Showing papers on "Referral published in 1985"

Implementing a Prereferral Intervention System: Part II. The Data

Abstract: This is the second of two articles on the implementation of a prereferral intervention model. The first article provided a rationale and description of the prereferral intervention model as the first phase in the special education services delivery system. In this article, the implementation of the model is described and data are presented on consultation, referral, testing, and placement rates before, during, and after implementation. Issues in implementation, including school system variables and barriers to implementing a consultation model, are also discussed.

Findings in psychiatric consultations with patients with acquired immune deficiency syndrome.

Abstract: Thirteen of 40 patients with acquired immune deficiency syndrome (AIDS) admitted to the wards of a large city hospital were seen by the staff of a psychiatric consultation service. Eleven were gay men and two were bisexual men. "Depression" was the stated reason for referral of 10 patients; of these, two met DSM-III criteria for major depression, one had dysthymic disorder, and seven had adjustment disorder with depressed mood. Recurrent psychological themes of the 13 patients were: dealing with a life-threatening illness, uncertainty about the implications of an AIDS diagnosis, social isolation, and guilt over their previous life style. The role of the primary physician and of the mental health professional in the psychological care of AIDS patients is discussed.

Work satisfaction of general practitioners and the quality of patient care.

Abstract: The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes.

The characteristics of dropouts from a child psychiatry clinic.

Abstract: The characteristics that distinguish nonattenders from attenders at a child psychiatry clinic prior to dropping out are presented. Nonattendance was primarily a function of referral source and the caretaker's symptomatology. Moreover, there was evidence of an interaction in the relationship of dropping out, referral source, and the caretaker's level of disturbance. There were no differences between the attenders and nonattenders on family sociodemographic characteristics or the child's symptomatology. The nonattenders' reasons for dropping out are delineated. The findings are discussed in terms of establishing procedures to counteract the factors influencing nonattendance, with a resultant increase in the effectiveness of an outpatient service, and the implications for research on clinical samples.

Delay in referral of patients with ruptured aneurysms to neurosurgical attention.

Abstract: Aneurysmal subarachnoid hemorrhage is a neurosurgical emergency. Early medical intervention is axiomatic for minimizing rebleeding and ischemia from vasospasm and achieving optimum results. The purpose of this study was to document the length and causes of the delay in referral which occur in patients following aneurysmal subarachnoid hemorrhage. The case histories of 150 consecutive patients admitted to The University of Iowa with proven ruptured aneurysms were studied. Medical records from The University of Iowa and referring hospitals were reviewed, and patients, families, and referring physicians interviewed. Overall, only 36% were referred within 48 hours of their first clear cut, recognizable sign or symptom of subarachnoid hemorrhage. Median time to referral was 3.6 days. Delay was due to physician diagnostic problems in 37%, delayed referral policy in 23%, unstable patient condition in 7%, failure of patients to recognize severity of illness in 8%, and logistical reasons in 12%. These data suggest that a large proportion of patients have a delay in achieving definitive neurosurgical care following aneurysm rupture, and that for the most part this delay is avoidable. More emphasis must be placed on public health and primary physician education regarding subarachnoid hemorrhage.

Delay in referral of patients with ruptured aneurysms to neurosurgical attention.

Abstract: Aneurysmal subarachnoid hemorrhage is a neurosurgical emergency. Early medical intervention is axiomatic for minimizing rebleeding and ischemia from vasospasm and achieving optimum results. The purpose of this study was to document the length and causes of the delay in referral which occur in patients following aneurysmal subarachnoid hemorrhage. The case histories of 150 consecutive patients admitted to The University of Iowa with proven ruptured aneurysms were studied. Medical records from The University of Iowa and referring hospitals were reviewed, and patients, families, and referring physicians interviewed. Overall, only 36% were referred within 48 hours of their first clear cut, recognizable sign or symptom of subarachnoid hemorrhage. Median time to referral was 3.6 days. Delay was due to physician diagnostic problems in 37%, delayed referral policy in 23%, unstable patient condition in 7%, failure of patients to recognize severity of illness in 8%, and logistical reasons in 12%. These data suggest...

What reasons are given by teachers who refer problem behavior students

Abstract: Referral information regarding 215 students referred to school psychologists was reviewed. Of this group, 74% were males and approximately one-half were referred while enrolled in the third through sixth grades. The most frequently stated reasons for referral were: (a) poor peer relationships, (b) displays frustration, (c) below academic expectations, (d) shy and withdrawn behavior, (e) disruptive behavior, (f) fighting, (g) refuses to work, and (h) short attention span. Referral reasons presented by classroom teachers correspond to the four major characteristics of behavior disorders: conduct disorders, personality disorders, inadequacy/immaturity, and socialized delinquency. Most referrals corresponded to reported behaviors representing conduct and personality disorders.

Effectiveness of home visits by public health nurses in maternal and child health: an empirical review.

Abstract: The effectiveness of public health nursing in promoting maternal and child health through home visits is summarized from empirical studies published between 1960 and 1984. Eight reports identified through a comprehensive reference search were first classified according to the components of nursing service studied (assessment, teaching, counseling or support, referral, and clinical services). The results of each study were then analyzed for study population characteristics, the research design and statistical methods employed, the reliability of the measures used, significant treatment effects, sample size, and statistical power. The research is evenly divided among studies employing an experimental design, a quasi-experimental design, and samples of low-income and middle-income mothers. The reliability of the measures was, with one exception, not reported. All but one study had final sample sizes for treatment and control or comparison groups of fewer than 100 subjects. Four of the studies thus had sample sizes sufficiently large to detect a medium treatment effect; power calculations showed that none could measure a small treatment impact. Within the methodological limitations of these studies, our review found that under certain circumstances public health nurses can effectively impart health knowledge to high-risk mothers and can effect positive change in maternal attitudes and parenting practices that in turn can be associated with positive changes in infant health and development. Cumulative knowledge from this body of research suggests that a priority for future evaluations of public health nursing is development of theoretical frameworks that maximize the fit between the needs of the population served and the services provided and between the outcomes measured and the nursing services being assessed.

Documenting the Relationship Between Homelessness and Psychiatric Hospitalization

Abstract: Homelessness among mental patients is frequently associated with deinstitutionalization. In a study to clarify the relationship between homelessness and psychiatric hospitalization, data from Illinois statistical reports and from admission reports of a state hospital that serves about 75 percent of the undomiciled mentally ill population in Chicago were analyzed. The rate of homelessness had increased substantially among psychiatric admissions over the last decade and was even higher among applicants for hospitalization. The homeless had lower admission rates than the domiciled, largely because of differing paths of referral. Nearly 20 percent of the homeless left the hospital against advice, and relatively few were referred to licensed long-term-care facilities. Until various systems develop adequate responses to the problem, both the numbers and the visibility of the homeless mentally ill are likely to increase.

Management of diabetes mellitus in children younger than 5 years of age.

Abstract: • Optimal treatment for children younger than 5 years of age with insulin-dependent diabetes mellitus is not well defined. Nineteen young children with this disease were treated with a program in which frequent home blood-glucose monitoring was used as the basis for an educational program emphasizing parental adjustment of insulin in response to current glucose levels and anticipated diet and exercise. Eleven children were treated from diagnosis (group I) and another eight (group D) were referred after less intensive treatment. The mean duration of observation of group I children was 13.6 months (range, six to 24 months). For group D, the mean time between diagnosis and referral was 14.9 months (range, seven to 24 months) and 14.6 months (range, six to 24 months) after referral. Before referral, there were 11 hospitalizations in group D. During the intensified program there were two hospitalizations in group D and one in group I. There were 3.3 episodes of severe hypoglycemia per child per 18 months in group D before referral, 1.7 episodes after referral, and 0.4 episodes in group I. Ten of 14 severe hypoglycemic episodes during intensified treatment occurred when there was no or infrequent home blood-glucose monitoring. Only four episodes seemed to have been unpredictable and unpreventable. Mean glycosylated hemoglobin levels were higher in group D patients when compared with both the duration of insulin-dependent diabetes mellitus and the time of initiation of intensified treatment. Mean daily insulin doses increased progressively in group I patients following diagnosis, and were comparable with those in group D patients at 15 and 18 months' duration of illness. Thus, frequency of hospitalization and severe hypoglycemia can be decreased in young children. Frequent home blood-glucose monitoring is required and extensive educational and psychosocial support is necessary for families to implement this intensive approach. The long-term effects on psychoneurological development need evaluation. (AJDC1985;139:448-452)

Facilitating Patient Acceptance of a Psychiatric Referral

Abstract: • There are five common ways in which a patient may object to a physician's suggestion of a psychiatric referral. The patient may reject the referral because of the social stigma of being a psychiatric patient; because the referral damages his or her self-esteem; because the patient does not understand the role of emotions in physical discomfort; because the patient feels rejected by the referring physician; or because of the effects of psychiatric illness. Following a thorough medical workup, the physician can best discharge his or her responsibility to the patient by paying attention to these possible misunderstandings. The physician can discuss the role of social stigma, offset the blows to the patient's self-esteem, educate the patient about the psychosomatic model of disease, and assure the patient of the physician's continuing interest and involvement. (Arch Intern Med1985;145:73-75)

Geropsychiatric consultation in a university hospital: a report on 67 referrals.

Abstract: The author describes the evaluation and treatment of 67 patients 60 years old or older who were referred to a consultation-liaison service in a university hospital. Age, sex, referring service, reasons for referral, psychiatric diagnosis, and interventions or recommendations were determined. Primary psychiatric diagnoses included depression (24%), dementia (19%), delirium (18%), schizophrenia (16%), and personality disorders (12%). Recommendations or interventions included advice in the use of psychotropic medications (61%), assistance with competency issues (25%), recommendation for further medical evaluation or treatment (36%), individual psychotherapy (28%), family therapy (25%), disposition planning (24%), and transfer to a geropsychiatry unit (12%). Hospitalized elderly patients with emotional problems represent a unique diagnostic and therapeutic challenge.

A Survey of Child Psychiatry Outpatients. 1. Clinical and Demographic Characteristics

Abstract: This paper describes clinical and demographic characteristics of 664 children who attended outpatient child psychiatry clinics in Perth, Western Australia, over a one-year period. All social classes were represented; parents were the most common source of referral and typically the child had been assessed or treated for emotional or behavioural problems by other agencies previously. Referrals from the juvenile justice system were uncommon. The accessibility of clinics to the child population was found to have a significant effect on the rate of referral. Only 10% of the sample received conduct disorder diagnoses, whereas 16.5% had mixed disorders of conduct and emotion, and 42% had emotional disorders. Environmental circumstances, particularly recent marital break-up, family discord and recent experience of loss, were contributing factors to the child's clinical presentation in a large proportion of cases.

Referrals to psychiatrists in a general hospital--comparison of two methods of liaison psychiatry: preliminary communication.

Abstract: Patients on a general medical ward were offered a liaison psychiatric service with 'unlimited' access, in which referrals were accepted from nurses, other paramedical staff and junior doctors in addition to senior medical staff. This new service (method II) was compared with the usual liaison service (method I, referrals initiated or approved by senior medical staff only) which was continued in parallel on a comparable general medical ward. Method II resulted in a threefold increase in referral rate and led to a significant alteration in the types of problem attracting referral. Despite the much higher rate of method II referrals, however, similar percentages of referrals by both methods were offered psychiatric follow up. The results do not support the commonly held belief that it is the failure of ward staff to recognize psychiatric morbidity which accounts for the low rate of referrals to many psychiatric liaison services.

The processes of referral and disposal within a London drug dependence clinic.

Abstract: Summary This study looks at the processes whereby individuals with drug problems were referred to a London drug dependence clinic during a seven month period, and at the responses of the clinic to such referrals. One hundred and ninety four cases were referred, mainly from G.P.s. Of the referrals, almost half (44%) failed to attend the clinic. Most of the people who did attend were opiate addicts. The movement of these people through the various procedures of the clinic is described. There were substantial waiting periods between each stage of treatment, though this was not found to be related to attendance or failure to attend. The results are discussed in terms of problems associated with the referral process and the issue of access to treatment facilities. The results provide basic information about the operation of one clinic but raises several important issues that deserve further empirical investigation.

An intervention to increase mammography screening by residents in family practice.

Abstract: Two groups of residents in family practice were used to evaluate the effectiveness of a multifaceted educational program that was designed to increase resident compliance with screening for breast cancer. In the experimental group, residents were given a two-hour seminar that responded to the literature on the difficulties of implementing preventive care in clinical practice; group consensus was developed for a more regular (exact frequency left to each resident) screening for women aged over 35 years, and specific barriers to breast cancer screening were analyzed and solutions presented whenever possible. In addition, these residents received two behavioral cues after the intervention to stimulate and reinforce referrals for mammography screening. The study was conducted over a period of one year, including a five-month preintervention period, a three-month post-intervention period, and a three-month follow-up period. As predicted, the increase in mean referral rate for the experimental group was significantly greater than for the comparison group. This increased rate of referral for mammogram was maintained for six months after the intervention. This intervention is easily reproducible in many residency training programs, especially those in family medicine and other small primary care programs.

Assessing clinical judgment with standardized patients.

Abstract: Family physicians and general practitioners see the majority of patients with uncomplicated rheumatic disease, yet information on database collection and clinical judgment in such practices is limited. Trained patients with uncomplicated rheumatic disease (standardized patients) were used to evaluate these abilities in 26 family physicians at the University of Arizona College of Medicine in blinded, but previously consented to, brief new encounters. Ability to formulate an assessment and to plan was evaluated as well as ability to collect diagnostic information. Few physicians explored the psychosocial impact of the illness (4 percent) or the role of depression (0 percent). In the brief encounter with a localized complaint, little inquiry was directed to systemic disease (46 percent). Physicians more uniformly asked about the chief complaint (96 percent) and time of onset (88 percent). Physical examination items most commonly omitted were evaluation of systemic joint involvement (69 percent) and muscle wasting in the involved area (59 percent). Referral occurred on 15 percent of encounters and patient education occurred in 62 percent. Three quarters of physicians developed an adequate assessment and virtually all developed an adequate patient care plan.

Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants

Abstract: Length of stay data collected for high-risk newborn infants admitted to a tertiary care children9s hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs) We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay Another contributor to the discrepancy was the lack of inborn patients in the children9s hospital cohort The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care

Referral of musculoskeletal disease patients by family and general practitioners.

Abstract: We surveyed general and family practitioners to evaluate their patterns of referring musculoskeletal disease patients to rheumatologists and orthopedists. Patients who had rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were most often referred to rheumatologists, whereas patients with osteoarthritis, persistent low back pain, and post-traumatic knee pain were most often referred to orthopedists. As conditions worsened in severity, referrals were more frequent. Patients with conditions that were difficult to diagnose, such as possible shoulder tendinitis that was unresponsive to initial nonsteroidal therapy, undiagnosed polyarthritis, and intermittent knee swelling with pain, were most often treated without referral and, when referred, were most often sent to orthopedists. Belief in the effectiveness of rheumatologists or orthopedists correlated strongly with reported referral behavior, yet most respondents considered themselves capable of managing the majority of patients with musculoskeletal diseases. Neither practice arrangement, board certification, nor educational background affected referral behavior. However, younger physicians were more likely (P = 0.002) to refer patients to rheumatologists. Multivariate analysis showed that the significant predictors of global referral behavior were belief in the effectiveness of subspecialists and a small number of musculoskeletal problems seen by the generalist. The predictors of referral to rheumatologists were belief in rheumatologist efficacy and young physician age.

Dentists reported willingness to treat disabled patients.

Abstract: Summary A survey of dentists who were licensed by, and resided in, New Mexico as of September 1982 was conducted for the purpose of determining their willingness to treat patients with disabilities. A referral directory was compiled and disseminated to organizations and agencies which serve such clients.

Educating community gatekeepers about alcohol abuse in women: changing attitudes, knowledge and referral practices.

Abstract: Two workshops were designed to influence community gatekeepers' knowledge, attitudes and referral practices toward women alcohol abusers. Both didactic and experiential approaches were employed by a staff of experts and facilitators in the area of alcohol abuse in women. Workshop participants completed self-administered pre- and post-workshop questionnaires and a six month follow-up questionnaire was administered via telephone interview to participants in the first workshop. The workshop format was successful in increasing participants' knowledge about alcohol abuse and women alcohol abusers and gains in knowledge persisted for six months. However, little change in attitudes or behavior was found. The importance of considering the prior training and background characteristics of participants is highlighted. In part, the limited success of the workshop may be due to its appeal primarily to gatekeepers relatively knowledgeable about women's issues and/or alcoholism. New interventions must design outreach te...

An Evaluation of the Impact of ES Referrals on Applicant Earnings

Abstract: The impact of the labor exchange activities of the United States Employment Service (ES) on job seekers is analyzed in this paper. We compare the labor market experiences following application to the ES of individuals who receive ES job referrals with the experiences of those who do not receive referrals. Extensive evidence is presented indicating that the not-referred group is a reliable comparison group for estimating the impact of ES referrals on applicant labor market experiences. Our impact estimates indicate that there are significant and sizable effects of a job referral for women, resulting in increased earnings and reduced length of time to reemployment. The impacts of a job referral for men, however, are not significantly different from zero.

Early Neonatal Deaths in Geographically Defined Populations with Different Organization of Medical Care

Abstract: . A comparison of early neonatal deaths was performed in fourteen Swedish referral districts over six years (1973–1978). Two populations of newborn infants were compared: those born of mothers resident in referral districts of general hospitals with specialized obstetric service but without own neonatal wards; and those born of mothers living in districts of central hospitals with specialized obstetric and neonatal care in the same hospital. The early neonatal death rates of these two populations did not differ significantly. However, a tendency was observed indicating a lower mortality in the former group, necessitating further analysis.

Consultation and Referral Between Physicians in New Medical Practice Environments

Abstract: The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

Patterns of referrals for school pscyhological services: replication of the Referral Problems Category System

Abstract: Those interested in studying patterns of referrals for school psychological services encounter the problem of working with data that are essentially idiographic Other authors concerned with this problem have developed categories for referrals based on logical groupings, but the fact that systems vary widely from study to study prevents data comparison Understanding referral patterns might lead to a more sophisticated appreciation of the circumstances in which children are referred for evaluation, in turn leading to improved planning for service delivery In a previous study by Ownby et al (in press) a 16 category system was developed with a sample of referrals drawn from a small suburban school system In the present study, analysis of referrals drawn from another school system revealed date-, sex-, and age-related patterns similar to those found by Ownby et al Comparison of data from the previous study to these data show statistically significant relations among frequencies of referrals within the ca

The Relationship Between Referral Types, Work Performance, and Employee Problems

Abstract: The relationship between the types of supervisory referrals and self-referrals to an employee assistance program to the work performance and kinds of personal problems of the employees referred is examined. For formal supervisory referrals Absenteeism was the most common work performance problems; for informal supervisory referrals Awareness of Slipping was the reason most commonly noted: and for self-referrals Interpersonal Relations problems predominated. Among employees wih alcohol and drug problems, more were self-referred than formally or informally referred by supervisors.