Psychiatric Consultations in Medical Outpatients with Abdominal Pain: Patient and Physician Effects

1994 ◽  
Vol 24 (4) ◽  
pp. 339-356 ◽  
Author(s):  
Ludwien Meeuwesen ◽  
Frits J. Huyse ◽  
Franka J. M. Meiland ◽  
Gerrit T. Koopmans ◽  
Ab J. M. Donker
Keyword(s):  
Health Care ◽  
Abdominal Pain ◽  
Psychological Status ◽  
Pain Patient ◽  
Control Group ◽  
Care Providers ◽  
Psychiatric Consultation ◽  
Index Group ◽  
Consultation Intervention ◽  
Medical Outpatients

Objective: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. Method: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain ( n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group ( N = 49) and a control group ( N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. Results: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. Conclusions: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.

Does Self-reporting Facilitate History Taking in Food Poisoning Mass-casualty Incidents?

2014 ◽  
Vol 29 (4) ◽  
pp. 417-420 ◽  
Author(s):  
Ya-I Hsu ◽  
Ying C. Huang
Keyword(s):  
Health Care ◽  
Medical History ◽  
Food Poisoning ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Control Group ◽  
History Taking ◽  
Care Providers ◽  
Time Required ◽  
Experimental Group

AbstractIntroductionMedical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response.Hypothesis/ProblemIn some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information.MethodsTwo resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students’ t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics.ResultsThere were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the questions were scored “good” in comprehensibility.ConclusionSelf-reporting of symptoms can shorten the time of history taking during a food poisoning mass-casualty event without sacrificing the completeness of information.HsuY, HuangYC. Does self-reporting facilitate history taking in food poisoning mass-casualty incidents?Prehosp Disaster Med. 2014;29(4):1-4.

scholarly journals ‘He should feel your pain’: Patient insights on patient–provider communication in Rwanda

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Vincent K. Cubaka ◽  
Michael Schriver ◽  
Janvier B. Kayitare ◽  
Phil Cotton ◽  
Helle T. Maindal ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Pain Patient ◽  
Provider Communication ◽  
Care Providers ◽  
Structured Interviews ◽  
Communication Preferences ◽  
Limited Literacy ◽  
Patient Provider Communication ◽  
Sub Saharan

Background: Patient–provider communication is an interpersonal interaction between a patient and a health care provider.Objective: This study explored patients’ communication preferences and perceptions on what factors influence the patient–provider communication in primary health care settings in Rwanda.Methods: In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used.Results: Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient–provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care.Conclusion: The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider’s side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients’ insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa.Practice implications: Findings call for more inclusion of patient perspectives in the patient–provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.

scholarly journals Opioid Tolerance – A Predictor of Increased Length of Stay and Higher Readmission Rates

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E503-E507 ◽  
Author(s):  
Padma Gulur
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care Providers ◽  
Massachusetts General Hospital ◽  
The United States ◽  
Opioid Tolerance ◽  
Control Group ◽  
Care Providers ◽  
Readmission Rates ◽  
Expected Length

The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to be a challenge amongst health care providers, there is little in the literature that has studied opioid tolerance as a predictor of outcomes. We conducted a review on all admissions to Massachusetts General Hospital over a period of 6 months, from January 2013 to June 2013, and identified opioid tolerant patients at admission using the FDA definition of opioid tolerance. To compare risk adjusted groups, we placed opioid tolerant patients and control patients into groups determined by expected length of stay of less than 2 days, 2 to 5 days, 5 to 10 days, and greater than 10 days. Opioid tolerant patients were then compared to the control for outcomes measures including observed length of stay and readmission rates. Our results show that all opioid tolerant patients have a significantly longer length of stay and a greater 30 day all cause readmission rate than the control group (P < 0.01). This trend was found in the first 3 risk adjusted groups, but not in the fourth group where expected length of stay was greater than 10 days. The opioid tolerant population is at risk given the poorer outcomes and higher health care costs associated with their care. It is imperative that we identify opportunities for improvement and delineate specific pathways for the care of these patients. Key words: Opioid tolerance, opioid tolerant patient population, opioid tolerant patients, readmission rates, length of stay

Although unseen, chronic pain is real–A phenomenological study

2015 ◽  
Vol 6 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Tapio Ojala ◽  
Arja Häkkinen ◽  
Jaro Karppinen ◽  
Kirsi Sipilä ◽  
Timo Suutama ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care Providers ◽  
Phenomenological Study ◽  
Mental Health Problems ◽  
Holistic Approach ◽  
Spinal Pain ◽  
Underlying Disease ◽  
Pain Patient ◽  
Care Providers

AbstractBackgroundResearch has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients’ perspective.MethodsThirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi’s four-phase phenomenological method.ResultsThe participants’ chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants.As a result from the interviews, subthemes such as “Being disbelieved”, “Adolescents’ pain is also disbelieved”, “Denying pain”, “Underrating symptoms”, “The pain is in your head”, “Second-class citizen”, “Lazy pain patient”, and “False beliefs demand passivity” were identified.ConclusionsIn health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice.ImplicationsThe Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.

The Effects of the Medical Pause on Physiological Stress Markers among Health Care Providers: A Pilot Randomized Controlled Trial

2021 ◽  
pp. 019394592110276
Author(s):  
Ebru Cayir ◽  
Tim Cunningham ◽  
Ryne Ackard ◽  
Julie Haizlip ◽  
Jeongok Logan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Health Care Providers ◽  
Physiological Stress ◽  
Intervention Group ◽  
Control Group ◽  
Care Providers ◽  
The Impact

Contemplative practices promote well-being, work engagement and resilience among health care providers. We examined the impact of The Pause, a brief contemplative intervention, on health care providers’ physiological stress response. Participants were randomly assigned to either The Pause or the control group. They participated in a high-fidelity, stressful medical simulation. Following the simulation, intervention group practiced The Pause. Outcome measures were heart rate variability, heart rate, and blood pressure. We adjusted for baseline physiological variables, sociodemographic variables, self-care practices, and perceived stress. Participants in the intervention group had a standard deviation of the normal-to-normal RR intervals (heart rate variability indicator) that was 13.8 (95% CI 4.0, 23.5; p < .01) points higher than those in the control group. There were no significant effects of The Pause on heart rate or blood pressure. The Pause may reduce stress reactivity, increase heart rate variability, and enhance resilience in health care providers.

scholarly journals Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial

2009 ◽  
Vol 13 (4) ◽  
pp. 556-565 ◽  
Author(s):  
Ling Shi ◽  
Jingxu Zhang ◽  
Yan Wang ◽  
Laura E Caulfield ◽  
Bernard Guyer
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Educational Intervention ◽  
Complementary Feeding ◽  
Intervention Group ◽  
Feeding Practices ◽  
Control Group ◽  
Local Health ◽  
Care Providers ◽  
Local Health Care

AbstractObjectiveInappropriate complementary feeding is one of the major causes of malnutrition in young children in developing countries. We developed an educational intervention, delivered by local health-care providers, aimed at improving complementary feeding practices and child nutrition.DesignEight townships in Laishui, a rural area in China, were randomly assigned to the educational intervention or control group. A total of 599 healthy infants were enrolled at age 2–4 months and followed up until 1 year of age. In the intervention group, educational messages and enhanced home-prepared recipes were disseminated to caregivers through group trainings and home visits. Questionnaire surveys and anthropometric measurements were taken at baseline and ages 6, 9 and 12 months. Analysis was by intention to treat.ResultsIt was found that food diversity, meal frequency and hygiene practices were improved in the intervention group. Infants in the intervention group gained 0·22 kg more weight (95 % CI 0·003, 0·45 kg, P = 0·047) and gained 0·66 cm more length (95 % CI 0·03, 1·29 cm, P = 0·04) than did controls over the study period.ConclusionsFindings from the study suggest that an educational intervention delivered through local health-care providers can lead to substantial behavioural changes of caregivers and improve infant growth.

scholarly journals Reducing Health Care Costs and Improving Clinical Outcomes Using an Improved Asheville Project Model

2015 ◽  
Vol 6 (4) ◽  
Author(s):  
Barry A. Bunting ◽  
Deepika Nayyar ◽  
Christine Lee
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Electronic Record ◽  
The Body ◽  
Control Group ◽  
Original Research ◽  
Group Model ◽  
Care Providers ◽  
Project Model ◽  
Care Costs

This study was designed to add to the body of knowledge gained through the original Asheville Project studies, and to address some of the limitations of the earlier studies. Scalability. Since the original Asheville Project publications there have been some successful replications, however, there is a need to broaden the geographic scope and increase the size of the study population. Study Design. Previous studies were limited to pre-post, self-as-control design. We added a control group. Model improvement. We were able to incorporate an electronic record of care. This allows incorporation of medical and prescription claims, ease of documentation, improved data capture, reporting, standardization of care, identification of deficiencies in care, and communication with other health care providers. This enhancement may be worthy of more comment than we devoted to it , however, we didn’t want to detract from the main goal of the study, and we wanted to avoid any hint of commercialization on the part of the organization that provided the electronic record. Relevance to profession. We sincerely hope the relevance goes beyond the profession of pharmacy and that it reinforces the message that the profession of pharmacy offers real solutions to rising health care costs in the U.S.   Type: Original Research

scholarly journals Community-based interventions to reduce dental caries among 24-month old children: a pilot study of a field trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marzie Deghatipour ◽  
Zahra Ghorbani ◽  
Amir Hossein Mokhlesi ◽  
Shahla Ghanbari ◽  
Mahshid Namdari
Keyword(s):  
Health Care ◽  
Social Network ◽  
Oral Health ◽  
Dental Caries ◽  
Field Trial ◽  
Control Group ◽  
Care Providers ◽  
Oral Health Promotion ◽  
Health Related ◽  
And Control

Abstract Background Early childhood caries (ECC) is the most common dental disease among children worldwide, leading to many difficulties on child’s growth. As WHO mentioned, educational interventions in addition to interprofessional collaboration are needed to achieve proper ECC prevention. In present study we’ve aimed to evaluate the effectiveness of some oral health promotion interventions to reduce dental caries among 24-month old children. Methods A field trial study was conducted amongst 439 mothers from pregnancy up to 24 months after delivery in Public Health Centers in Varamin, Tehran, Iran. Participants were allocated to intervention (n = 239) and control groups (n = 200). Demographic, socioeconomic status and dental care behavior data were collected using a questionnaire. The content of our study intervention consisted of nutritional and behavioral oral health-related messages. Mothers received messages via either of four methods (A: comprehensive method including all other methods together (n = 74), B: group discussion by dentists (n = 59), C: face to face education by primary health care providers (n = 53), and D: social network (n = 53). The control group received routine maternal and oral health care. To assess the effectiveness of interventions on promoting children’s oral health, the oral health-related behaviors data, the number of decayed teeth (d), and being caries free at the age of two were considered. Results Among the 436 examined children, with a mean age of 23.7 months, 48.2% were male. The frequency of using finger toothbrush increased from 53.4% to 89.8% in all intervention groups. The mean (SD) of decayed teeth at 24 months in intervention and control group were 0.36 (0.93) and 1.61 (2.61), respectively. All the four intervention groups, except social network, had more chance of being caries free compared to control group (P value < 0.05). Analysis showed that children in comprehensive intervention group had a higher chance of being caries free compared to all other groups, after adjustment for covariates. Conclusions Performing oral health interventions could help the prevention of dental caries in newborn children. Also, using a combination of different methods of sending messages can have the best results in promoting oral health.

scholarly journals Early Obesity Prevention: A Randomized Trial of a Practice-Based Intervention in 0–24-Month Infants

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Natalia Schroeder ◽  
Berenice Rushovich ◽  
Edward Bartlett ◽  
Sangita Sharma ◽  
Joel Gittelsohn ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Parental Monitoring ◽  
Overweight And Obesity ◽  
Growth Patterns ◽  
Control Group ◽  
Socioeconomic Indicators ◽  
Care Providers ◽  
Child Feeding ◽  
Phone Calls

Objective. A pediatric office-based intervention was implemented following a randomized, controlled design, aimed at improving child feeding practices and growth patterns and ultimately reducing risk for overweight and obesity later in life.Methods. Four clinics (232 infants) were randomized to control or intervention (I), the latter delivered by health care provider at each of 7–9 well-baby visits over 2 years, using a previously developed program (Growing Leaps and Bounds) that included verbal, visual, and text advice and information for parents.Results. The I group offered significantly less sodap=0.006, sweetened teap=0.01, punchp=0.02and/or cow’s milkp=0.001to infants and delayed the introduction of drink/food other than breast milkp<0.05. Parents in the I group had a higher perceived parental monitoringp=0.05and restrictionp=0.01on infant feeding. While the I group exhibited at baseline more adverse socioeconomic indicators than the control group, growth trajectory or body size indices did not significantly differ between groups.Conclusions. Education provided by health care providers in addition to follow-up monthly phone calls may help modify parental behaviors related to child feeding and increase parental sense of responsibility toward child eating behaviors.

scholarly journals Rationale and design of an interventional study of cross-sectoral, coordinated treatment of stroke patients with patient-orientated outcome measurement (StroCare)

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
David Leander Rimmele ◽  
Theresa Schrage ◽  
Christian Brettschneider ◽  
Alexander Engels ◽  
Christian Gerloff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Managed Care ◽  
Care Program ◽  
Control Group ◽  
Care Providers ◽  
Stroke Patients ◽  
Use Of Resources ◽  
Patient Reported

Abstract Introduction Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients’ health and cost-efficient use of resources. The aim of this study is the implementation and evaluation of an optimised cross-sectoral, coordinated and managed care program for stroke patients bridging secondary and tertiary care. Methods In this multi-center mixed method sequentially controlled intervention study, stroke patients with ischemic stroke (I63), transient ischemic attack and related syndromes (G45), or intracerebral haermorrhage (I64) will be invited to participate. For a 12-months period, 235 consecutive patients are expected to be enrolled and assigned standard of care treatment as an active control group. During the following 12 months, 235 consecutive patients will be enrolled and assigned to a post stroke intervention program. The StroCare intervention consists of repeated outpatient visits with specialized stroke teams, the implementation of a case manager, the use of an electronical tool for communication between acute care, rehabilitation facilities, and out-patient care, and the definition of individualized treatment targets. Patients will be followed up for 24 months. The primary outcome is health-related quality of life measured by the Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) at 12 months after the index event, i.e. stroke or TIA. For the qualitative survey of the implementation process, 21 patients in the intervention group will be interviewed after implementation of the interventions. In addition, 20 health care providers and staff members will be interviewed before and after implementation. Additionally, economic outcomes will be evaluated after 6 and 12 months. Perspective The study will not only provide information about the tested intervention but is likely to be helpful for clinicians, suppliers of reimbursement, and researchers in implementing and evaluating complex interventions in stroke care in general. With this program, the health care system will have a reference model at its disposal for transfer to other regions and settings. Trial registration The trial is registered at ClinicalTrials.gov (NCT04159324). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg, Niedersachsen, Schleswig-Holstein) has been obtained.

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