Community 3-Referral, Consultation and team care FINAL PDF

FAMILY MEDICINE Community -3 0 RefeRRal, Consultation & team CaRe I D EFINITION OF C ONSULTATION...

FAMILY MEDICINE Community -3 0 RefeRRal, Consultation & team CaRe I D EFINITION OF C ONSULTATION Written  It is the occasion (interview) when a person who is ill or believes himself to/be ill seeks the advice of a doctor whom he trusts.  It occurs in the intimacy of the consulting room. D EFINITION OF M EDICAL C ONSULTATION  A process by which a professional person reaches an understanding of a patient. Aim of Consultation:  Doctor having gathered his evidence → will give explanation & advice. Types (Models) Types (Models) of Consultation: MCQ What is a Model?  Biological model (Hospital model).  Definition: A map which can be used to help  Bio-psychosocial model. describe the behavior that is observed.  Balint model.  It is concerned with a specific subject area.  Pendleton model.  It is used mainly as an aid for analysis →  Neighbor model. End in depth understanding of areas which  Stott and Davis model. are complex and involve many elements.  Pendleton model (The Doctor’s Tasks)  There is defined seven tasks forming the aims of each consultation: Written  To define the real reason for attendance.  To consider other problems.  To choose “with the patient” the appropriate action for each problem.  To achieve a share of understanding of the problem with the patient. To involve the patient in the management.  To use time and resources effectively.  To establish and maintain doctor-patient relationship. Dr. Ziad Mahana 23  FAMILY MEDICINE Community -3 Phases Phases of Consultation: MCQ  Offering the problem.  Elucidation of key issues.  A targeted physical examination.  Explanation of the diagnosis.  Negotiation of plans of management.  Follow up. II D EFINITION OF C OUNSELLING Written  It is interpersonal communication designed to help another person to make a decision.  OR: It is to give a professional help or advice to someone to solve physical or psychological problem (‫ أو بكل بساطة‬Give an advice to someone). *‫الشح‬‫*إضافة من ر‬  OR: Activity of trained person listening to someone that has a problem to give him an advice to solve problem. *‫الشح‬ ‫*إضافة من ر‬ Types Types of Counselling: MCQ  Preventive counseling.  Crisis counseling.  Problem solving counseling.  Decision making counseling. Process Process of Counselling involves: Written Listening Skills  Listening. 1. Be accepting.  Discussion. 2. Be concerned.  Talking and negotiation. 3. Be patient.  Explaining and education. 4. Be specific. 5. Be honest. 6. Be faithful. Dr. Ziad Mahana 24  FAMILY MEDICINE Community -3 Medical Counselling Elements of medical Counseling: MCQ GATHER ‫ أفعال‬4 ‫ صفات‬4  Introduce yourself.  Be polite, friendly & respectful. G GREET THE  Ask how you can help?  Give the clients your full CLIENTS  Explain what will happen during the visit. attention as soon as you meet  Conduct counseling privately. them.  Reasons for coming. A ASK CLIENTS  Their experience with the health matter that concerns them. ABOUT  Any information needed to complete client records.  Ask Clients about themselves. T TELL THE  Their condition. CLIENTS ABOUT  or Choices. ‫ خطوات‬4 ‫ صفات أثناء المحادثة‬4  Help the clients to think about the results of  Keep questions open, each possible choice. simple & brief.  Ask if the client wants anything matte clearer,  Look at your client as you H HELP CLIENTS repeat & rephrase information as needed. speak. TO UNDERSTAND  Check whether the client has made a clear  Listen actively to what the understanding. client says.  “What have you understood?”  Show your interest &  “What have you decided to do?” understanding all the time  Wait for the client to answer.  Give supplies, if appropriate.  If the service cannot be given at once..  Tell the client how, when and where it could be provided. EXPLAIN WHAT  Describe possible side effects and what to do if they occur. TO DO?  Ask the client to repeat instructions. E  Make sure the client remembers & understands! If possible, give the client printed materials to take home.  For more supplies. EXPLAIN WHEN  For routine follow up. TO COME BACK?  For any complication or therapeutic side effect.  For any reason or as they wish.  Check if the client is using the treatment correctly.  Ask if the client has any question or anything to discuss.  CONSIDER ALL CONCERNS SERIOUSLY! R RETURN VISITS  Ask if the client is satisfied, have there been any problems? & FOLLOW UP  Help the client handle any problems. Ask if any problems occurred since last visit.  Refer client who need specialized care. Dr. Ziad Mahana 25  FAMILY MEDICINE Community -3 III D EFINITION OF F AMILY H EALTH T EAM  A group of people who make different contributions toward the achievement of a common goal. *‫*تعريف الكلية‬  OR: A primary health organization that includes a team of different health care providers to co- ordinate the best patient care possible. *‫*إضافة‬ Members of health team: Written  Family physician (leader).  Dentist or dental assistant.  Psychologist.  Nurses & midwives.  Pharmacist/pharmacy assistant.  Lab technician and X-ray technician.  Epidemiologist  Sociologist.  Administrator.  Health inspector. ⓫ Health educator. ⓬ Other as appropriate (drivers, cleaners, cooks, Janitors and Guards). The Family Physician directs the team and supports team building. Factors that help team upgrading:  Job description for each member of the team.  Regular training.  Regular meeting.  Incentives. Dr. Ziad Mahana 26  FAMILY MEDICINE Community -3 Services The team provides the following services: MCQ  Creating family folders.  Conducting initial examination for all family members.  Early detection of health problems among family members..  By periodic examination and screening tests.  Providing curative care and referral when needed.  Follow-up of chronic conditions, especially: A. Hypertension. B. Diabetes. C. TB cases receiving DOT. DOT: Directly Observed Therapy  Implementing specific programs. E.g., A. IMCI (Integrated Management of Childhood Illness) B. FP (Family Planning).  Implementing all Primary Health Care (PHC) activities.  Providing appropriate bio-psycho-social care at all stages of the life cycle.  Providing the Basic Benefits Package (BBP) at the Family Health Unit/Centre.  In relation to family practice activities, the family health team is responsible for a roster of families in the catchments area. IV Written D EFINITION OF F AMILY H EALTH R ECORDS (FHR)  FHRs are unique instruments in family practice where patient’s information is gathered in one medical file. Importance of Family Health Records (FHR):  Enables documentation of the family members’ main health problems.  Enables easy access to this information to deliver family health care. Dr. Ziad Mahana 27  FAMILY MEDICINE Community -3 Main elements of Family Health Records (FHR): Written  Personal and demographic information of every family member.  Insurance information if present.  Family health history.  Children growth information.  Childhood and adult Immunization record.  Significant medical Problems list.  Medications/allergies.  Lab. & radiological investigations and their results.  History of hospitalizations/surgeries.  Special forms for follow up & control of cases of: A. DM. B. HTN. C. Antenatal care. Dr. Ziad Mahana 28  FAMILY MEDICINE Community -3 V D EFINITION OF R EF ERRAL I N F AMILY P RACTICE  Referral is known as formal communication between family physicians and other medical specialists to care for a patient. CONSULTATION REFERRAL The practice of one physician asking another The transferring the responsibility of a patient for an opinion or assistance to another physician for care of specific problem regarding the diagnosis and management Purpose of Referral:  Primary purpose of referral or consultation is to improve quality of care delivered to the patients  By making available the knowledge, skills, and experience of someone skilled in the management of a particular problem. When to Refer?  Family physicians should refer when:  They feel that the patient will get benefit from referral.  OR They are unable to care for the patient efficiently at family practice setting.  Reasons that are responsible for most of the referral to secondary care: MCQ Written 1. Inadequate diagnostic, therapeutic resources and service in the family practice clinic. 2. Confirmation of diagnosis or plane of management 3. When physician is unsatisfied with the patient prognosis. 4. Patient's request for referral:  The patient has the right to ask for a second opinion. FOR PATIENT  It’s opportunity for the patient to receive the reassurance he needs. FOR PHYSICIAN  It's opportunity to confirm your findings. FOR BOTH  In long term, it will be beneficial for the doctor-patient relationship Types of Referral Written  URGENT When patient is likely to suffer harm if not referred  ELECTIVE When the patient's condition is not emergent. LATERAL From specialist to specialist  REFERRAL Without involvement of the original referring family physician compromise patient care Dr. Ziad Mahana 29  FAMILY MEDICINE Community -3 Referral letter Elements of Referral letter: Written  Socio-demographic data such as name, age, sex, family health record number.  Name of hospital or specialty to which the patient will be referred.  Type of referral (urgent or elective).  Complain & Present history.  Past medical & surgical history.  Medication in use (type, dosage and allergies).  Relevant physical examination.  Relevant investigation.  Clinical diagnosis.  Reasons for referral. ⓫ Name & signature of the referring physician. ⓬ Customize the referral form with enough space for feedback information. Dr. Ziad Mahana 30  FAMILY MEDICINE Community -3 Criteria of good Referral letters: Written  Referral letter should be concise and contains essential information.  Select the relevant data and information that will help the patients and the doctors who receive the letter.  All information in the referral letter should be accurate.  Write clearly and use simple language.  Clarify and specify the reasons for referral and your expectation from the refer.  Document the referral in:  The file of the patient.  Referral register. Responsibilities Responsibilities of the physician making the referral to a specialist: Written  Ensure that the patient understand the need for and purpose of referral.  Clearly specify whether the patient is:  Being sent for consultation.  OR Being transferred to the specialist's care.  Fulfillment the criteria of the referral letter. Responsibilities of the specialists or consultants in the referral process: Written  Provide his services in a timely manner depending on the urgency of the condition.  Communicate his findings in a timely matter to the referring physician.  Notify the referring physician when his or her patient has been admitted to the hospital. Dr. Ziad Mahana 31  FAMILY MEDICINE Community -3 A 30-year-old female, have 2 month baby, visits family health center for using suitable family planning method for her. This type of counseling is: A. Preventive. 1 B. Curative. D C. Crisis. D. Decision Making. E. Problem Solving. Which of the following acronyms represents the basic elements for medical counselling? A. ROLES. B. CLEAR. 2 E C. SPIKES. D. GABAR E. GATHER. A 28-year-old female with chronic headache comes to your office as family physician for a specific purpose of seeking referral to a neurologist. After doing complete assessment of the case, you think that the patient have a migraine headache and her medications for this case are enough. You try to explain but she is insisting to be referred. Which of the following would be best of your response? 3 A. Try to negotiate with her and you insisted on your opinion B B. Refer the patient on her request. C. Try another lines of management with her. D. Tell the patient that she is having no right to ask another opinion. E. Refer the patient for MRI. Dr. Ziad Mahana 32