assess procedure are significantly more effective than standard referral systems.

Liaison psychiatry: referral patterns and their stability over time.

Abstract: The authors analyzed referral patterns for psychiatric consultation from medical and surgical wards on the basis of 2,000 referrals. They found that patients' demographic characteristics were stable over time. The diagnoses of depressive disorders and organic brain syndromes consistently predominated. Other studies have shown similar findings. The authors stress the importance of research on depressive disorders in the physically ill and of teaching the diagnosis of organic brain syndromes. They also underscore the value of the liaison nurse.

Do general practitioners have different "referral thresholds"?

Abstract: One of the most interesting puzzles in general practice is why doctors differ so greatly in the frequency with which they refer patients to hospital. Published figures range from less than 0-5 to more than 15 per 100 consultations,1 and from only 0-6% to 25-9% of patients on a practice list a year." ? Obvious differences in patient characteristics, such as age, sex, social class, type and severity of problem, and distance from the practice; in doctor characteristics, such as age, years in general practice and in a particular practice, special medical interests, and postgraduate training ; and in practice characteristics, such as size of list, work load, urban or rural setting, partnership or single-handed structure, and distance from hospital1'11 may explain many of these marked variations. These differences in referral rates may also be explained by what other authors have called a "referral threshold"' * >*? that is, doctors have a personal level at which the stimulus of a consultation produces a referral. This concept would be supported if doctors were observed to refer at dissimilar rates even when patient, doctor, and practice characteristics were the same. Unfortunately, only a few studies* ' of the referral process have controlled for more than one of these characteristics at a tame. Since 1971, the general practice partnership of one of us (BJ) has kept extensive records on every consultation. The size and detail of these data allowed us to carry the observations of previous workers one step further?we compared the referral rates of several doctors while a number of patient and practice variables were controlled. Our purpose was to examine the hypothesis that general practitioners have a personal referral threshold. Practice characteristics were the same for each

Diagnostic Classification Decisions as a Function of Referral Information

Abstract: Educational decision makers (n = 224) participated in a computer-simulated decision-making experience designed to ascertain the extent to which referral information biased classification decisions. Subjects were randomly assigned to 16 different conditions that varied on the basis of the referred child's sex, socioeconomic status, physical attractiveness, and nature of referral problem. Subjects accessed test data, all of which reported performance in the normal range. Only the nature of the referral problem was found to be influential in the simulated decisions. A referred child was more likely to be diagnosed as emotionally disturbed when the referral statement of the problem was listed as behavioral rather than academic. Subjects ignored standardized test information indicative of average performance, and retained the stereotype created by the referral information. The results are discussed with regard to implications for assessment of children and future research.

Determinants of foster care placement for the maltreated child

Abstract: This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p less than 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R2 = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specif...

The high prevalence of hearing disorders and its implications for services in the UK.

Abstract: Data from a pilot population study of hearing impairment give a high estimate (10%) for the prevalence of clinically significant hearing loss in the UK. This carries implications for the nature of further research, in particular that within the National Study of Hearing conducted by the Institute of Hearing Research. It also carries important implications for the scale and nature of audiological services, the projected need for which could not be met by present audiological staffing. Service-monitoring data obtained in ENT outpatient and hearing-aid clinic populations suggest that only about one-half of the potential numbers receive help from the Health Service. In particular prevailing criteria for referral, while referring absolutely more elderly than younger people, still do not parallel the progression of audiometric impairment in the population.The large short-fall in referral plus technological progress suggest that a large absolute growth in service take-up could come from the mildly impaired in th...

Factors associated with dropping out of child and family treatment

Abstract: This study investigated factors related to attendance and continuation in family-oriented treatment at a child guidance clinic. As expected, attendance and continuation were related with chronicity of the presenting problem, nature of the referral source, initial clinical perceptions of the family and predictions about termination, and family attendance in evaluation and treatment sessions. Attendance and continuation in treatment, however, were not related with family socioeconomic status and other demographic factors. The implications of these findings for treatment planning are discussed.

Assessment of Elderly Patients at Home: A Report of Fifty Cases*

Abstract: Fifty elderly patients were assessed at home by physicians trained in geriatric medicine. The patients had been referred by physicians, relatives, or community services. Reasons for referral usually were nonspecific and involved either a request for overall assessment or recommendations about placement. Assessment included medical, psychiatric, social and functional components. Mental impairment and impairment in the activities of daily living were common. New medical or psychiatric diagnoses were contributed in 36 instances. The most frequent previously unnoticed pathologic disorders were mental impairment and depression. Assessment resulted in specialists' advice concerning such matters as the medication program, placement, increased support, further diagnostic work and, in two instances, prompt admission to a hospital.

Utilization of medical services after short-term psychiatric therapy in a prepaid health plan setting.

Abstract: Utilization of medical services in Group Health Association of Washington, D.C., was analyzed for patients referred in 1970 for short-term psychiatric therapy under benefits but who had no therapy or referral for at least the 12 preceding months. A matched comparison group and family members were also studied. Medical visits were analyzed in three time periods: the 12 months preceding referral, the next 4 months when therapy was likely to be received, and a final 12 months. Compared with controls, the Index Cases did not show a significant reduction of "offset" in utilization of outpatient medical services after referral, but they did decreases days of medical hospitalization significantly. When Index Cases were divided into low and high users of psychiatric therapy, the former showed a decline, the latter an increase in medical visits, and the difference between them was significant. The before-after change in utilization among other family members was similar to that for index and control subjects. The findings suggest the need to identify the types of patient and the clinical settings which are most likely to maximize the offset effect of brief psychotherapy. Medical care programs should be tailored to meet the different psychotherapy. Medical care programs should be tailored to meet the different psychiatric needs of these and other patients in an effective and efficient manner.

The private general hospital's psychiatric emergency service in a decade of transition.

Abstract: The psychiatric emergency ward of the private general hospital is faced with increasing demands for services and a changing role as a result of the progression of deinstitutionalization and shifts in the relationships between public and private facilities. Ten years ago the psychiatric emergency ward operated primarily as an evaluation and referral unit, triaging patients to primary sources of care; today the public facilities that serve as the primary caregivers frequently turn referrals away. Thus the referral model of service delivery is no longer viable for a psychiatric emergency ward, but it is yet to be replaced by other programs within the ward that will enable the chaos of the current system to be bypassed and prevent furtber deterioration of patient care. The authors discuss the dilemmas facing the emergency ward staff in the management and treatment of involuntary, psychotic, and chronic crisis patients.

Assessment of a secure/intensive care/forensic ward

Abstract: Recent trends in psychiatric hospitals have re-established the need for semi-secure, well-staffed acute wards. Such a ward is described and 400 consecutive admissions over a 34-month period reviewed. Using 13 beds all the acute patients requiring security and intensive treatment are managed from a total catchment area of 600,000. A wide range of referral agencies and diagnostic categories are encountered. Staff in the general psychiatric hospital where the ward is situated are satisfied with the service. A small group of chronically-disturbed patients require separate facilities.

Needle in the heart.

Abstract: A patient accidentally drove a darning needle through her chest wall into her left ventricle. After referral five weeks later as possible case of infective endocarditis, the needle was detected and removed successfully by open heart surgery. It was localised precisely by echocardiography.

The Mayo three-community hypertension control program. IV. Five-year outcomes of intervention in entire communities.

Abstract: A pronounced decline in blood pressure levels of hypertensive patients occurred in each of three rural Minnesota communities 1 to 2 years after the inception of community programs to control high blood pressure in these populations. An experimental hypertension clinic was established in one community to integrate a nurse practitioner into a physician-supervised program of long-term patient management. In the community with this innovative, partially subsidized practice arrangement, we observed declines in diastolic pressures of hypertensives. However, comparable degrees of blood pressure reduction occurred in the two other communities, with traditional solo or small group practice arrangements, where intervention was limited to detection and referral alone or was supplemented with continuing education of physicians in the management of hypertension. The evaluation of these three community programs suggests, among other conclusions, that this innovative community model for hypertension control, based on the recommendations of the Inter-Society Commission for Heart Disease Resources, contributed to favorable short-term blood pressure outcomes for the community. The observation of similar overall outcomes as measured by blood pressure reduction in all three communities was unexpected; the clinic's impact appears to have been matched by the effectiveness of screening and referral, alone or with continuing education, in the two other communities.

Characteristics of general hospital patients referred for psychiatric consultation.

Abstract: An analysis of 151 psychiatric consultations at a large publicly supported teaching hospital indicated that referral rates were greater from the medical services as compared with the surgical services. Minorities, elderly, and widowed persons were underrepresented. Depression and organic brain syndromes were the most common diagnoses and the presence of an organic brain syndrome had been frequently missed by the referring physician.

Social Factors and Admission to Psychiatric Hospital: Schizophrenia in Plymouth

Abstract: While they are a dubious measure of spatial variations in the effectiveness of health care provision, rates of readmission do reflect areal differences in the degree to which hospital admission occurs in the management of schizophrenia. Areal analysis involving census data can help to identify the causal factors responsible, but the examination of case notes is a necessary extension. In Plymouth such data informed some aspects of the differences between patterns of male and female illness demonstrated by aggregate areal analysis. Nevertheless case-notes data have their own weaknesses. Prospective studies encompassing the complex phenomenology of the referral and admission processes would seem to be necessary for the full understanding of spatial distributions of admissions to psychiatric hospitals. There is a good deal of evidence that the spatial incidence of schizophrenia measured by hospital admission rates, is related to environmental, social and economic variables.' Few inferences as to aetiology are possible, however, from such geographical research. Even if schizophrenia is assumed to have an entirely genetic origin there remains ample scope for the operation of social factors in the admission process.2 Social factors may be crucial in deciding whether the display of schizophrenic symptoms, regardless of their origin, results in admission or not. The source of referral, the status of the decisionmakers, the sex of the patient, the presence of relatives, the availability of beds and the degree of community orientation appear to be among the more important factors.3 These influences continue to operate after the initial diagnosis and may be investigated in patterns of readmissions. Aggregate areal analysis can identify the main factors but the processes that they summarize require an examination of case notes. The linkage of different levels of analysis, which is attempted in this paper, has been recognized as a necessary development in the geography of psychiatric illness.4 Parallel trends have occurred in other branches of urban social geography, particularly in studies of suicide,5 voting behaviour, crime and juvenile delinquency.6 Readmissions are a particular concern in this paper and their context in the psychiatric service needs to be discussed. Since the early 1960s a policy of community care, involving two new out-patient departments and a community nursing service, has been enthusiastically pursued in Plymouth. This community orientation has been seen as the most effective way of providing for the needs of patients. The maintenance of patients in the community has become a service goal the achievement of which seems measurable in terms of the frequency Trans. Inst. Br. Geogr. N.S. 6, 39-52 (1981) Printed in Great Britain This content downloaded from 157.55.39.181 on Thu, 29 Sep 2016 05:52:30 UTC All use subject to http://about.jstor.org/terms 40 IC G. DEAN AND H. D. JAMES of readmissions and the time spent in hospital. Evaluative studies of an out-patient department and the community psychiatric nursing service in Plymouth have used frequency of readmissions and the length of stay as primary indicators.7 However, there are problems in using these indicators to assess the effectiveness of nonresidential care facilities. The Plymouth research into non-residential care suggested that as the amount of observation and support for patients in the community increased so did the rate of readmissions and even the average length of stay in hospital. These findings thus confirm the conclusions of Brown et al. who found, in a study of three psychiatric services, that the most community-orientated had the highest rate of readmissions for schizophrenia.8 They saw greater awareness of the morbidity of the patient on the part of psychiatrists and social workers as the most likely reason for this. Thus, ironically, intervention designed to improve the performance of the system measured against a declared aim may have an opposite effect. System goals regarding the optimum form of treatment are, it seems, being frustrated by the day-to-day practice of doctors. This discrepancy between 'system goal' and 'system practice' has to be seen against the background of the 1959 Mental Health Act which encouraged community orientation.9 The Act sought to produce as normal an environment as possible for mentally ill patients. This meant an emphasis on treatment in the community and the avoidance of institutionalization. At the same time the Act was concerned to protect members of the public. With psychiatric illness, especially psychoses such as schizophrenia, it is not necessarily the patient who suffers most, and psychiatrists are bound to take the well-being of others into account. Thus the social or family setting of the patient, embracing both the availability of care and the likely harmful effects on others, may well influence decisions about the optimum form of treatment. Given this background it would be wrong to suggest that frequent admission, for example, indicates ineffective treatment. It is only ineffective given a system goal of keeping psychiatric patients out of hospital. Thus in analysing, in particular, rates of readmissions our purpose is not to assess the effectiveness of non-residential care but to show how social factors may influence the emphasis on hospitalization as a mode of treatment. AGGREGATE AREAL ANALYSIS For a number of well-documented reasons it is hazardous to proceed from the analysis of aggregate areal data to statements about individuals.10 The ecological fallacy, the coarseness of the independent variables and their precise meaning are among the more obvious difficulties. However, it is legitimate to make statements about spatial patterns of illness and to develop causal hypotheses from what Johnston has called 'areal studies'." Such studies can show which social factors are likely to be most relevant for different populations of admissions defined by sex and the number of previous admissions, although a more direct mode of analysis is required to determine how social factors operate. Data and method of analysis A total of 881 admissions involving a primary diagnosis of schizophrenia occurring in the period 1970-75 were considered. Table I identifies eight admission categories on the basis of sex and the number of previous admissions. As the ratios in respect of admissions from private addresses indicate, the excess of female admissions rises steadily with the number of previous admissions.12 All admissions involved in the aggregate areal analysis were from private households to the one psychiatric hospital serving Plymouth. However, Table I also lists the 84 admissions from non-private addresses that occurred within the study period. Most of these admissions were classified as being from 'no fixed abode' with the remainder This content downloaded from 157.55.39.181 on Thu, 29 Sep 2016 05:52:30 UTC All use subject to http://about.jstor.org/terms Schizophrenia in Plymouth 41

Social support and alternatives to institutionalization for the at-risk elderly.

Abstract: Selected findings are reported from a follow-up study conducted to determine what happened to persons aged 65 or older who were referred for evaluation to an urban Geriatric Evaluation Service (GES) but who were not approved by the GES for admission to a mental hospital. Reasons given for the referral included both physical and behavioral problems. The alternatives to institutionalization were based upon the nature of the available social support system, and the functional health status. The family provided most of the care for its aged ill, and the adult children provided most of the social support. In the absence of support by adult children, other relatives gave the necessary care, which included a wide range of services such as personal care, housekeeping, cooking, running errands, transporting, and the important service of just being present or available. Community services were used infrequently. The majority of the subjects were in the "poor health" category and required supervision or care for impaired mobility, one or more physical health problems, and sometimes for mental confusion or disorientation.

A queueing network approach to health care planning with an application to burn care in New York State.

Abstract: Treatment of severe thermal burns is a medical care problem which has not previously received the support and attention required on both the national and state level. With the advent of the Health Systems Agencies and the Systems Perspective to Health Care Planning, there will be a need for analytical planning and evaluation models which produce results with respect to controlling health care costs. A descriptive planning model has been developed based on the theory of finite capacity multiserver queues and continuous-time Markov chains, which can be used to describe the operations of a system of burn care facilities linked together by a referral policy to accommodate patient overflow. This model has been combined with a heuristic optimization procedure to answer the relevant questions for burn care in New York State.

Hearing Assessment of At-risk Infants: Current Status of Audiometry in Young Infants

Abstract: This study reports hearing status on a consecutive series of infants who had required neonatal intensive care. A relatively high percentage of infants demonstrated hearing impairment. Results are discussed in terms of their implications for the pediatrician who often serves a "case manager" role for families. An underlying assumption is that pediatricians are better equipped to advise parents and make referral decisions if they have an awareness of the current audiologic assessment strategies for infants and young children. The strengths and limitations of the currently employed methodologies are defined and discussed.

Psychiatric aftercare: identified needs versus referral patterns.

Abstract: Although psychiatric aftercare has received increased attention, little is known about patients' needs for community resources or about predischarge referral patterns. The authors interviewed hospital staff about needs and referrals for each of 747 patients about to be discharged. Nearly all patients had needs in the medical/therapeutic area and most received referrals. In three other nonmedical aftercare areas needs were identified for a much lower percentage of patients, and identified need was two to three times greater than referrals made. The authors discuss the implications of these findings for the provision of aftercare services.

Errors in the diagnosis of schizophrenia in black and Indian patients.

Abstract: The referral and/or final diagnoses of schizophrenia in 100 patients were examined. Discrepancies between these diagnoses were frequent and little evidence of a standardized approach to this diagnosis was revealed. Misinterpretation of cultural phenomena emerged as a further source of error. The critical nature of the interview and assessment situation, together with the need for standardized criteria and comprehensive understanding of cultural factors, is emphasized.

Vision Screening for Persons with Severe Handicaps.

Abstract: This article discusses vision screening programs designed to serve persons with severe handicaps. The discussion includes information on establishing a system or upgrading existing services, selecting appropriate screening tools, referring persons in need of professional vision care, obtaining appropriate treatment, and providing follow-up services required to ensure that all persons with severe handicaps receive the best possible vision care.