Cent Of Consultations Research Articles

Medical record prompts improve the frequency and documentation of dizziness and driving conversations in the ENT balance clinic.

Driving capacity is affected by vestibular disorders and the medications used to treat them. Driving is not considered during medical consultations, with 92 per cent of patients attending a centre for dizziness not discussing it with the doctor. To investigate if medical record prompts facilitate dizziness and driving conversations in ENT balance clinics. A questionnaire was designed to reflect the current standards of practice and advice given regarding driving and dizziness during balance clinic consultations. Medical record prompts facilitated the improved frequency and recording of shared decision-making conversations about driving and dizziness in 98 per cent of consultations. This study highlights the benefits of medical record prompts for documented and accurate shared decision-making conversations surrounding dizziness, vertigo, vestibular conditions and driving. This potentially improves safety for all road users, and protects the patient and clinician in the event of road traffic accidents and medico-legal investigations.

BH09 Patient experience of off-label Janus kinase inhibitor use for alopecia areata in a cohort of 34 patients from a single UK practitioner: exploring changing trends in healthcare provision and access to drug treatments

Abstract We present data from a UK cohort of patients with alopecia areata (AA) who have sought Janus kinase inhibitor (JAKi) treatments prior to National Health Service funding. We have explored referral methods, access to consultations, and shared care in monitoring and acquisition of medication both from the UK and abroad. We have looked at the drugs and dosage, adjuvant therapies and response to treatment, and report data on side-effects and reasons for changing drugs or stopping treatment. Thirty-four patients (25 adults and nine children) self-referred to a UK-based private hair clinic for JAKi treatment over a period of 36 months. The median age of patients was 40 years (interquartile range 18–50). The patients sought treatment from a wide geographical area in the UK, with one patient living 400 miles from the clinic. Seventeen (50%) and 14 (41%) patients were prescribed baricitinib and tofacitanib, respectively, with three (9%) patients prescribed both. Nineteen (56%) patients had severe alopecia with > 95% hair loss. Social media, in particular a closed Facebook group, was an important source of referral and information on sourcing medication from abroad. Nine per cent of consultations were virtual (telephone/video). The cost of treatment varied from £100 per month to £1400, with a large difference between UK-sourced medication and that from abroad. Eight (24%) patients showed no scalp regrowth response to first-line treatment, despite dose escalation, with one subsequently experiencing total hair regrowth on swapping to a different JAKi class. One patient had to stop treatment after developing breast cancer. JAKi are an exciting and emerging treatment for AA that are yet to be widely prescribed by UK practitioners. However, the response to JAKi is not universal. Owing to the cost of private prescription, patients are choosing to source JAKi from abroad. Our study presents data on how the alopecia community has helped inform patients about treatment access.

What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemic.

This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations. A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital. Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required. Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.

Pilot study evaluating the monitoring of canine diabetes mellitus in primary care practice

ObjectivesThis study aimed to describe how canine diabetes mellitus (CDM) is monitored in primary care practice (PCP) and to report outcomes.DesignRetrospective case review.SettingPCP.Participants40 dogs of 22 different pedigrees and five...

The frequency and outcome of acute dyspnoea in primary care: An observational study

Background: Little is known about the occurrence of acute dyspnoea in primary care and its underlying causes.Objectives: What are the occurrence and most frequent causes of acute dyspnoea in primary care, predictors of referral, hospitalization, death and possible underlying causes?Methods: Twenty-five general practitioners (GPs) in Flanders (Belgium) recorded patient contacts for four periods of two weeks during one year. They recorded patients presenting with acute dyspnoea, location of contact (surgery versus home visit), new dyspnoea versus exacerbation, tentative diagnosis, referral to a specialist and hospital, and one month later final diagnosis, its justification, referral, hospitalization and death.Results: Twenty-two GPs recorded 14,620 patient contacts. Acute dyspnoea was encountered in 317 patient–doctor contacts (2.2%; 95%CI: 1.9–2.4), without significant association between the acute dyspnoea frequency, and age and gender. Immediate referral and hospitalization were most frequent in patients 61 to 90 years old. Forty-five patients (14.2%; 95%CI: 10.4–18.0) were referred to a specialist immediately and an additional 34 (10.7%; 95%CI: 7.3–14.1) by one month follow-up. Fourteen patients (4.4%) were hospitalized immediately, and 11 (3.5%) within one month. Six patients (1.9%), all 61 to 90 years old, died within one month.Conclusion: Dyspnoea occurs in about two per cent of consultations. Serious cases are rare and are much more likely in the older age group. Twenty-five per cent of the contacts concerning acute or worsening dyspnoea were referred to a specialist or hospitalized. In daily practice, the risk of immediate referral, hospitalization and death is higher in men and older patients, especially if the contact is at the patient’s home.Key MessagesAcute dyspnoea was encountered in 2.2% of patient–doctor contacts.The risk of immediate referral, hospitalization and death was higher in men and patients 61 to 90 years old, especially if the contact was at the patient’s home.There is no association between the acute dyspnoea frequency and age and gender.

Consultation length in first opinion small animal practice

CONSULTATIONS are the cornerstone of veterinary practice, and while the length scheduled for consultations varies, 10 minute appointments are a frequent feature in first opinion practice. Previous research has suggested...

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be explored to better understand the relationship between HR management and FP service quality.

Use of the Patient Concerns Inventory to identify speech and swallowing concerns following treatment for oral and oropharyngeal cancer

The Patient Concerns Inventory is a holistic, self-reported screening tool for detecting unmet needs in head and neck cancer patients. This study aimed to assess its value in screening for self-perceived swallowing and speech concerns, and in facilitating multidisciplinary supportive care. The Patient Concerns Inventory and the University of Washington Quality of Life questionnaire were completed by 204 post-treatment patients attending routine out-patient review clinics, and those with speech or swallowing issues were identified. Swallowing and speech issues were respectively reported by 21 and 7 per cent of University of Washington questionnaire respondents and by 17 and 13 per cent of Patient Concerns Inventory respondents. The two surveys combined indicated that speech or swallowing issues arose in 39 per cent of consultations (n = 178), involving 48 per cent of patients (n = 97). Of these 97 patients, 74 were known to the speech and language therapist. The remaining 23 patients had their concerns discussed in the clinic; three were referred on, and were assessed by the speech and language therapist and given appropriate interventions. The use of both surveys concurrently enabled all patients with swallowing or speech issues to discuss these concerns in the clinic and to access appropriate multidisciplinary interventions.

Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice — pharmacist interventions and review outcomes

Abstract Objectives To describe the nature and rate of interventions made by a pharmacist conducting clinical medication reviews in general practice. Method Patients, randomly allocated to the intervention group, in a randomised controlled trial of 1,188 patients, were invited to a pharmacist-conducted medication review clinic at their general practice. Patients were seen over one year from June 1, 1999, to May 31, 2000. In the consultation an assessment was made of the patient, their clinical conditions and medication. Consultation outcomes for each patient and intervention outcomes for each medicine were evaluated. Setting Patients were recruited from four randomly selected general practices in Leeds, UK. Patients were eligible if aged 65 years or over and on at least one repeat medicine. Key findings Consultations were held with 590 patients in the intervention group (97 per cent). A recommendation for change was made in 44 per cent (258/591) of consultations. The most common outcome was a change in medication: 29 per cent of consultations (170/591). Doctor referral occurred for 28 patients (5 per cent) and nurse referral for 25 (4 per cent). Study patients were recorded as taking 2,927 repeat medications (mode of two per patient). Interventions were made for 21 per cent of medications (603). Clinically related interventions accounted for 71 per cent (430/603). Recommendations were spread evenly across therapy groups. At the study end, 90 per cent (433/484) of recommendations remained implemented. Conclusion A pharmacist who clinically reviewed elderly patients, their conditions and their medications, intervened in nearly half the patients. The pharmacist was able to implement most interventions without referring the patient to a doctor or nurse.

Antibiotic use and health‐seeking behaviour in an underprivileged area of Perú

To describe the health-seeking behaviour and use of antibiotics in the urban community of Yurimaguas in the Amazonian area of Peru. Cross-sectional survey of caregivers of 798 children aged 6-72 months by interview using a semi-structured questionnaire. Reported symptoms were classified as illnesses where antibiotics would or would not be recommended based on principles of the integrated management of childhood illnesses algorithm. Forty-one per cent of consultations were with health care professionals; 71% of antibiotics were obtained through the formal public health sector and prescribed mainly by medical doctors. All prescribed antibiotics were on the Peruvian essential drugs list. When prescribing, doctors and nurses hardly discriminated between illnesses where antibiotic treatment was or was not indicated; there was no significant difference in antibiotic prescribing rates between the two (doctors, P = 0.24; nurses, P = 0.32). Not all caregivers sought help for children with severe symptoms. Although most of the antibiotics were prescribed by doctors and nurses, they were commonly prescribed for illnesses where they were not indicated. The use of antibiotics needs to be rationalized, and barriers to health care must be overcome.

Atopic eczema:

Children Paediatric nursing Eczema Atopic eczema is a common problem. In the GP’s surgery, 10-12 per cent of consultations will be related to skin problems and, of those, about 30 per cent are for atopic eczema (Watts 1996). Studies suggest that 80-90 per cent of affected children first develop symptoms before the age of five and that the majority of these show signs of the problem before the age of six months (Holden 1997). This chronic, relapsing, inflammatory skin condition may be just a minor inconvenience for some but many will suffer recurrent and debilitating problems that are not only distressing to the child, but may have severe and stressful repercussions on the whole family. Traditionally, the first port of call for help is the GP who may refer the child to a consultant dermatologist when control of the condition is not achieved. Basic advice, emollients, steroid applications and antibiotics may be prescribed, but when all else fails, hospital admission may be on the agenda. With relapse of the condition, further admissions may follow. At the Royal Bournemouth and Christchurch Hospitals, the team approach to the management of atopic eczema in children has been shown to be effective in helping families to cope. A specialist nurse in the team plays a crucial part in offering time, practical advice, planned treatment regimes and support, without the need for admission. Treating children in the home setting, thus avoiding hospital admission and its expense to the NHS, brings long-term benefits to the child and the family (Edwards 1997).

Standards of documentation of the surgeon-patient consultation in current surgical practice.

This study was designed to assess the reliability of the system whereby junior doctors document the surgeon-patient consultation in general surgical practice in the UK. A prospective observational study was carried out, with an independent observer recording details of the surgeon-patient consultation and assessing the reliability of documentation. An exact record of the information given by consultants was transcribed in shorthand at the time of consultation. Data were recorded in the categories recommended for notation by the General Medical Council: clinical findings, decisions made, information given to patient and treatment prescribed. Case notes were examined within 24 h of the ward round to ascertain reliability of the documentation. The study population comprised 432 surgeon-patient consultations. There were important deficiencies in the documentation of consultants' clinical findings and management decisions. In addition, information given by consultants to the patients regarding clinical findings and treatment planned (including the need for operation) was recorded in a median of 6 per cent of consultations. This study provides objective evidence of shortfalls in the documentation of the surgeon-patient consultation process. These deficiencies are such that, under present circumstances, the requirements of the General Medical Council with respect to case note documentation are not fulfilled in this setting.

Northwick Park Infection Consultation Service Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Utilization of psychiatric consultation for elderly patients.

Six hundred fifty-one psychiatric consultations performed during a one-year period were reviewed retrospectively. Cognitive impairment was present in 54 per cent and depression in 27 per cent of the elderly patients in the population studied. A second study of the point prevalence of cognitive and emotional disorders in the hospital was carried out using the Mini-Mental State Exam and the General Health Questionnaire. Emotional disorders had similar prevalences in all age groups but cognitive disorders were more common in the elderly. Twenty-one per cent of consultations were done on patients over the age of 60, although elderly patients occupied 28.5 per cent of hospital beds. Thus, elderly patients were less often referred for psychiatric consultation than younger patients, although the incidence of psychiatric disorders increases with age.

Anti-rabies treatments in New Mexico: impact of a comprehensive consultation-biologics system.

Fewer than 20% of the 30,000 anti-rabies treatments administered in the United States each year are necessary. New Mexico established a comprehensive consultation-biologics program to assist physicians in making appropriate and systematic rabies treatment decisions. In 1978, 32 individuals received anti-rabies treatments as the result of 144 physician consultation requests. Dog and cat exposures accounted for 70 per cent of consultations and 63 per cent of the treatments. A seasonal peak of both consultations and treatments was observed in the summer and early autumn. The cost of biologics was $212 per treatment. Coordinated use of laboratory diagnostic services and animal control resources obviated the need for treatment in over 60 per cent of the 112 consultations not resulting in treatment. Experience in 1978 suggested that the system was probably responsible for a greater than five-fold reduction in the annual rate of anti-rabies treatments in New Mexico. Efficient physician utilization and high acceptability of the program may be attributed to maximization of private sector input into design and implementation of this public health program.