Showing papers on "Referral published in 1988"

The Effect of Teacher Self-Efficacy on Referral Chance

Abstract: Relationships were explored between teacher characteristics and their ratings of problem behavior and likelihood to refer students to special education. Participants were 230 Dutch primary teachers. Teacher self-efficacy proved to be a significant predictor of both problem ratings and referral chances in a MANCOVA design. Pupil problem type (learning, behavioral, or both) also had a significant effect on both dependent variables. Implications for further research are discussed.

The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue.

Abstract: Study Objective:To determine the frequency of the chronic fatigue syndrome among patients with symptoms of fatigue. Design:Prospective, cohort study. Setting:Referral clinic, based in a pr...

Child and family factors associated with referral to child psychiatrists.

Abstract: We compared children aged 7-12 years referred to child psychiatrists by general practitioners (GPs) with community control children matched for the presence of psychiatric disorder. Referral status in psychiatrically disturbed children was linked to male sex, severity of the disorder, mental problems in the mothers, high levels of psychosocial stress in the family, and less support from extended families. For the whole group of referred children, the referral was associated with high antisocial scores on parental questionnaires, with parental reports of problems in controlling the children, and of high levels of stress felt in relation to them. In addition, parents of referred children were in disadvantaged socioeconomic groups.

Adult and Child Client Differences in Therapy Dropout Research

Abstract: In spite of the high dropout rate from child and family therapy, few studies have investigated the premature termination of treatment of children We argue that, due to decision-making and motivational differences of children and adults in psychotherapy, different variables would relate to treatment continuance for the two groups We investigated the relationship of demographic, therapist, and treatment variables to premature termination for both children (n = 212) and adults (n = 118) in outpatient therapy Multiple-regression analysis revealed that therapist experience and referral source predicted adult continuance, but none of the variables investigated related to child treatment continuance We conclude that data from children and adults should be analyzed separately in dropout research, that more research should be devoted to the study of the continuance of children in treatment, and that parent variables influencing continuance of their children's treatment should be identified

Service Utilization and Psychiatric Diagnosis in Pediatric Primary Care: The Role of the Gatekeeper

Abstract: Levels of morbidity in 789 children 7 to 11 years of age attending two primary care pediatric clinics in a health maintenance organization were examined in relation to psychiatric disturbance Physical morbidity was measured as mean number of illness episodes per year enrolled, based on the child's medical record Two measures of psychiatric disturbance were compared: the pediatricians' judgment and a detailed assessment using standard psychiatric interviews with parent and child Children identified by pediatricians as disturbed had more than twice as many physical illness episodes as nonidentified children Children identified by the standard psychiatric assessment had the same number of physical illness episodes as nondisturbed children Pediatricians showed high specificity but low sensitivity to mental illness Their sensitivity in the high user group was double that in the low user group These results suggest that (1) the association between mental illness and high use may be, in part, the result of the confounding factor of physicians' judgment; (2) in settings where primary care practitioners serve as "gatekeepers" to mental health services, the offset effect of lower medical service use following psychiatric treatment may be partially explained by this; (3) the source of referral must be taken into account when assessing the offset effect in other settings

Legal pressure in therapeutic communities.

Abstract: Therapeutic community (TC) studies are reviewed to assess the effects of legal referral on treatment retention and outcome. The main findings reveal little evidence for differential outcomes between legally referred and non-legally referred clients in TCs, although legal referrals to TCs remain longer in treatment than do “voluntary” clients. Thus, there is an indirect relationship between legal referral and outcome which is mediated through retention in treatment. Issues are discussed which have confounded interpretation of research on the efficacy of compulsory treatment, e.g., definitions, client perception of pressure, implementation of legal referral procedures and the complexity of the recovery process itself. It is hypothesized that legal pressure can have a limited but potent role in the recovery process for appropriately identified substance abusers.

The process of parenting a child with a disability: normalization through accommodations.

Abstract: Professionals commonly advise parents of disabled children to raise their children as they would children who were not disabled. The purpose of this study was to describe the management styles used by the parents of 15 children and adolescents with osteogenesis imperfecta. In particular, the behavioural strategies related to providing a normalized existence for the child and the family are discussed. Sources of threats, validation, and support for the process are also described. The convenience sample of parents was selected from the appointment calendar of a specialty clinic in a midwestern philanthropic, paediatric-orthopaedic referral hospital. Qualitative interview data were gathered using a semi-structured guide. During interviews parents described behavioural strategies they used to normalize their child's and family life. Data were analysed using a previously developed framework of normalization. This work of normalization was described as a constant process of active accommodation to the changing physical and emotional needs of the child or adolescent. It was initiated out of practical necessity at birth as a conscious solution to problems with activities of daily living, relating to the child, and engaging in family activities. Certain events constituted ‘threats’ to normalization and served as an impetus for parents to alter behavioural strategies. Implications for clinical practice and research are explicated.

Factors influencing non-attendance at child psychiatry out-patient appointments.

Abstract: The clinic attendance of 100 consecutive referrals to child psychiatry is described. Only 47 cases ended in agreed discharge. Different factors were found to be associated with attrition at different stages in the treatment-uptake process. Of referrals offered an appointment, 16% failed to attend at all; this was significantly associated with parents being against referral. Of cases offered a subsequent appointment, 40% dropped out. Continued attendance was associated with a presenting problem of general anxiety and with consultation to the referrer. Dropping out was associated with parents who were separated.

Referrals to hospital by general practitioners: a study of compliance and communication.

Abstract: To determine the extent of non-attendance at first hospital appointments 269 hospital referrals made in one practice over 14 weeks were analysed retrospectively. Non-attendance was more likely among patients referred to outpatient departments than to casualty or for admission. Fifteen per cent (41/269) of all patients and 20% (33/167) of outpatients failed to keep their initial appointments. Prolonged waiting times from referral to appointment were significantly related to non-attendance. Twenty weeks after the last referral had been made no communication had been received by the practice for 24% (61/252) of all referral letters received by the hospital. Minimum delays to appointments and improved communication between hospitals and general practitioners would help general practitioners to make appropriate referrals and improve compliance.

Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup.

Abstract: This study reported here was undertaken to determine the probability of malignancy in patients presenting with unexplained lymphadenopathy in primary care practice and to estimate the effectiveness of current referral patterns by family physicians in relation to malignant disease. Clinical characteristics that may be discriminatory for malignant causes were also investigated. A retrospective analysis was performed of 82 patients who underwent biopsy for unexplained lymphadenopathy from 1982 to 1984; data regarding the incidence of unexplained lymphadenopathy and the referral rate for this problem were obtained from registration projects. A total of 29 malignant lymphadenopathies were identified for a prior probability of 1.1 percent and a posterior (after referral) probability of 11 percent. The ability of the family physician to refer malignant cases within four weeks after initial consultation (sensitivity of referral) was 80 to 90 percent; 91 to 98 percent of benign cases were not referred (specificity of referral). An increased likelihood of malignancy was associated with age over 40 years (4 percent) and supraclavicular lymphadenopathy (50 percent). The incidence of malignancy in patients presenting with unexplained lymphadenopathy to the family physicians is very low (1 to 2 percent). Nevertheless, despite the paucity of validated discriminatory factors, the family physicians perform a reasonably effective selection process toward referral and biopsy.

Development of a Comprehensive Supportive Care Team for the Hopelessly Ill on a University Hospital Medical Service

Abstract: We developed a supportive care service for a university hospital medical service that serves a socially and medically disadvantaged urban population. The team includes a faculty physician and a clinical nurse specialist who provide primary medical care, family support, and in-service guidance to hospital staff about ethical issues. A multidisciplinary approach incorporates nursing, pastoral care, social work, and other hospital services. We report our experience from November 1985 through May 1987, during which time 222 patients were referred to the team; 212 patients were accepted. The goals and operation of the service are described. The most common (n=62, 29%) diagnosis on referral was global central nervous system anoxia following cardiopulmonary arrest. Other severe neurological conditions accounted for an additional 79 patients (37%). Comparison of patients on the service with a similar group revealed no difference in survival rate, although hospital length of stay and charges were progressively reduced after implementation of the service. This approach to the care of hopelessly ill patients may serve as an alternative method of treatment in similar hospital settings. ( JAMA 1988;259:378-383)

Are referrals by general practitioners influenced by the availability of consultants

Abstract: To investigate variations in the number of outpatients seen in different NHS regions of Great Britain data on numbers of outpatients, number of consultants per 100,000 population, mortality, and prescribing rates were analysed for four specialties: medicine, thoracic medicine, psychiatry, and dermatology. The number of outpatients seen was strongly associated with the provision of consultants in all four specialties and only weakly associated with need for outpatient services as measured by standardised mortality ratios and mean numbers of prescriptions per patient issued by general practitioners. Interpretations of differences in referral rates need to take into account variations in the supply of specialists as a factor that may influence the referral behaviour of general practitioners.

Effectiveness of smoking cessation interventions integrated into primary care practice.

Abstract: Using a complete factorial design, we tested three interventions for smoking cessation in routine primary care practice. The interventions tested were 1) physician counseling, 2) mailed letters and educational materials designed by the National Cancer Institute (NCI), and 3) referral to smoking cessation classes. Thirty-seven family practice physicians at three of Group Health's outpatient facilities participated. Patient participation rates were 95%, and follow-up was complete for 92% of those participating. None of the interventions had any effect on point prevalence of quitting as determined 8-9 months later by self-report. However, the combination of physician counseling and NCI materials doubled the odds of occurrence of significant antismoking behavior (quit, quit and relapse, or cut down) during the ensuing 8-9 months in those individuals receiving that combination. Referral to smoking cessation classes was strikingly ineffective in this setting. Of 369 individuals designated by study design for referral, only 14% even investigated the classes. This compares with a 10% self-referral rate for those persons not designated for referral by our study design. Our results and other recent work suggest that more intensive interventions on multiple occasions based on relapse prevention strategies hold promise for future success in smoking cessation efforts in primary care.

Referral to hospital: can we do better?

Abstract: The variation in rates of referral to hospital in general practice-is such that questions about quality and cost can no longer be avoided. In considering referral to hospital the government has now declared that family practitioner committees and the health authorities \"should act to ensure that the use of hospital facilities achieves the maximum benefit for patients and services are used to ensure quality of care in a cost effective way.\"' No definition of benefit is vouchsafed. Benefits might be finding disease, altering the outcome of the disease, or reducing anxiety. In this paper we consider four broad strategies that could be envisaged: adopting norms, rationing, management incentives, and performance review.

Patterns of travel for rural individuals hospitalized in New York State: relationships between distance, destination, and case mix.

Abstract: : The travel patterns of individuals living in rural areas of New York State who were discharged from short-term general hospitals in New York State in 1983 are examined. Counties are used as the geographical unit, and rural individuals who cross geographic boundaries to obtain inpatient hospital care are compared with those who receive such care in their own geographic area. Hospitals serving the rural population of New York are classified into three types: urban, consisting of all hospitals located in MSAs; rural referral centers; and other rural hospitals. Next, the rural patients who are admitted to each of these three types of hospitals are characterized in terms of distance traveled, case mix, length of stay, and age. Individuals who travel beyond the counties adjacent to their county of residence had a higher case mix index but were less likely to be more than 75 years old. Distance traveled and the expected cost of care were strongly positively related for patients admitted to urban and rural referral center hospitals, but were only weakly related for other rural hospitals. Finally, comparisons of rural patients in these three types of hospitals were performed adjusting for DRG mix, a comparison which is relevant to hospital reimbursements under the Medicare Prospective Payment System. Using several measures of illness severity, rural patients in urban hospitals and rural referral center hospitals were more severely ill than rural patients in other rural hospitals after adjusting for DRG mix. We conclude that somewhat higher payments to urban hospitals and rural referral center hospitals in New York are justified based on the more severely ill patients which they treat.

Underuse of screening mammography by family physicians.

Abstract: Although the American College of Radiology, the National Cancer Institute, and the American Cancer Society recommend screening mammography for women more than 40 years old, there is little compliance with these recommendations. Primary-care physicians are often reluctant to refer patients for the procedure, whereas the patients are usually willing to undergo the procedure. This survey documents the underuse of screening mammography by family physicians who are members of the Michigan Academy of Family Physicians. The underuse of mammography by this physician sample was due to two main factors: The physicians perceived far more disadvantages than advantages with mammography and perceived problems (with, e.g., equipment, effectiveness, and patient acceptance) as pervasive. To change the attitudes and referral behavior of family physicians, one must take into account the specific, negative perceptions of the procedure and place an emphasis on the initial referral, since subsequent referrals are easier to imp...

Complementary medicine and the general practitioner: a survey of general practitioners in the Wellington area.

Abstract: A questionnaire was sent to 226 general practitioners in the Wellington region to determine the relationship between the general practitioner and complementary medicine. A 77% response rate was achieved. Twenty-four % of doctors had received training and 54% wanted further training in a complementary therapy; 27% currently practised at least one therapy. The majority of doctors (94%) knew of complementary practitioners in their locality; 77% indicated they referred to other medical practitioners for complementary therapies and 80% to nonmedical practitioners. Acupuncture, hypnosis and chiropractic were the most popular therapies. The general practitioner's role was perceived as ranging from comprehensive provider of both conventional and complementary medicine to selective practitioner of some options. It is concluded that complementary medicine is of considerable interest to general practitioners; there is demand for more training and information to be made available for doctors and for better referral networks to be developed between the practitioners.

Comparison of the work of a nurse practitioner with that of a general practitioner

Abstract: The work of a nurse practitioner was compared with that of a general practitioner. Both were equally available to the same patient population over the same period. The nurse practitioner saw a similar age and sex distribution of patients to the doctor but saw different types of problems. More of the patients she saw were for followup of chronic diseases, health advice and screening measures while fewer were acutely ill. The doctor dealt with four times as many patients. The nurse practitioner managed 78% of her consultations without referral to a doctor, and 89% without resorting to prescribed drugs. There was a high level of patient satisfaction with her work and 97% of the patients who saw the nurse would choose to consult her again. The role of the nurse practitioner in our practice has developed differently from a similar post in another setting, thus emphasizing the need for flexibility when defining the role.Nurse practitioners are a valuable extra resource for the development of new areas of care, rather than a cheaper substitute for a general practitioner.

Consumer selection of physicians and dentists: an examination of choice criteria and cue usage.

Abstract: If health care marketers can understand the criteria consumers use to evaluate them and can identify which cues are used to assess those criteria, they will be better able to manage and influence the consumers' evaluations and perceptions of their service offering. In an exploratory study, the authors examine the criteria and cues used by consumers in selecting physicians and dentists. Competence and courtesy are found to be the most important criteria. Personal referral cues emerge as often determinant in the initial selection of physicians and dentists. The actual interactive nature of the service encounter, however, determines continued consumer patronage.

Behavioural disorder in the mentally handicapped. The role of life events.

Abstract: A retrospective study of 65 consecutive referrals for behavioural disorder of mentally handicapped patients living in the community revealed that 31 of these were associated with life events sustained in the 12 months prior to the referral. These patients were usually mildly handicapped, while those who presented with behaviour disorder without a history of recent life events were usually more severely retarded. The differences between the two groups are discussed and the need for further research emphasised.

Health belief model intervention to increase compliance with emergency department patients.

Abstract: The effects on compliance of clinical and telephone intervention, based on the Health Belief Model (HBM), were investigated for 842 Emergency Department (ED) patients. The influence of mediating variables on compliance was also examined. Compliance was defined operationally as follow-through on a recommended referral originating in the ED. The study design was a 2 X 2 X 11 factorial design, in which the first factor was the HBM clinical intervention, the second was the HBM telephone intervention, and the third was the type of presenting problem. Patients were randomly assigned to one of four intervention groups, with all nursing care, interventions, and follow-up telephone calls being done by the research nurse. The HBM clinical, telephone, and combination clinical/telephone interventions were strongly associated with increased compliance in the 11 presenting problems. Availability of child care, knowledge of presenting problem, nature and duration of the illness, and demographic variables (such as age of the patient) were also related to compliance.

AIDS and Dental Practice

Abstract: Dental health care workers (DHCWs) can provide important diagnostic, treatment, and referral services for patients with AIDS and at risk for AIDS. They also have a responsibility to protect all patients in their practices, and themselves, from infectious disease transmission through the use of infection control. To determine the extent to which DHCWs are prepared to assume these responsibilities, a randomized survey of California DHCWs was conducted. Responses were obtained from 297 dentists, 128 hygienists, and 177 dental assistants. DHCWs who expressed a greater willingness to treat people with AIDS or HIV infection also practiced more thorough infection control. Respondents in all groups who perceived a greater percent of their patients to be at risk for AIDS were more likely to use infection control procedures (P less than .0001). They also were more willing to treat such patients (P less than .004) and were more likely to assess patients for AIDS by taking a thorough medical history (P less than .02) and sexual history (P less than .04). Since attitudes toward AIDS and perception of the percent of patients at risk in one's practice affect patient assessment and infection control procedures used by dental health care workers, educational programs designed to enhance DHCWs' response to the HIV epidemic should alert them to the extent of the problem and help them cope with their concerns.

Referral of lung cancer patients to university hospital cancer centers. A population-based study in two rural states.

Abstract: To determine whether the referral of lung cancer patients to university cancer centers was related to nonclinical factors, the medical charts were reviewed for almost all lung cancer patients diagnosed during the period of 1973-1976 in New Hampshire and Vermont. Greater distance from a cancer center, lower functional status, and age over 75 years were all inversely related to the use of university cancer centers both for diagnosis and for referral for treatment. Tumor cell type, patient marital status, and private medical insurance coverage were not related to the likelihood of being diagnosed in or referred to a university cancer center. In rural areas distance from a specialized medical center may be the dominant factor in determining whether patients are referred, especially for a disease such as lung cancer in which referral does not offer substantial survival advantages.

New Issues in Geriatric Care

Abstract: The rapid growth of the elderly population has increased the need for improved geriatric care and prevention of disability. For example, the prevalence and severity of osteoporosis can be reduced significantly by the use of estrogen, with or without added progestin, in postmenopausal women. A common and devastating problem of frail elderly persons is urinary incontinence, most cases of which can be classified without referral for urologic services. Appropriate treatment can improve nearly half of all cases of persistent incontinence. Comprehensive geriatric assessment is effective in guiding the treatment of frail elderly patients and leads to significantly improved outcomes under appropriate conditions. The advent of the teaching nursing home has shed light on the medical problems of elderly residents of nursing homes, including malnutrition, dysregulation of water and electrolyte balance, falling, cognitive and affective illnesses, behavior disturbances, infections, and pathogenic drug use. The future application of advanced technology may revolutionize nursing home care.

Oral manifestations of AIDS: a study of 84 patients

Abstract: Early diagnosis of AIDS is vital in providing appropriate referral for medical care and counseling. Subtle intraoral signs and symptoms identified by the dental practitioner can aid in the diagnosis of the disease. Because the role of the practitioner in detection and treatment of AIDS patients is becoming greater, signs found in 84 patients are described.

A Novel Methodology for the Study of Children at Risk for School Failure

Abstract: This paper introduces the conceptual framework guiding a 3-year investigation of first-grade children at risk for referral and placement in special education. Preliminary data for the first of three planned cohorts are presented that illustrate a novel methodological approach to identifying the characteristics of children at risk for referral. The sample (n = 35) consisted of 25 first graders who were referred by their teachers to Teacher Assistance Teams and 10 control children, matched for classroom membership and sex. Children's scores on a battery of standardized and experimental tasks were used to form subgroups based on the presence or absence of risk factors. The resulting profiles were examined via a relative risk analysis to determine degree of risk for referral associated with each subgroup. The potential of the proposed methodology to understanding the characteristics and learning environments of at-risk children is discussed.