Showing papers on "Referral published in 1984"

Incidence of anterior shoulder dislocation in Olmsted County, Minnesota.

Abstract: The records of all Olmsted County, Minnesota residents treated for an initial traumatic anterior shoulder dislocation during a ten-year period were reviewed to study the incidence and natural history of this condition. One hundred twenty-four patients had been treated during the study period, and in 116 patients (93.5%) complete follow-up evaluation was available. The overall adjusted incidence of initial traumatic shoulder dislocations was 8.2/100,000 person-years; of all traumatic shoulder dislocations, the rate was at least 11.2/100,000 person-years. Incidence rates were significantly greater for men than for women. There was no urban versus rural difference in incidence or recurrence rates. The authors concluded that shoulder dislocation occurs most frequently in younger male patients and occurs with similar frequency in urban and rural settings. Except for age-related differences in recurrence rates no significant referral bias was found among patients treated at a tertiary care facility as compared with patients from the local community.

Late referral for maintenance dialysis.

Abstract: A study of patients accepted for maintenance dialysis at the Oxford renal unit in 1981 showed that 23 out of 55 patients were referred late, very shortly before the need for dialysis. This pattern of referral was associated with a higher morbidity at the start of dialysis which may have been preventable. In the late referral group 16 patients (70%) suffered major complications and three (13%) died; by contrast, in the early referral group three patients (9%) suffered complications and one died. Early referral to a renal unit plainly benefits the patient and allows Health Service resources to be used more economically.

Development of Indicator Scales for the Comprehensive Assessment and Referral Evaluation (CARE) Interview Schedule

Abstract: The objective of this research was to develop indicator scales for major health and social problems of individuals aged 65 or over who live in the community. A semistructured interview technique, the Comprehensive Assessment and Referral Evaluation (CARE), was used in two large surveys in London and New York City. Twenty-two indicator scales were developed by using items that met certain clinical and statistical criteria. These indicator scales are intended for use in developing a general taxonomy of the problems of older individuals, for clinical assessment and referral of such individuals, and for use in geriatric epidemiological research. The scales were developed to be comprehensive with regard to the CARE, to be relatively independent of one another, and to have satisfactory content, clinical, and face validities, and interrater and internal consistency reliabilities.

How Good Is Communication Between Primary Care Physicians and Subspecialty Consultants

Abstract: • We prospectively studied the communication between 27 referring practitioners and their consultants for 464 consecutive patient referrals from a general internal medicine group practice at a university medical center. The rates of referral among practitioners varied from 0 to 28.1 per 100 patient visits. Though referring physicians provided patient background information in 98% of the cases, they made explicit the purpose of the referral in only 76% of the cases. They contacted consultants directly in only 9% of the cases. In return, consultants communicated their findings to referring practitioners in only 55% of the consultations. Referring physicians who personally contacted consultants or who supplied them with more clinical information were more likely to learn the results of the consultation. While communication between the referring physicians and consultants in this setting is limited, it may be improved if referring physicians supply more clinical information to consultants and contact them directly. ( Arch Intern Med 1984;144:1265-1268)

Curriculum-Based Measurement: An Alternative To Traditional Screening, Referral, and Identification

Abstract: Curriculum-based measurement of academic performance is an alternative to traditional referral and assessment models in psychoeducational evaluation. This study contrasted a screening and referral procedure that used weekly measurement of performance in reading, spelling, and written expression with a traditional teacher-referral procedure. Students referred by the 2 methods were compared with respect to referral rate, cognitive functioning, achievement level, social behavior, sex differences, and identification as learning disabled. The number of students referred through curriculum-based measurement was similar to the number referred by teachers. In addition, the results indicated that academic achievement was almost the sole criterion used in teacher referral, although teacher-referred students were more likely to be rated as behavior problems. Finally, students referred through weekly achievement measurement were as likely to have an aptitude-achievement discrepancy as were students referred by teachers.

Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer.

Abstract: Delay in the presentation of symptoms and in referral of patients for surgical opinion remains an important problem in colorectal cancer. Factors influencing patients to consult early include advice from close family or other associates and abdominal pain or vomiting, or both, as one of the early symptoms. More localised rectal symptoms and loss of weight are often associated with long delay. The "classic" symptom pictures are not often seen in the early stages of the disease. Few identifiable factors were associated with delay in referral for surgical opinion. Doctors who examine their patients (rectally or otherwise) refer them sooner. In the districts studied delay in instituting definitive treatment after consultant referral does not seem to be a major problem. There is some evidence that delay is associated with stage of the disease at presentation.

Dropout from adolescent psychotherapy: a preliminary study.

Abstract: Patient, therapist, and treatment variables were related to unilateral termination and length of stay in a retrospective study of 102 adolescents accepted for psychoanalytically oriented individual psychotherapy at an adolescent outpatient clinic. Despite the severity of their presenting complaints, the majority of these adolescents received only brief psychotherapy. However, dropout rates were not higher than those reported for children and adults seen in public and private settings. Demographic variables, presenting complaints, and patient reaction to the referral were associated with premature termination. Therapist professional affiliation and sex matching were related to therapist “holding power.” Higher frequency of sessions was associated with remaining in treatment. Clinical recommendations drawn from the findings are discussed.

Concurrent and predictive validity of indicator scales developed for the Comprehensive Assessment and Referral Evaluation interview schedule.

Abstract: Evidence for the concurrent and predictive validity of indicator scales developed to assess psychiatric, social, and medical conditions of elderly adults is presented. These scales were developed from the Comprehensive Assessment and Referral Evaluation (CARE) on probability samples of 445 elderly community residents in New York City and 396 in London, England. Corroborative information was also collected from key collaterals of a random subsample of 162 of the New York elderly adults. Concurrent validity of the cognitive impairment and activity limitation scales was tested in relation to family report of inconvenience and decision to institutionalize. Predictive validity of the scales was assessed using morbidity and mortality as outcome variables. Individuals classified as having medical and psychiatric disorders at Time 1 were significantly more likely to manifest such disorders 1 year later at Time 2 than were persons not so classified. In addition, the odds that individuals with cognitive impairment, somatic complaints, activity limitation, and difficulty ambulating at Time 1 would be dead within 1 year were two to three times greater than for those without the disorder, a result that provides support for the contention that these scales are useful predictors of outcomes.

Admission Decisions and Multiaxial Diagnosis

Abstract: • We comparatively examined the relevance of the various components of an expanded DSM-III diagnostic formulation to admission decisions by studying all 745 new patients who came to a 24-hour walk-in clinic during a six-month period and who were admitted to either inpatient or outpatient care at a comprehensive psychiatric institute. A diagnosis of psychotic disorders was found to be significantly associated with hospitalization, while anxiety disorders, adjustment disorders, personality disorders, and nonmental disorder conditions were associated with outpatient referral. The strongest correlations with hospitalization, however, were obtained for current adaptive functioning and, to a lesser extent, for highest level of adaptive functioning in the past year.

The Care Interview Revisited: Development of an Efficient, Systematic Clinical Assessmen

Abstract: This paper introduces a series on a method of systematically assessing the health and social problems of elderly adults, the Comprehensive Assessment and Referral Evaluation (CARE). AN overview is given of the conceptual approach and development of the CARE and its principle features including clinical relevance, semistructured format, criterion-based diagnosis, and psychometric properties as established on a probability sample of the elderly population. The reduction of the CARE is described, from a 1500-item instrument covering a wide range of problem areas and taking 90 minutes to administer, to shorter, more efficient and selective versions, the CORE-CARE and SHORT-CARE. The subsequent papers give details of the properties, reliability, validity, and reduction of the CARE.

Referral bias in diabetes research

Abstract: Of all the known diabetic individuals residing in the community of Rochester, Minnesota, only about one-half would have been recognized through a review of the medical records of 1 yr. Only one-fifth of the diabetic residents were hospitalized during the index year and a similarly small proportion were attended in a diabetes clinic. This selective process produced distortion in the apparent clinical spectrum of diabetes observed at different levels in the medical care system. Notable was overestimation of the relative importance of insulin-dependent diabetes and of the vascular complications of diabetes among hospital and diabetes clinic patients. Referral bias should be taken into account when differences are noted in the epidemiologic features of diabetes as reported from different types of medical care settings.

Some factors associated with compliance in the treatment of alcoholism.

Abstract: The investigation set out to examine the extent of problems of low compliance at an alcoholism clinic, to investigate some variables that might differentiate referral failures and initial clinic attenders as well as categories of patients who attend for treatment, and to generate hypotheses concerning these differences as a means of developing a compliance-enhancement strategy. Information, including sociodemographic and personality variables, patient self-reports of drinking behaviour, self-perceptions of their need for help and of drinking problem severity, and therapist ratings of drinking problem severity, was gathered on one hundred referrals to a clinic for new patients. Results showed that 46% of patients were referral failures and that, in comparison with attenders, the former group had both waited longer for the initial appointment and were younger. Few variables differentiated the categories of attenders. A greater proportion of those remaining in treatment contact for longer than a month rated the change in their drinking problem over the previous year as 'worse' and more of them had been arrested for public drunkenness. Those who made five or more clinic visits had waited a shorter time for their initial appointment, and a greater proportion rated the effects of their drinking on their work as 'serious' and the change in their social life as 'worse' than patients who had made fewer visits. The findings suggest that variables related to personal perceptions of drinking problems offer a better account of compliance behaviour than the sociodemographic variables which have been the focus of previous research.

Telephone counseling and crisis intervention: A review

Abstract: The empirical research pertaining to the effectiveness of telephone counseling and referral systems personnel was critically reviewed. The assessment was organized according to several evaluation strategies that researchers have utilized to evaluate effectiveness. These strategies included, for example, client self-reports, client "shows" versus "no-shows" following referral, data pertaining to suicide rates, counselor ratings of personal effectiveness, and phone workers' ability to offer empathy to clients. It was concluded that discussions of effectiveness should be constrained by a careful consideration of the specific index of efficacy chosen by investigators as well as methodological issues associated with current research in this area. There is reason to believe that the availability of telephone crisis services may be related to reduced suicide rates among young white females. Also, there is a significant need to empirically associate counseling technique and indices of effectiveness with substantive measures of client outcome in future research. Additional topics reviewed include the probable differential effectiveness of lay workers with various presenting problems of clients, and the role that training and maturity seem to play in successful interventions. Guidelines for the use of evaluation techniques which coincide with service goals are also offered.

Differences in medical referral decisions for obesity among family practitioners, general internists, and gynecologists.

Abstract: This study explored variation in the decisions of primary care physicians to refer or not to refer obese patients to an endocrinologist and the principles underlying their decisions. Forty-five physicians--family practitioners, obstetricians, and general internists--made referral judgments on 24 cases and completed a questionnaire. Data indicated a difference among specialties in the number of cases referred (P less than or equal to 0.01) that was not accounted for by physician characteristics. The number of cases referred ranged from 0 to 19, with a mean of 8. The patient's desire for treatment by an endocrinologist was overwhelmingly the major factor in decisions to refer. Gynecologists differed from other physicians by referring for management and not expecting the patient to return to their care. Referrals were not made primarily to rule out suspected endocrine disease or out of concern for morbidity due to obesity. These referrals are thus not perceived as medically beneficial, but are responses to patient pressure or physicians' desire to transfer management.

Referral and survival of patients accepted by a terminal care support team.

Abstract: The first year's work of Bloomsbury terminal care support team has been analysed from routinely recorded information. The patients accepted by the team were of younger average age than all people dying from cancer within the catchment population. The median survival of patients after first contact with the team was 49 days, but survival of patients referred by general practitioners and hospital general physicians was substantially shorter than of those referred by hospital oncologists and radiotherapists. The growing number of district terminal care services suggests the need for continued research to develop guidelines for referral of patients and methods of evaluating the team's work.

Japanese American response to psychological disorder: referral patterns, attitudes, and subjective norms.

Abstract: The underutilization of services by Japanese Americans has raised questions as to the variables that account for this phenomenon. The present study examined the referral patterns and their bases using the Fishbein-Ajzen model of attitude-behavior relationships. Vignettes describing disorders were each responded to by 106 Japanese Americans. Results indicated that self resources were the most commonly mentioned referral across disorders and generations, and that mental health resources only occasionally crossed the person's mind. Attitudes were as favorable for psychologists as preferred intentions though subjective norms were less favorable for psychologists. More severe disorders yielded more favorable attitudes and more permissible social norms than disorders of a lesser degree. These data suggest implementing mental health education programs in Japanese-American and other Asian-Pacific communities to increase service utilization by increasing awareness of mental health personnel as resources and to increase social norms in support thereof.

Physician Knowledge and Utilization of Physical Therapy Procedures

Abstract: The purpose of this study was to assess physician knowledge and utilization of physical therapy procedures. We sent a questionnaire to 600 physicians in three medical specialties (neurology, orthopedic surgery, and physical medicine and rehabilitation), in four geographic regions of the United States. The usable return was 41 percent. Overall knowledge, technical knowledge, and professional knowledge scores were compared by medical specialty, region of the country, years in practice, and three measures of utilization using analysis of variance, student's t, and chi-square statistics. Physical medicine and rehabilitation specialists and physicians in practice 10 years or more had the most knowledge of physical therapy procedures. Respondents preferred a prescriptive relationship when referring patients to physical therapists, and they most often selected "technical" procedures traditionally associated with the profession rather than "professional" procedures when referring patients to physical therapy. Those practicing medicine in their specialty 10 years or more were more conservative in their referral preferences than those in practice less than 10 years. The implications for educational intervention concerning the professional role of the physical therapist are briefly discussed.

The Effects of a Referral Coordinator on Compliance With Psychiatric Discharge Plans

Abstract: To investigate the effectiveness of a referral coordinator on patient compliance with initial aftercare referrals, the authors conducted a three-phase study involving 554 adult psychiatric patients at a Veterans Administration medical center. The first phase of the study established baseline data on compliance; the second phase monitored compliance following staff attempts to provide patients with more assistance in making initial aftercare appointments; and the third phase monitored compliance following the interventions of the referral coordinator. Analysis of the data on patient, hospital, and treatment characteristics indicated a marked increase in aftercare compliance after the addition of the referral coordinator to the treatment team. Compliance was especially increased in the most difficult patient group--the more acutely disturbed, chronic older patients. The authors discuss the implications of the results for discharge planning.

Effect of nurses' attitudes toward alcoholism on their referral rate for treatment.

Abstract: The attitudes of 27 industrial nurses at Ford's Rouge Plant were determined by use of a questionnaire. The score on the questionnaire was correlated to the number of referrals each nurse had made to the company's Employee Recovery Program during a two-year span. A positive correlation of + .54 was found. A comparison of high referral nurses to low referral nurses found major differences between the two groups in the response to some of the items on the instrument. High referral nurses reported more experience with alcoholics in their family. Low referral nurses had some of the same stereo-types that previous researchers have found. Recommendations for improvement are given.

Mycoplasma pneumoniae pneumonia. Experience at a referral center.

Abstract: Mycoplasma pneumoniae pneumonia is usually a benign illness, and respiratory complications and extrapulmonary manifestations occur rarely. In this series, patients admitted to a referral hospital with this disorder had unusual symptoms, signs and findings on chest roentgenograms and laboratory studies. Pneumonia was often severe and extrapulmonary manifestations were frequent, resulting in prolonged hospital stays and illnesses. Although this extreme end of the spectrum of disease caused by M pneumoniae is not representative of this type of pneumonia as seen in outpatients, it is important to realize that patients admitted to hospital with severe, complicated pneumonia frequently have unusual manifestations of a common disease.

Technology and interorganizational activity as predictors of client referrals.

Abstract: The client referral activity of 41 human service agencies operating within the same community was examined using recently collected data. Hypotheses were developed focusing on agency service techno...

The Congruence between Reason for Referral and Placement Outcome

Abstract: The relationship between referral and special education outcome was investigated in a state where students are referred by category of handicapping condition. Of specific interest was the congruence between categories for which students were referred and eventual placements. Results indicated that 72% of the students referred were placed in some form of special education and that most were placed in the special education category for which they were referred. Variations in the congruence between referral and outcome as a function of the person submitting the referrals were relatively minor, except for parents, for whom 79% of the referred students were not placed in special education. Implications of the results for special education decision making are discussed.