Dissertations / Theses: 'Health consultations'

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Collins, Sarah Frances. "Communication and strategy in health care consultations." Thesis, University of York, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431649.

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Andén, Annika. "Outcomes from GPs' Consultations." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18483.

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Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes. Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs. Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients. Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice. The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.

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O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.

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"June 2002" Errata inside back cover. Bibliography: leaves 244-256. The first aim of this thesis was to determine the relationship between medical student clinical competence and patient-centredness, and maternal satisfaction and subsequent recall of information in child health consultations. The second aim was to test the application of this knowledge in medical student teaching programmes. The study demonstrated the ability of mothers to assess the clinical competence and patient-centredness of medical students in videotaped consultations. Applications in medical student learning were also developed and evaluated.

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Siouta, Eleni. "Communication Patterns in Consultations Between Patients with Atrial Fibrillation and Health Professionals." Licentiate thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-19834.

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Background Patients’ preferences, needs and desires are important when discussing treatment. In consultations between patients with atrial fibrillation (AF) and health professionals, knowledge, understanding and insight about communication patterns are of vital importance for strengthening patient involvement in decision-making about their care and treatment. Aim The general aim of this thesis was to describe communication patterns in consultations between patients with AF and health professionals. Specific aims (1) To describe (i) the topics patients with AF and their nurses and physicians discuss; (ii) the use of discursive space in consultations between these participants; and (iii) the frequencies with which patients and nurses/physicians introduce the identified topics. (2) To describe the types of patient resistance to accepting treatment with warfarin and how cardiologists respond to such resistance. Methods An inductive design was used. In study I, the sample consisted of 23 consultations between patients with AF (13 women and 10 men) and health professionals (5 women and 5 men) who were employed in six different cardiologic outpatient clinics. Content analysis was used to obtain a description of topics discussed. The patterns of dominance for the various topics and participant were explored from the framework of an analysis of dominance (I). In study II, the sample consisted of 11 consultations between patients with AF (7 women and 4 men) and cardiologists (2 women and 3 men). Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. Findings Study I. Four topics were introduced by both nurses and physicians during the consultations. These were “pathophysiology”, “treatment”, “diagnostic procedures”, and “activity”. In the nurse–patient consultations an additional topic, “routines related to the physician’s responsibilities”, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between nurses and patients, and unequal between physicians and patients. The patients were the dominant initiators of the topic “activity”, which refers to adaptation of activities in daily life in relation to AF. Study II. There were four types of patient resistance to accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggesting other treatment options”, “Stating treatment preferences” and “Questioning or challenging the cardiologist’s treatment recommendations”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information about the recommended treatment” and “Extending their explanation of the purpose of the treatment”. Conclusions The medical-driven agenda dominated over the patient-driven agenda in consultations between health care professionals and patients with AF. During conversations in consultations with nurses, the patients initiated discussion of living with AF and were more talkative than they were with physicians. An awareness of types of patient resistance to treatment would enable cardiologists to consider patients’ experience-based views about their treatment;

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Dalgarno, Elizabeth Louise. "'Through the looking glass' : primary care consultations, work and health : a qualitative study." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5580/.

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Musculoskeletal conditions are believed to cost UK society approximately £7.4 billion per year, with 30 million working days lost each year due to musculoskeletal conditions. Currently, within the UK, sickness certification can be self-certified for a period of seven days after which time a General Practitioner is required to authorise any further period of absence from work for patients. In April 2010 the Sickness Certificate was replaced with the Fit Note. The existing literature has offered little ‘in-vivo’ insight into the primary care consultation in relation to the management of patient musculoskeletal work-related concerns since the introduction of the Fit Note, and there is a paucity of research exploring the patient experience of these consultations. The research questions in this thesis broadly ask: How are musculoskeletal work-related concerns discussed and managed within the primary care consultation? How do patients experience these consultations? Mixed qualitative methodology is used within this study. Interpretative methods are used to thematically analyse 100 video-recorded consultations and 19 semi-structured interviews to answer these research questions and provide insight into this area. Findings reveal that the management of musculoskeletal work-related concerns within the primary care consultation is sub-optimal. Accessing work-related support for these people is complicated and contingent upon how they come to identify themselves as candidates for work-related support. The theoretical framework of candidacy is offered as a useful device for understanding and conceptualising the patient experience of these consultations. Interactions with healthcare, in combination with sociocultural factors, mediate how people come to understand their candidacy to seek musculoskeletal work-related support. Directions for further research in this area are provided.

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Kumarapeli, Pushpa. "Modelling the computerised clinical consultations : a multi-channel video study." Thesis, Kingston University, 2011. http://eprints.kingston.ac.uk/22364/.

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This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.

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Willcox, Adrienne. "Nurse-led pre-travel health consultations : evaluating current practice and developing a new model." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/38542/.

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This study explores the pre-travel consultation between nurses and people who plan to travel abroad from the UK. Travel health services have developed ad hoc in response to rising public demand, and are mainly nurse-led in UK general practice. There is little research evidence to describe or evaluate pre-travel healthcare provision. Using a mainly qualitative bricolage design of six methods, the research traces the ‘journey’ of health recommendations made to travellers. Starting with guidance documents produced by experts, it then tracks the fulfilment of these recommendations through consultations conducted by nurses and captures the ways in which travellers use or discard the recommendations while travelling. It explores the clinical reasoning behind activities in pre-travel consultations, and generates ideas for practice development. The key findings are that pre-travel healthcare is medicine-centric and issues of time, organisation, and the model adopted by nurses affects the quality of consultations. Two styles of consultation were identified: the Kitchen Sink style was comprehensive and verbose; the Medical and Minimal style focused on vaccinations. Travellers recalled or used very little of what was imparted during their consultations, but far from being ‘blank slates’, travellers usually managed their health appropriately and had far more knowledge than nurses recognised. The thesis offers conceptual insights to the pre-travel consultation which relate to patient safety, quality and the legal integrity of practitioners. It offers a prototype model of the pre-travel consultation that takes account of the challenges associated with current practice. The implications for practice relate to education for nurses in consultation management, patient-centredness, proactive versus reactive service provision, and patient education. PRE-TRAVEL - the new model for consultations - contributes a framework for engaging with these issues, subject to post-doctoral testing.

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Campion, Peter David. "On structures in medical interactions : a conversation analytic study of general practice consultations." Thesis, University of Liverpool, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387372.

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This thesis addresses from within the research paradigm of Conversation Analysis (CA) the question "How are interactions between patients and general practitioners organised? ". CA is a relatively recent tradition within the "interpretative paradigm" of sociology, growing out of the ethnomethodology of Garfinkel. The thesis first reviews the relevant literature of CA and medical interactions, and critically discusses the methodology. The empirical analysis used naturally occurring consultations in British general practice, video-recorded in five practices, involving 14 doctors, and about 50 hours of recording, made between 1987 and 1992. Recordings were observed first in an unmotivated way, to note occurrences of interesting interactional phenomena. Objects for further study were copied onto secondary "collection" tapes, which were then examined in depth, and transcribed in detail using conventions developed within CA. The analyses described here are: the use of time in the consultation; the impact of medical records on the interaction; prescribing and associated talk; the phenomenon of "facilitation", how doctors appear to enable patients to talk; patient-initiated questions, and rejection of patients' ideas by doctors; and finally the use of the word "we". The aim was to describe and explore, but not necessarily to explain, although in describing the mechanism of interaction in these areas of activity, empirical evidence is advanced for particular explanations. The phenomenon of patients raising new topics at the end of consultations is described, with its interactional implications: the "by-the-way" phenomenon is explored and documented. Case-notes are seen to contribute to consultations in a complex way, and like talk, are both context-dependent and context-forming. Utterances such as "right", "uhuh", "mmhm" which appear on the face of it to be facilitatory, can be the reverse. The phenomenon of dispreference for disagreements by patients is re-examined, and contexts in which patients do disagree are explored. Doctors' rejections of patients' ideas are described, and implications for teaching about the consultation are drawn. Finally the various ways in which the word "we" is used by doctors are described and critically appraised, in the context of a philosophical understanding of "intersubjectivity". The study adds to the body of transcribed interactions drawn from general practice, and sheds some light on ways in which general practitioners and patients structure their consultations. It has implications for the way medical students learn how to consult, and for how research on the consultation can be conducted. Conversation analysis is shown to be a powerful qualitative analytic methodology, relevant to the study of medical interactions.

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Wyman, Jamie L. "Facilitating Feminist Ethics Consultations: A Legal Solution to Encourage Innovative Ethical Analysis." Thesis, The University of Arizona, 2008. http://hdl.handle.net/10150/193240.

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This thesis aims to make feminist theory an integral part of hospital ethics committee ("HEC") decisionmaking. Specifically, the feminist theories discussed in this thesis prioritize an awareness of social context. The small-scale study conducted for this thesis found that HECs already consider social context to some extent but that they may also be open to more systematic integration. As opposed to courts, HECs provide a space where innovative alternatives (e.g., feminist approaches) to principalist bioethical decisionmaking can be tested. In order to encourage the development of such alternatives, this thesis has proposed a framework for the relationship between courts and HECs so that patients can benefit from the strengths of both entities in ways that have not been possible in the past.

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Andersson, Sven-Olof. "Time and general practice consultations : aspects of length, attendance and quality." Doctoral thesis, Umeå universitet, Allmänmedicin, 1995. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100583.

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The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary.

Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.

digitalisering@umu

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Clarke, Andy. "Parental health beliefs and respiratory illness consultations at general practitioners in multi-ethnic and multi-cultural areas." Thesis, University of Leeds, 1989. http://etheses.whiterose.ac.uk/1514/.

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This research was concerned with how parents from different ethnic groups manage their children's respiratory and febrile illnesses, and their consultations at the general practitioner (GP). A review of the few British studies looking at parental health behaviour revealed that parents are continually having to make complex decisions, in which the clinical characteristics of the illness and the behaviour of the child are the most important factors in predictions of what the parent will do. Despite the belief among some GPs that their Asian patients consult more often and for trivial illnesses, we predicted that consultations, however many there are, will reflect rational decisions on the part of the parents. What may appear trivial to a doctor may not be for a parent. Including our pilot studies, we interviewed parents of 159 children - aged between two and eleven years - from three general practices in the inner-city area of Leeds. These parents were either white and indigenous, Muslims, Sikhs or Afro-Caribbeans; and approximately half of the children had been taken to see the doctor in the previous fortnight with a respiratory/febrile complaint, whereas the other half had not been to see a doctor for at least four months.

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Wheat, Hannah. "The interactive management of common mental health problems by general practitioners and patients in primary care consultations." Thesis, University of Exeter, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574492.

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Background: The primary care consultation is the arena in which UK patients typically first formally present their mental health concerns. Despite the 'interactive' nature of the management of mental health, most consultation research has focused on the behaviour, perspectives, or characteristics of only one of the participants. There has been no sequential, real-time analytic work, despite GPs reporting that such interactions are difficult and related training is lacking. Objective: To analyse the interactive management of mental health in the primary care consultation, specifically, the way patients present their mental health-related problems and how GPs respond, and patient requests and GP offers for mental health-related sickness certification. Method: Conversation analysis (CA) was used to examine an existing set of 76 audio-recorded 'early' mental health consultations, from a wider corpus of 506 patient consultations, collected in 2004, from 5 practices in London, involving 13 GPs. Consultations were classified as 'early' mental health consultations if: (A) the patient scored 11 or more on the HADS depression questionnaire, (B) they scored between 8-10 and there was emotional content in the consultation or (C) the HADS depression score was under 8 but there was a GP diagnosis of depression, post-consultation. The first analytic section was on patients' problem presentations: From the 76, 15 consultations were examined. 7 of these consultations fell into classification A. These 7 also fell into category B, as they all contained emotional content. 6 fell into category B (but not A) and all 15 fell into category C. The second analytic section was on GPs' responses to patients' trouble talk surrounding an emotional issue. From the 76, 23 consultations were examined. 9 consultations fell into classification A. These 9 all also fell into category B. 8 fell into category B (but not A). While all 23 cases fell into classification C, 6 only fell into C (not A or B). Sickness certification: From the 76, 10 consultations were examined. 7 cases from the wider corpus (ongoing mental health consultations) were all selected. In total there were 17 consultations examined during analysis. Only the 10 consultations from the 'early' sample were classified. 6 of these fell into 2 classification A. 5 of these 6 consultations also fiited into B, one did not, as there was no emotional content. 2 of the A categorised consultations did not fit into C, as there was no diagnosis of depression. 2 consultations fell into classification B and also C (but not A) and 8 fell into classification C. Findings: Patients typically present first experiences of mental health problems as late-arisinq concerns, through indirect means, preferring a collaboratively built presentation. This delayed presentation format contrasts to physical health problems, which typically get presented after the GP's opening question. In 3 out of the 11 problem presentations of a previously un-experienced common mental health problem, the problem was not taken up by the GP. However, within these problem presentations the GP typically did not initially acknowledge the concern and the patients would have to re-do the presentation of the problem before it would be addressed. GPs claimed and demonstrated understanding of patients' emotional troubles through various means. The impact of these understanding displays on the interaction was influenced by their lexical content, their spoken delivery and where they were positioned with regard to the progression of problem presentation. The responses resulted in either the expansion of the problem presentation or its curtailment. Building and successfully demonstrating understanding, resulted from a series of turns of talk which employed 'interpretive talk' from the GP and in which both GP and patient were fully engaged i.e. they were both contributing more than one word responses before the topics conclusion and through their responses they both expanded and progressed the discussion of the problem. In consultations in which sickness certification was mentioned, patients displayed an awareness of the constraints on the issuing of a first certificate through their request formats and their indirect efforts to induce an offer. GPs often indexed the patients' interactional work to secure a sick certificate through the offer format 'do you want', which oriented to the certificate being a desire rather than a need. Both GPs and patients treated repeat certification as non- problematic. Conclusion: Patients used a variety of strategies to cautiously 'manage' the introduction, elaboration of, and decision-making regarding their mental health concerns. This cautiousness suggests that patients are uncertain of how legitimate their common mental health problems are and of how they will be received by the GP. Cautiousness was less apparent when the problem was a 3 4 repeat occurrence. Throughout the analysis a 'collaborative' approach to talking about and 'managing' the common mental health issues led to a more productive discussion.

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Pullen, Celine C. "Dietary Intake and Frequency of Physician Consultations, Infections, and Antibiotic Treatments in the Quebec Longitudinal Study of Child Development." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28740.

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Many Canadian children are not eating in accordance with the recommendations of Canada's Food Guide. The health effects of such behaviours are widely unknown. Using the Generalized Estimating Equations technique and data from the Quebec Longitudinal Study of Child Development, this study longitudinally explored the effects of low, medium, and high dietary intake of grain products, vegetables, fruits, milk and alternatives, and meat and alternatives on three indicators of child health, namely: the frequency of physician consultations, infections, and antibiotic treatments, in children from age1 to 7. Using multivariable models, high intake of vegetables (two or more times per day) was found to significantly reduce the risk of physician consultations and antibiotic treatments. Low intake of meat and alternatives (less than once per day) reduced the risk of physician consultations, and high intake of fruits (two or more times per day) reduced the risk of general infections.

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Butler, Nina Mary. "An exploration of doctor and patient agendas in general practice consultations : principal agendas and problem solving." Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335901.

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DiMaso, Sabrina Nichole. "Pre-appointment Information Seeking and Scanning Behaviors in Individuals Scheduled for Cancer Genetics Consultations." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523620330447886.

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Radosteva, Alesya. "Cultural Consultations in Criminal Forensic Psychology:A Thematic Analysis of the Literature." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1536856667462656.

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Landgren, Sara. "Non-use of Digital Health Meeting Services Among Swedish Elderly Living in the Countryside." Thesis, Uppsala universitet, Institutionen för informatik och media, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-414834.

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Digital consultations in primary care have the advantage of offering equal healthcare for people residing in the countryside. While it is gaining acceptance among young- and middle-aged people, the elderly are reluctant to use it. The aim of this study was hence to identify reasons for non-use among elderly in the countryside and describe perceived possible challenges and opportunities with digital consultations. Semi-structured interviews were conducted with 13 persons over 65 years old residing in the Swedish countryside. There was a mistrust for services offered by private companies and their public funding, a lack of knowledge of available services, and a lack of perceived usefulness. Personal interaction and continuity was more important than time or travel conveniences, although these advantages were recognized. To prevent digital exclusion, caregivers need to offer information, encouragement, or tools for the elderly. Digital primary care also needs to offer familiarity, with continuity and personal connections.

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Miliauskaitė, Danguolė. "Moksleivių ir mokyklų visuomenės sveikatos priežiūros specialistų požiūris į privalomus profilaktinius sveikatos patikrinimus." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2009. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2009~D_20090612_130311-21995.

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Darbo tikslas: Įvertinti privalomų profilaktinių sveikatos patikrinimų apimtis ir vyresnio mokyklinio amžiaus moksleivių bei mokyklose dirbančių visuomenės sveikatos priežiūros specialistų požiūrį į juos. Darbo uždaviniai: Išsiaiškinti moksleivių privalomųjų profilaktinių sveikatos patikrinimų apimtis ir dokumentų pildymo kokybę. Įvertinti vyresniųjų klasių moksleivių požiūrį į privalomus profilaktinius sveikatos patikrinimus bei palyginti miesto ir kaimo moksleivių, merginų ir vaikinų požiūrius. Įvertinti mokyklose dirbančių visuomenės sveikatos priežiūros specialistų požiūrį į privalomus profilaktinius moksleivių sveikatos patikrinimus . Tyrimo metodika. Darbe buvo derinama kiekybinė ir kokybinė tyrimo metodologija. Kaišiadorių rajone 2007 m. apklausta 280 vyresniųjų klasių moksleivių: 55 proc. merginų ir 45 proc. vaikinų iš jų 57 proc. tiriamųjų gyvena mieste ir 43 proc. -kaime. Statistinė duomenų analizė atlikta SPSS 12.0 duomenų analizės paketu. Diskusijoje dalyvavo 6 visuomenės sveikatos priežiūros specialistai. Analizuota į mokyklos sveikatos kabinetus patenkanti sveikatos pažymų informacija. Rezultatai. Nustatyta, kad sveikatos pažymą į mokyklą atnešė absoliuti dauguma (97,4 proc.) moksleivių, tačiau sveikatą jie tikrinasi dažniausiai todėl, kad į mokyklą reikalaujama atnešti pažymą (61,9 proc. merginų ir 51,2 proc. vaikinų bei daugiau kaip pusė moksleivių gyvenančių mieste ir kaime). Iš mokykloms pateiktų pažymų tik 34,98 proc. buvo pilnai užpildytų. Daugiau kaip... [toliau žr. visą tekstą]
Aim of the Study: To assess the range of compulsory preventive health check-ups and the sudents as well as school health care specialists‘ attitude towards them. Objectives of the Study: To evaluate the range of compulsory preventive health check-ups and and the quality of document filling in Kaišiadorys District. To assess the attitude of senior class students towards compulsory preventive health check-ups, and to compare the difference between the attitude of students living in the town and countryside. To assess the attitude of school health care specialists towards compulsory preventive health check-ups. Methods of the survey The qualitative (interview) and quantative methods were combined in the study. In 2007, an ananymous questionnaire survey was carried out, during which 280 people were interviewed: 55% of girls and 45% of boys. 57% of those interviewed lived in the town and 43% of them were rural residents. The statistic analysis of data was performed on the basis of documents SPSS 12.0/w. Six health care specialists working in the schools of the district also participiated in the survey.. The information of health certificates presented to the school health rooms was taken as a basis of the analysis. Results It has been determined that the total (97,4 % ) of students presented health certificates, however, they went for check-ups because school demands the health certificate (61.9 % of girls and 51.2 % of boys more than half of both students living in the... [to full text]

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Santos, Greice Maria Mansini dos. "Demanda por atendimento nutricional em uma operadora de autogestão em saúde suplementar." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/89/89131/tde-08032013-165808/.

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Introdução - A Agência Nacional de Saúde Suplementar determinou, em 2008, que os planos de saúde oferecessem seis consultas anuais com nutricionista. Objetivo - Avaliar os determinantes da demanda por consultas de nutrição em uma operadora de autogestão em saúde entre 2009 e 2011. Métodos - Trata-se de um estudo retrospectivo realizado a partir dos registros administrativos dos beneficiários da Sabesp Previdência. A demanda foi estimada por meio de um modelo tobit para os gastos com consultas de nutricionista. Foram incluídas variáveis demográficas, socioeconômicas, de estado de saúde e de influência familiar. Resultados - A influência familiar, o sexo, o estado civil, a escolaridade e o estado de saúde no período e passado foram os principais determinantes do gasto com consultas de nutrição. A elasticidade renda da demanda, embora estatisticamente significante (p<0,1), foi pequena em relação ao efeito das demais variáveis e a idade não teve impacto significativo. A baixa probabilidade estimada de realizar gastos mostrou que ele é subutilizado. Conclusão - Os resultados evidenciaram a necessidade de estímulo à utilização, numa perspectiva de prevenção de doenças, promoção da saúde e redução dos custos assistenciais no setor de saúde suplementar.
Introduction - The Brazilian private health sector regulatory agency determined, back in 2008, that the insurance plans should offer six nutrition consultations. Objective - To assess the nutrition consultations demand determinants in health insurance plan between 2009 and 2011. Methods - This is retrospective study performed using data from Sabesp Previdência. We used Tobit model to analyze the expenditure on nutritional consultations and tested demographic, socioeconomic, health status and family influence variables. Results - Family influence, sex, marital status, education and health status were the expenditure main. Income elastic of demand, although statistically significant, wasn\'t expressive when compared to other variables effects. Age had no significant impact on individual nutrition consultation expenditure. The low probability of having expends with nutrition consultations showed it is an underutilized service. Conclusion- The results highlighted the need to stimulate the demand for nutrition consultations, in concordance with a disease prevention, health promotion and healthcare care reduction perspective in private health care sector.

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Mullen, J. M. "The relationship between empathy and Self-Management Support in general practice consultations in areas of high and low socio-economic deprivation." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4533/.

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Aim: Empathy is widely regarded as an important attribute of healthcare professionals, and has been linked to higher patient satisfaction, enablement, and some health outcomes. The ‘mechanism of action’ of clinical empathy is not well understood. An ‘effect model’ of empathic communication in the clinical encounter has been proposed by Neumann et al (2009). In this model, clinician empathy is seen as having a positive effect in encouraging patients to tell more about their symptoms and concerns (for example, by picking up on emotional cues and responding in an encouraging way). This can result in ‘affective-oriented effects’ (such as the patient feeling listened to and understood) or ‘cognitive/action-oriented effects’ which include the clinician collecting more detailed information (medical and psychosocial), gaining a more accurate perception of the problem (and possible diagnosis) and enhanced understanding and responses to the patients’ individual needs. Such responses may include Self-Management Support of various kinds, which help enable the patients to better manage their condition(s), leading to improved outcomes. Recent Government policy in Scotland has focused on Self-Management Support and Anticipatory Care as key priorities in primary care, in response to the rise in chronic disease and health inequalities. However, the amount and type of Self-Management Support and Anticipatory Care that occurs in routine consultations in primary care is not known, nor their relationship with empathy and patient enablement. Thus the ‘effect model’ of empathy as proposed by Neumann, which postulates a relationship between empathy, Self-Management Support, and outcomes in the consultation remains largely theoretical. The aim of this thesis was to examine the relationships between patients’ perceptions of doctors’ empathy, patient enablement, health outcomes and the amount and the type of Self-Management Support (including Anticipatory Care) in general practice consultations. Due to the wide health inequalities that exist in Scotland, and the continuing operation of the ‘inverse care law’, a comparison was made between consultations in areas of high or low socio-economic deprivation to establish whether the relationships varied by deprivation. The thesis had the following research objectives; • To assess the nature, type and frequency of Self-Management Support (including Anticipatory Care) in general practice consultations in high and low deprivation groups • To determine whether patients’ perceptions of GP empathy is related to Self-Management Support (including Anticipatory Care) in consultations in high and low deprivation groups • To explore the effects of Self-Management Support (including Anticipatory Care) on patient enablement and health outcomes in high and low deprivation groups • To assess patients’ perception of empathy in terms of the nature, type, and frequency of emotional Cues and responses by GPs rated as high or low in empathy by their patients in consultations in high and low deprivation groups Methods: The research objectives were investigated by a secondary analysis of data collected between 2006-2008 by Mercer and colleagues in the Section of General Practice and Primary Care at the University of Glasgow. These data were collected as part of a research project in general practice in areas of high and low deprivation funded by the Chief Scientist Office of the Scottish Government. The research produced database, includes 659 videoed baseline consultations, with patient rated experience measures, including the Consultation and Relational Empathy (CARE) Measure, the Patient Enablement Instrument (PEI) and outcomes (self-reported symptom change and well-being) at 1 month post-consultation available on 499 patients. An observer-rated method of assessing Self-Management Support and Anticipatory Care was sought from the literature to answer objectives 1-3. However, there were a lack of validated observer-rated tools available that were specifically designed to measure these constructs. As such, the Davis Observation Code was identified as a validated system of coding primary care consultations across a broad range of consultation components which included items deemed to relate to Self-Management Support and Anticipatory Care. The process of selecting the Davis coding system, and the rejection of alternative coding systems is discussed in detail in Chapter 5. The Davis coding system was also considered feasible given the large size of the database. Self-Management Support and Anticipatory Care were then measured by using combinations of seven codes deemed relevant to Self-Management Support within the consultation setting. Four additional codes were added to the Davis system, in order to include tasks relevant to UK general practice consultations. These additional codes were not part of Self-Management Support or Anticipatory Care but were added to achieve a complete coding system of activities within the consultations. The Verona coding system measured emotional cues, concerns and health provider responses that were observed within the consultations. As such, this system was used to answer objective 4. The choice of this system reflected a desire to use an observer-rated measure to help ‘validate’ the patient-rated empathy measure (the CARE Measure) in terms of the first part of the Neumann et al (2009) model, i.e. eliciting concerns and symptoms, separate from the cognitive/action oriented effects relating to Self-Management Support. Results: Reliability of the objective coding systems Preliminary work was carried out on both coding systems in order to establish reliability in the application of the codes. This was a lengthy process, involving several cycles of coding by two coders (the author and one of her supervisors) but resulted in acceptably high levels of inter-rater reliability (kappa > 0.7 for the Davis coding system, and > 0.9 for the Verona coding system). Objective 1: The nature, type and frequency of Self-Management Support (including Anticipatory Care) in general practice consultations in high and low deprivation groups In both the high and low deprivation groups, time was predominantly allocated to gaining information about the patient’s complaint, conducting physical examinations and planning treatment. There was no difference observed in the amount of Self-Management Support overall in the consultations between high and low deprivation areas. However, there were significant differences in the nature, type and frequency of certain aspects of Self-Management Support, with significantly more Anticipatory Care in the consultations in the high deprivation areas. The results also showed that patients in the high deprivation group tended to experience a more direct biomedical focused consultation that featured practical tasks such as physical examinations and discussion of substance misuse. In the low deprivation group, a biopsychosocial approach was more common, which involved more time spent within the consultation discussing treatment effects, compliance or discussing how previous interventions had impacted on the patient’s health. For both groups, little time was allocated to gathering family information or counselling, answering patient questions or discussing health knowledge. Objective 2: Patients’ perception of GP empathy and relationship with Self-Management Support (including Anticipatory Care) in consultations in high and low deprivation areas. The relationship between empathy and Self-Management Support was explored using the Consultation and Relational Empathy Measure (CARE) and the Davis observation code respectively. Potential confounding variables were taken into account. Patients' perceptions of their GP's empathy were significantly associated with Self-Management Support in the low deprivation group, but not the high deprivation group.

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Tylienė, Violeta. "Ambulatorinių konsultacinių paslaugų teikimas Vilniaus teritorinės ligonių kasos veiklos zonos gyventojams." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2006. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2006~D_20060613_144747-79451.

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Enhancement of the quality of outpatient services and the problems of accessibility of services become more and more important part of the health care reform. The importance of increasing the provision of the services in outpatient institutions and developing of outpatient services of physicians-specialists are the priorities in the plan of re-structuring of health care. Aim of the study. To analyze the provision and tendencies of the secondary and tertiary level outpatient services to inhabitants of the area Vilnius Territorial Patient Fund in 2003-2005. Objectives. To evaluate the provision of the secondary level outpatient services by specialty, by municipalities and age groups. To analyze the tertiary level outpatient services by municipalities. To evaluate the changes and tendencies in providing secondary and tertiary level outpatient services. Materials and methods. Analysis was done using the data of health insurance information system SVEIDRA on inhabitants registered to primary health care institutions and outpatient services provided to inhabitants of the area of Vilnius Territorial Patient Fund in 2003-2005. In order to evaluate distribution of services by municipalities, the number of outpatient services per one inhabitant, registered to primary health care institution, was calculated. Four age groups (0-5, 5-18, 18-65, over 65 years old) were chosen to analyze distribution of services by age groups. The existence of statistically significant differences was... [to full text]

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Reid, Noreen. "An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27690.

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Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.

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Alata, Acuache Estefany Haydee, Chávez Mercy Elizabeth Calderón, Pastrana Alfredo Javier Mujica, Licas Lucia Patricia Ortiz, and Baltazar Jennifer Lesly Romero. "Ammy – asistencia virtual de salud reproductiva." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/652847.

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En toda la etapa de vida, las mujeres pasan por determinadas experiencias físicas para la conformación de su femineidad como la menstruación, el parto, lactancia, embarazo y menopausia. Los estudios sobre el tema explican que las mujeres enfrentan enfermedades complejas y otras menos severas, algunas enfermedades son: cáncer de ovarios, miomas, ovarios poliquísticos, infecciones, entre otros. Siendo las infecciones la principal causa que lleva a las mujeres al ginecólogo, según el Inem, además, se sabe que mensualmente casi 7 mil mujeres acuden a una consulta ginecológica, de ellos cerca del 70% acuden solo por infecciones (Álvarez et al., 2017). Por ello, se creó Ammy, una idea de negocio que busca solucionar los problemas relacionados con la salud reproductiva femenina y que funciona a través de una aplicación móvil. El servicio consiste en brindar un monitoreo menstrual con alertador de normalidad o anormalidad del ciclo menstrual, con opción para ingresar los síntomas, de esta manera alertar a la usuaria cuando sus molestias requieran acudir a un ginecólogo, luego de ello, sugerirle un listado de médicos para realizar sus citas médicas por la aplicación de Ammy. Si bien, en el mercado existen varias aplicaciones extranjeras, lo cierto es que ninguna de ellas permite realizar las consultas médicas virtuales. Además, existen miles de mujeres en Lima que están dispuestas a pagar por este servicio y por las suscripciones para el monitoreo de su ciclo menstrual. Sin duda este negocio es innovador y muy rentable demostrado en sus indicadores de rentabilidad del presente trabajo.
Throughout the life stage, women go through certain physical experiences to shape their femininity, such as menstruation, childbirth, lactation, pregnancy and menopause. Studies on the subject explain that women face complex diseases and others less severe, some diseases are: ovarian cancer, fibroids, polycystic ovaries, infections, among others. Being infections the main cause that leads women to the gynecologist, according to the Inem, in addition, it is known that almost 7 thousand women go to a gynecological consultation every month, of them about 70% go only for infections (Álvarez et al., 2017). For this reason, Ammy was created, a business idea that seeks to solve problems related to female reproductive health and that works through a mobile application. The service consists of providing menstrual monitoring with an alert of normality or abnormality of the menstrual cycle, with the option to enter the symptoms, thus alerting the user when her discomfort requires going to a gynecologist, after which, suggesting a list of doctors to make your medical appointments by the Ammy app. Although there are several foreign applications on the market, the truth is that none of them allow virtual medical consultations. In addition, there are thousands of women in Lima who are willing to pay for this service and for subscriptions to monitor their menstrual cycle. Without a doubt this business is innovative and very profitable, demonstrated in its profitability indicators of this work.
Trabajo de investigación

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Almond, Stephen. "GP consultation and prescribing behaviour : a health econometric approach." Thesis, University of Kent, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242942.

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Keenaghan, C. "Public consultation in public health policy and planning in Ireland." Thesis, Queen's University Belfast, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432596.

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Holdsworth, Marion. "Consultation and training challenges at the Mamre Community Health Project." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/13476.

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Bibliography: leaves 58-65.
South African mental health services are in a crisis. Rural areas are particularly neglected. While shortage of resources is readily acknowledged, there have been various suggestions mooted to address these inadequacies. These solutions include: decentralisation, promotion of primary mental health care, encouraging community participation and involvement of indigenous helpers. Psychological consultation and training is a valuable way of implementing most of these suggestions as it is estimated that many mental health disorders are not diagnosed or treated because front-line workers do not have the knowledge or skill to do so. Although consultation and training is accepted as a useful way of working, it is not without problems. Certain factors make it more or less possible to implement. These factors are discussed. Particular attention is paid to the topic of hierarchical relations inherent in intra-and interprofessional contexts. It is believed that these relations may interfere with the creation of equitable consultant-consultee partnerships, and therefore hinder the consultation and training process. The present research evaluates factors which facilitate or hinder the consultation and training programme at the Mamre Community Health Project. This project is a non-government organisation aiming to improve of the health of the community of Mamre, a small rural town on the west coast of the Western Cape. Target consultees, including nursing sisters, social workers and paraprofessionals, were interviewed using a semi-structured interview schedule. The aim was to elicit experiences and opinions of consultation and training. Psychological consultants who had worked at the Mamre Community Health Project were also interviewed using a semi-structured interview schedule to elicit their experiences of consultation. Athematic analysis highlights factors which facilitate and factors which inhibit the process. Results are discussed in the light of the literature review, and recommendations are made regarding the future practice of consultation and training.

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Nickell, Debra Faith. "SCREEN DOOR MEDICINE: THE INFORMAL MEDICAL CONSULTATION." UKnowledge, 2010. http://uknowledge.uky.edu/gradschool_diss/6.

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This study explores the phenomenon of the informal medical consultation, a communication event in which an individual asks for medical information, advice, or care from an off-duty health professional with whom the individual has no formal patient-provider relationship. Using surveys and interviews, the study describes these consultations from the perspective of the health care professional and the informal patient. The study explores foundational theories that offer explanations for the phenomenon. The theories considered include social support, decision-making, social exchange, perceived partner responsiveness to needs, and uncertainty management. This study suggests health care providers perceive informal medical consultations to be more problematic than do the informal patients who consult them. The problematic nature of informal consultations increases as the type of request moves from purely informational to a request for treatment. Informal patients do not perceive this distinction. The informal patient’s motivation to pursue an informal consultation instead of a formal consult is affected by the relationship with, trust in, and access to the informal consultant. The willingness of the informal consultant to engage in an informal consultation is affected by the relationship with the informal patient, the type of request made, and perception of risk/benefit for both the provider and the patient. The study supports the idea that informal medical consultations are potentially problematic within the current medico-legal-ethical environment. Alternately, these consultations may be viewed as offering positive contributions to the health and well-being of informal patients. The study suggests translational research is needed to guide health professionals in considering requests for informal medical consultations.

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Morrison, Pamela A. "Early Childhood Mental Health Consultation: A Comparison of Unlicensed and Licensed Professionals." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1793.

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This study was conducted to comparatively examine child specific expulsion rates and parent satisfaction of children who received early childhood mental health consultation (ECMHC) services delivered in 2 states for the 2012 program year: Maryland (unlicensed) and Delaware (licensed) . This current study examined secondary data to determine whether unlicensed (Maryland) ECMHC professionals are equally or more effective than licensed (Delaware) ECMHC professionals. Of the total number of child specific consultations or cases referred for services in Maryland (unlicensed), N = 370, n = 266 children avoided expulsion and were able to remain at their childcare placements while n = 17 children were expulsed. Of the total number of child specific consultations or cases referred for services in Delaware (licensed), N = 135, n = 119 children were able to remain in their childcare placements while n = 3 children were expulsed. The results of this study revealed that there is no statistically significant difference in expulsion rates between Unlicensed (Maryland) professionals and Licensed (Delaware) professionals. Results suggest that licensure status of ECMHC professionals has no affect on expulsion rate outcomes and should receive further examination. Additionally, results could support policy changes that could lead to a national credentialing process that would address the current gap in ECMHC services due to the shortage of qualified ECMHC professionals. This study was unable to determine the outcome of parent satisfaction due to missing data. Future direction should include replication using a mixed longitudinal study.

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Epperson, Sidney Reins. "Models of Consultation, Referral Problems and the Perceived Effectiveness of Parent and Teacher Consultation." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc501027/.

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This study evaluated the school psychologist's perception of effective models of consultation based upon referral problem and parent, teacher, and student response to treatment. Analyses of covariance determined that (a) parents' receptivity and total number of teacher contacts significantly influenced the parents' response to treatment; (b) teacher receptivity and total number of parent contacts significantly affected teachers' response to treatment; (c) students' response to treatment was significantly affected by the model of teacher consultation and the average number of minutes spent with the school psychologists; and (d) students in a Mental Health consultation group responded significantly more favorably than s tudents in Behavioral or Collaborative consultation groups.

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Hsieh, Sheau-Ling 1952. "Distributed multimedia collaborative system framework for tele-healthcare remote consultation systems." Diss., The University of Arizona, 1998. http://hdl.handle.net/10150/284034.

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The Remote Consultation and Diagnosis (RCD) in Global Picture Archiving and Communication System (Global PACS) is a unique suite of multimedia telemedicine applications developed at the University of Arizona. The applications support real-time patients' data, image files, audio and video consultation and diagnosis annotation exchanges. The RCD enables joint collaboration between pathologists, radiologists, or physicians while they are at distant geographical locations. This project provides four RCD scenarios, i.e., Case Review, Case Acquire, Store and Forward Analysis, as well as Interactive Diagnosis and Consultation. The RCD Global PACS environment consists of heterogeneous, autonomous, and legacy resources. The Common Object Request Broker Architecture (CORBA), Java Database Connectivity (JDBC), and Java language provide the capability to combine the RCD Global PACS resources into an integrated, interoperable, and scalable system. The underneath technology, including IDL, ORB, Event Service, IIOP, JDBC/ODBC, legacy system wrapping and Java implementation are explored. This distributed collaborative CORBA/JDBC based framework will challenge the advanced, medical information management requirements. It also makes the RCD Global PACS both hardware and software technologically independent. As our research and development extend, we will continue to incorporate the latest advances in computer technology. RCD Global PACS is not another new tool in telemedicine, but rather a new paradigm for the delivery of health services that requires process reengineering, cultural changes, as well as organizational changes. It is a whole new way of practicing in telemedicine. We ensure that the RCD Global PACS project has long-term, comprehensive solutions for today and tomorrow's healthcare needs.

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Walker, Zoe Alice Katherine. "The effects on health and health behaviour of inviting adolescents to a consultation within the general practice setting." Thesis, University of Hertfordshire, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366036.

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Bryant, Brenda L. "Perception of consultation among professional school counselors, teachers and mental health professional counselors." Thesis, University of Missouri - Saint Louis, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10249064.

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This is a study concerning the perception of consultation among school counselors, teachers, and mental health professional counselors (MHPCs) working collaboratively in the public school setting for the benefit of the academic and behavioral success of students. Although there are many consultation models and theoretical views (Brigman, Mullis, Webb, & White, 2005; Caplan, Caplan, & Erchul, 1995; Erchul & Conoley, 1991; Erford, 2011; Kampwirth, 2006), this study utilized the American School Counselor Association (ASCA) framework for consultation in schools.

Although MHPCs are not considered school counselors by definition, and they are not compensated by school districts, they still serve as consultants with school counselors and teachers for the purpose of student success. This study explored the perception held by school counselors, teachers, and MHPCs regarding consultation conducted in the public schools. It also examined the perception of how the consultation process between these three professional groups affects students’ behavioral and academic success. This study utilized a qualitative design which used grounded theory methods of data analysis, collecting and analyzing data from interviews of school counselors, teachers, and MHPCs as they collaborate in the public schools. The participants included the MHPCs from one Midwestern agency and school counselors and teachers with whom the selected MHPCs had opportunity to interact in consultation in elementary and secondary schools.

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Guedes, Fernando Soares. "Encontro terapêutico: avaliação de uma abordagem integral em pacientes com dispepsia funcional, ensaio clínico controlado aleatorizado." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-26022015-091109/.

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INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arte
INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art

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O’Dwyer, Niamh. "Impact of injection anxiety on recall of health information in the travel clinic consultation." Thesis, Royal Holloway, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.588612.

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A large proportion of United Kingdom (UK) residents are now travelling abroad. The pre-travel consultation provides a good opportunity for clinicians to educate travellers about the risks involved with travel, and prevention strategies which they could utilize. Adherence to health travel advice prevents travel-related illness and reduces the risk of contracting infectious diseases. It is therefore important to assess whether health travel advice is retained post consultation. Anxiety and, specifically, anxiety about receiving a vaccination, could influence a traveller's ability to recall health advice. The present study aimed to investigate whether anxiety and, more specifically, injection anxiety can predict recall of health information following a travel clinic consultation. In addition, it also aimed to provide further information on the prevalence of injection anxiety in a travel clinic setting in the UK, as this has not been explored previously. Participants were recruited from two fee-paying travel clinics which they were attending for pre-travel advice and vaccinations. They completed a number of self-report measures exploring injection anxiety, state anxiety, and psychological and physical reactions to blood tests and injections. A recall questionnaire, designed for the study, was completed post consultation to assess recall of health information. Analysis of the data revealed that injection anxiety did not account for variance in recall ability. The prevalence rate of injection anxiety was found to be 39%, higher than previous studies completed outside the UK. The recall of information varied, and for the majority of participants not all information was retained post consultation. The implications for clinical practice are discussed and suggestions for future research are considered.

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Gardner-Elahi, Catherine. "Developing a model of consultees' understanding of mental health consultation in a school setting." Thesis, University of East London, 2011. http://roar.uel.ac.uk/3708/.

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Recent development of comprehensive Child and Adolescent Mental Health Services (CAMHS) has seen the growth of Tier 2 mental health consultation in school settings. Little of the literature considers consultees' perspectives on this, nor presents systematic studies of interpersonal process in consultation. Using interviews with consultees and a constructivist grounded theory methodology, I explored parent and school staff consultees' understanding of their experience of mental health consultation in a school setting. Consultees talked about the school, service, consultee and consultant conditions that created the context for consultation. They described the process they experienced through the consultative relationship overtime, and within consultation meetings; this included their experience of being supported, learning new strategies and changing their thinking through sharing perspectives and becoming more reflective. Finally, they talked about the outcomes of consultation for consultants, consultees, the school and the referral process to Tier 3 CAMHS. Consultees' descriptions of support and change connected to psychodynamic understandings of containment and systemic theories of conceptual change. Consultation service models should be designed in a way that supports these processes. Consultees' description of a disparity in consultees' and consultants' expectations of use of the expert stance in consultation suggests that more research is needed to explore the value of this stance. Consultees' understanding of the changes in the referral process suggested that consultation may bring referrers and CAMHS workers closer together in their construction of the referral process, thereby streamlining the referral process. This raised questions about how consultation affects referral rates, and whether it holds potential for improving access for hard-toreach clients. Finally, the extension from consultation about cases to consultation about organisational level processes suggests that training about consultancy and psychological processes at the organisational level may be useful.

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Churchill, Richard. "General practice consultation patterns by teenagers and their associations with health risks, needs and attitudes." Thesis, University of Nottingham, 2008. http://eprints.nottingham.ac.uk/10595/.

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During the transition from childhood to adulthood young people are vulnerable to relatively unique health problems and risks, whilst also developing personal autonomy, and learning when and how to access health services. This thesis describes three studies, the overall aim of which was to gain a greater understanding of how teenagers use general practice, and to identify those factors that influence this behaviour and ultimate health outcomes. The aim of the first two studies was to identify demographic, health, and attitudinal factors associated with both overall general practice consultation rates and consultation for specific types of condition. The first study involved identifying annual consultation rates and reasons for consultation from the medical records of 836 (94.4%) of 886 teenagers aged 13 to 15 registered with five general practices across the East Midlands, covering the 12 month period prior to the second study. In the second study, 713 (80.5%) of the 886 teenagers from the first study responded to a postal questionnaire survey, carried out between May and August 1997, which explored health concerns, help-seeking behaviour, health related behaviour, use of health services, and attitudes to general practice. The results from each of the first two studies were linked, in order to identify associations between self-reported health status, attitudes and behaviour and recorded consultation behaviour, based on the 678 teenagers for whom complete data sets were available. The median annual consultation rate was two, with 76.1% of teenagers consulting at least once and 23.8% consulting on four or more occasions. Consultation rates increased with age amongst girls, who had significantly higher rates than boys by age 15. Most consultations were for respiratory and skin problems, with consultations for psychological problems being least frequent. Teenagers reported a wide range of health concerns and, whilst general practitioners were identified as the most frequent source of health advice from formal health services, friends and family were cited far more frequently. Although 91.8% of survey respondents rated confidentiality as important, there was no association between attitudes towards confidentiality and actual consultation behaviour. In contrast, teenage girls who expressed concerns about embarrassment were less likely to consult about gynaecological problems and contraception. The third study was a case control study in which the general practice consultation patterns of 240 young women who subsequently became pregnant (having a recorded termination, delivery or miscarriage between January 1995 and January 1998) were compared with those of 719 age-matched controls without a history of pregnancy. Cases were significantly more likely than controls to have consulted in the year prior to conception with 93% of cases consulting at least once and 71% having discussed contraception at some time. Teenagers whose pregnancy ended in a termination were significantly more likely than controls to have received emergency contraception. In conclusion, whilst teenagers have been shown to use general practice for a range of health problems, the results from these studies suggest that there is a need to facilitate access for teenagers with more sensitive problems, and to improve identification and follow-up of those at greatest risk of adverse outcomes.

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Cimino, Emily Luis. "Factors associated with school-based mental health services delivered by school psychologists." [Tampa, Fla] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0001878.

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Adeponle, Ademola. "Use of cultural consultation to resolve uncertainty of psychosis diagnosis in ethno-cultural minority and immigrant patients." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95167.

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In North America, ethnic minority patients are at high risk for misdiagnosis of psychosis. A number of care models are in use for delivery of mental health services in multicultural settings, cultural consultation being one. Research on how these models address bias in diagnosis however remains sparse. We analyzed data from a cultural consultation service to determin e the frequency of re-diagnoses and associated factors, and describe the reasoning process used in resolving uncertainty of a psychosis diagnosis. Re-diagnoses occurred in 49% of cases and was more likely in recent immigrants and persons of non-Black ethnicity. A 3-step reasoning process was identified: (1) problematizing the original diagnosis; (2) explaining symptoms in terms of biomedical, psychological or social processes; (3) confirming or re-interpreting the diagnosis of a psychotic disorder. This process sheds light on psychiatric reasoning in complex cases and can be used in refining cultural competence training and service delivery.
En Amérique du Nord, les patients issus de minorités ethniques sont à haut risque de diagnostic erroné de la psychose. Un certain nombre de modèles de soins sont en cours d'utilisation pour la fourniture de services de santé mentale dans un environnement multiculturel, de consultation culturelle en être un. La recherche sur la façon dont l'adresse biais de ces modèles dans le diagnostic reste cependant rare. Nous avons analysé les données d'un service de consultation culturelle de déterminer la fréquence de ré-diagnostics et les facteurs associés, et de décrire le processus de raisonnement utilisé dans la résolution de l'incertitude d'un diagnostic de psychose. Re-diagnostics eu lieu dans 49% des cas et était plus élevée chez les immigrants récents et les personnes d'origine ethnique non-Noire. Un processus de raisonnement en 3 étapes a été identifié: (1) problématiser le diagnostic initial, (2) expliquer les symptômes en termes de recherche biomédicale, les processus psychologiques ou sociaux, (3) de confirmer ou de ré-interpréter le diagnostic d'un trouble psychotique. Ce processus met en lumière le raisonnement psychiatriques dans les cas complexes et peuvent être utilisés dans le raffinage de formation des compétences culturelles et la prestation des services. fr

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Moran, Tracy E. "Infant health care use : the influences of maternal psychosocial factors." Diss., University of Iowa, 2008. http://ir.uiowa.edu/etd/39.

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Grant, Sally Jane. "Computers in the consultation in general medical practice : some effects on the delivery of health care." Thesis, University of Nottingham, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335327.

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Shamblin, Sherry R. "An Evaluation of Partnerships for Early Childhood Mental Health." Ohio University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1365093576.

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Beckham, Tony A. "Adolescent mental health services the use of psychological consulting /." Theological Research Exchange Network (TREN), 2005. http://www.tren.com.

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Meakin, Richard Peter. "An investigation of an hermeneutic model of patient satisfaction with the consultation in general practice : the relationship between doctor-patient agreement and patient satisfaction with the consultation in general practice." Thesis, University College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367586.

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Petteys, Annie R. "Effects of neonatal palliative care consultation on parental stress of patients in the neonatal intensive care unit." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1522646.

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The hospitalization of one's infant is a stressful situation that can lead to decreased bonding and poor health outcomes. This longitudinal comparative design study examined the effects of neonatal palliative care (PC) consultation on stress levels and satisfaction scores of parents of neonatal intensive care unit (NICU) infants. Clinical data was abstracted from the medical record. Demographic data, stress scores, and satisfaction reports were obtained via self-report.

Mean stress scores indicated most parents experienced moderate stress due to NICU hospitalization. Some parents met diagnostic criteria for acute stress disorder. While all parents expressed satisfaction with care received; PC parents were extremely satisfied with care. No statistically significant differences in stress or satisfaction scores were noted between parents who received PC consultation and those who did not. Study conclusions validate previous research regarding NICU parent stress and show that additional quantitative and qualitative research regarding NICU palliative care is warranted.

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Georgy, E. E. "Met or matched expectations : what accounts for a successful back pain consultation in primary care." Thesis, Bournemouth University, 2011. http://eprints.bournemouth.ac.uk/18685/.

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Background: Back pain is a common disorder, affecting up to 2 in 3 of the adult population, with the general practitioners (GPs) being the first point of contact for help. Bio-psychosocial management of back pain has been shown to be problematic. Meeting patients‟ expectations is alleged to play a vital role in concordance, adherence and satisfaction with the given treatment; a more potent aspect, however, could be a state of matched patient-GP expectations, which could have an influential effect on the process and outcome of the medical consultation. This aspect, however, has not been fully investigated in the literature and further research is needed to discern the potential importance of this matching on different aspects of the consultation. Methods: The main aim of the study was to investigate the matching of patient-GP expectations related to the back pain consultation in primary care by means of (1) developing a structured questionnaire that can measure this matching; (2) using the tool to measure the matching of patient-GP expectations; and (3) exploring the perceived importance of such matched expectations on different aspects of the consultation. Using a mixed methods sequential nested design, 11 GPs and 57 back pain patients (from 11 general practices in the South of England) completed the Expectations Questionnaire (EQ) that measured the matching of their expectations. Telephone interviews were then used for exploring the perceived importance of this matching. The study tested the hypothesis that the matching of patients‟ and GPs‟ expectations was perceived as an important attribute for a successful back pain consultation in primary care, from the patients‟ and GPs‟ perspectives. Results: The study showed that the EQ can be used as a valid and reliable tool for measuring the matching of patient-GP expectations. The results showed that patients and GPs had mismatched expectations regarding one third of the EQ items. These were mainly related to the psychosocial aspect of the management. The data suggested a trend within the back pain consultations, where patients were less likely to express their expectations and the GPs were less likely to enquire about any unmet expectations at the end of the visit, which could render many expectations unaddressed and unmet. Thematic data analysis revealed several emerging themes with regard to the importance of matched expectations, namely, enhanced communication, trust, empathy, satisfaction and adherence, and have identified different or lack of agendas, time, caseload, cultural and language variations and continuity of care as possible barriers to this matching. Conclusion: The study revealed several convergences, but also identified a significant mismatch between patients‟ and GPs‟ expectations. Matched expectations were perceived as a significant indicator of the quality of the back pain consultation. Considering the many challenges and difficulties in managing back pain in general practice, a state of matched patient-GP expectations has the potential for improving the overall consultation experience, in terms of both the process and the outcome.

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Loughlan, Christopher W. "Increasing health related physical activity in previously sedentary adults : a comparison of fitness testing and exercise consultation." Thesis, University of Glasgow, 1995. http://theses.gla.ac.uk/6294/.

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The research has demonstrated that giving appropriate information to carefully targeted sedentary employees who work in a supportive environment can help increase physical activity levels. At the adoption phase there seems to be no advantage in carrying out a fitness assessment or an exercise consultation. Information giving is most cost effective and one that can be implemented in the many and varied opportunities which exist for health professionals. The general trend, as discerned from the plots of PA over time, showed that any initial positive change dropped markedly in the period between three months to six months post test. Furthermore, the stage of change by time interaction showed, rather surprisingly, that 'contemplators' required relatively less support than 'preparers' in the maintenance phase. No matter what type of intervention takes place, it was clear that on-going support was required to assist individuals maintain any initial positive change. Exercise consultation is a new approach to helping sedentary individuals increase physical activity levels. This type of intervention was found to be appealing from a subjective level and there was some evidence (from planned comparison) to suggest that it was more effective than fitness assessment in helping sustain the change in the move from adoption to maintenance. It is important that sedentary individuals who adopt more physically active lifestyles are given further support and a range of choices to maintain this behaviour change. Exercise consultation is particularly suited to help individuals in this dynamic process.

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Maphis, L. E., C. Smith, K. Hicks, Jodi Polaha, P. Cronin, and W. T. III Dalton. "Improving Behavioral Health Consultation Skills for Serving Rural Populations: An Advanced Trainee’s Experience in Pedagogy and Practice." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6586.

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Moser, Michele R. "ETSU Center of Excellence for Children in State Custody: Consultation Model." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/4980.

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Chapman, Hazel Margaret. "The health consultation experience for people with learning disabilities : a constructivist grounded theory study based on symbolic interactionism." Thesis, University of Chester, 2014. http://hdl.handle.net/10034/620698.

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Aims. The aim of this study was to explore the effects of the health consultation experience for people with learning disabilities, particularly in terms of their self-concept Background. Annual health checks have been introduced as a reasonable adjustment for health providers to make in meeting the needs of people with learning disabilities, who experience significantly poorer health outcomes than the general population. Evaluation of the health consultation from the service user perspective can inform this service provision. Design. A constructivist grounded theory approach, based on symbolic interactionism, was used to explore the meaning of the health consultation experience for the person with learning disabilities, and its effects on their sense of self. Methods. Purposive and snowballing sampling was used to recruit 25 participants with learning disabilities through a GP practice, self-advocacy groups and a health facilitator. Nine individual interviews, three interviews with two participants, three focus groups (n=7, n=5 and n=3), and an audio-recorded health check consultation were carried out (with two participants interviewed twice and four attending two focus groups), as well as a member check used to assess the resonance of the findings. Data collection was undertaken in different primary care trusts across the north west of England. Data were subjected to constant comparative analysis, using a symbolic interactionist approach, to explore all aspects of the health consultation experience and its effects on the self. Findings. Current expectations, attitudes and feelings about health consultations were strongly influenced by previous experience. Participants negotiated their own reality within the consultation, which affected their self-concept and engagement with their health care. Respectful and secure health professional – service user relationships, developed over time, were central to an effective consultation. Perspectives on the consultation, and engagement within it, were co-constructed with a companion, who could help to promote the personhood of the service user with support from the health professional. Anxiety, embarrassment and felt stigma were identified as significant barriers to communication and engagement within the consultation. Conclusions. People with learning disabilities have similar health consultation needs and expectations to other people, but may have more difficulties in engaging with the process and building trusting relationships with the health professional, due to previous negative experiences, anticipated stigma and loss of self within health settings leading to a fear of disclosure. This, combined with difficulties in communication and cognitive processing, results in less satisfactory outcomes persisting over time. The effects of triadic consultations are generally positive, particularly where relatives or health facilitators are involved. However, continuity of companion as well as health professional is needed, and more service user engagement should be supported. Fundamental attitude change by health professionals, supported by specific educational initiatives to enhance their understanding of the service user perspective, is needed to reduce health inequalities. Participatory research by people with learning disabilities should inform future health care practice.

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Vasconcelos, Camila Teixeira Moreira. "Effects of an educational intervention on the women adhesion to return consultation for receive the Papanicolaou smear result." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2576.

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Universidade Federal do CearÃ
Ã fato que a problemÃtica relacionada ao nÃo retorno das mulheres para receber o resultado do exame preventivo tem causas multifatoriais, no entanto, partimos do pressuposto que a educaÃÃo perpassa todas essas Ãreas e que se realizada de forma dialÃgica e reflexiva levarÃ Ãs mulheres da passividade Ã criticidade, de forma a serem sujeitos no processo de adoÃÃo de comportamentos saudÃveis e busca pela melhoria dos serviÃos de prevenÃÃo do CCU. Este trabalho trata-se de um estudo experimental randomizado, cujo objetivo foi avaliar os efeitos de uma intervenÃÃo educativa sobre o exame de Papanicolaou em relaÃÃo Ã adesÃo das mulheres Ã consulta de retorno para receber o resultado. O local selecionado para realizaÃÃo do estudo foi o Centro de SaÃde da FamÃlia (CESAF) AÃda Santos e Silva, situado no bairro Vicente Pinzon, em uma Ãrea da periferia da cidade de Fortaleza-CE. A populaÃÃo do estudo foi composta pelas mulheres que realizaram o exame de prevenÃÃo do CCU no referido CESAF. A coleta de dados aconteceu no perÃodo de fevereiro a julho de 2008, sendo realizada em trÃs etapas para o grupo de intervenÃÃo (inquÃrito CAP, intervenÃÃo educativa e consulta de retorno), e em duas etapas para o grupo controle (inquÃrito CAP e consulta de retorno). Os dados foram compilados e analisados atravÃs do programa estatÃstico Statistical Package for the Social Sciences (SPSS) versÃo 13.0. Para todas as anÃlises, um valor de p <0,05 foi considerado estatisticamente significativo. Durante a pesquisa foram realizados 261 inquÃritos CAP (150 do grupo intervenÃÃo e 111 do grupo controle). No entanto, foram excluÃdas do estudo, 11 mulheres (09 do grupo intervenÃÃo e 02 do grupo controle) por nÃo terem realizado o exame de Papanicolaou, o que totalizou uma amostra de 250 mulheres (141 do grupo intervenÃÃo e 109 do grupo controle). Quanto ao conhecimento sobre o Papanicolaou, apenas 40,4% foram classificadas com conhecimento adequado. Em relaÃÃo Ã atitude e prÃtica das mulheres frente ao exame, o percentual de adequaÃÃo foi de 28% e 67,6% respectivamente. Das 230 (92%) mulheres que retornaram para a consulta no presente estudo, 173 (75,2%) compareceram na data aprazada e 57 (24,8%) apÃs a data aprazada. Esses dados sÃo relevantes, na medida em que permitem afirmar que somente o fato de ter consulta de retorno, como no caso do grupo controle (n = 110), a taxa de exames retidos na instituiÃÃo caiu de 23,98% para 10,0%. Quando se associou a consulta de retorno Ã intervenÃÃo educativa (grupo intervenÃÃo/n = 140), essa taxa baixou para 6,4%. A aplicaÃÃo da estratÃgia elaborada durante esta pesquisa demonstrou sua efetividade, na medida em que despertou o interesse das mulheres, mesmo as que eram do grupo controle, em participar da intervenÃÃo educativa e em debater sobre a problemÃtica em questÃo. A eficÃcia da intervenÃÃo educativa aplicada durante o estudo pode ser comprovada atravÃs da diminuiÃÃo da taxa de nÃo retorno Ã unidade de aproximadamente 24% para 6%. NÃo houve diferenÃa estatisticamente significativa entre as taxas de nÃo retorno dos grupos controle e intervenÃÃo. O resultado desta pesquisa demonstrou que Ã primordial a garantia de consulta de retorno Ãs mulheres que realizam o exame de Papanicolaou em um dia normatizado pela instituiÃÃo, com flexibilidade no atendimento Ãs mulheres que nÃo comparecem na data aprazada, para diminuir as taxas de nÃo retorno. AlÃm disso, quando associada a garantia de consulta de retorno Ã utilizaÃÃo da intervenÃÃo educativa sugerida nesta pesquisa, a taxa de nÃo retorno Ã bem menor, assim pode-se garantir serviÃo de qualidade na prevenÃÃo e controle do cÃncer cÃrvico-uterino

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Dissertations / Theses on the topic 'Health consultations'

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