Requesting physicians' experiences regarding infectious disease consultations

Infectious Diseases Unit, Grenoble University Hospital, F-38043, Grenoble, France.
BMC Infectious Diseases (Impact Factor: 2.61). 03/2011; 11(1):62. DOI: 10.1186/1471-2334-11-62
Source: PubMed


Solicited consultations constitute a substantial workload for infectious disease (ID) specialists in the hospital setting. The objectives of this survey were to describe requesting physicians' experiences regarding ID consultations.
A cross-sectional survey was conducted in a university-affiliated hospital in France in 2009. All physicians were eligible (n = 530) and received a self-administered questionnaire. The main outcomes were reasons for request and opinion. Secondary outcomes were frequency of request and declared adherence to recommendations.
The participation rate was 44.7% (237/530). Among the responders, 187 (79%) had solicited the ID consultation service within the previous year. Ninety-three percent of the responders (173/187) were satisfied with the ID consultation. The main reasons for requesting consultations were the need for therapeutic advice (93%), quality of care improvement (73%) and the rapidity of access (61%). ID consultations were requested several times a month by 52% (72/138) of senior physicians and by 73% (36/49) of residents (p = 0.01). Self-reported adherence to diagnostic and therapeutic recommendations was 83% and 79%, respectively.
The respondent requesting physicians expressed great satisfaction regarding ID consultations that they requested principally to improve patient care and to assist in medical decision making.

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    • "MedQual center experience, in the last 10 years, has led us to observe a permanent and increasing demand for infectious diseases expertise both in hospital and in community settings. The MedQual center has assessed the possibility to pool resources in the Pays-de-la-Loire region by implementing a network of antibiotic therapy referents to answer the expectations of community healthcare professionals [10], and healthcare professionals working in institutions without any infectious disease or intensive care specialist [11] "
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    ABSTRACT: Objectifs Conformément au nouveau Plan Antibiotique, MedQual évalue la possibilité d’organiser en Pays-de-la-Loire, un réseau de référents en antibiothérapie afin de répondre aux attentes des professionnels de santé libéraux et des établissements de santé (ES) dépourvus d’infectiologue. Méthodes Une enquête, menée en collaboration avec les antibioréférents de la Région, pendant cinq jours, a permis d’évaluer l’activité réelle en antibiologie de liaison. Quatre critères étaient retenus : origine de l’appel (interne/externe à l’ES), type de question (diagnostic/thérapeutique), temps mobilisé pour le conseil prodigué, type de conseil. Résultats Vingt antibioréférents ont participé à l’enquête. Sur les 323 questions, 81 % étaient internes à l’ES, 7,7 % provenaient d’un autre ES et 11,3 % du secteur ambulatoire ; 56,3 % des questions concernaient une stratégie thérapeutique, 21 % une aide au diagnostic et 22,6 % une aide à la fois diagnostique et thérapeutique. Les deux tiers des questions étaient traités en moins de dix minutes. Dans 68,7 % des cas, l’antibioréférent a apporté un conseil ponctuel ; 19,8 % des appels nécessitaient un suivi du patient, 6 % ont conduit à orienter le patient vers une consultation. Conclusion Ce travail démontre clairement qu’une mutualisation des antibioréférents serait d’un grand intérêt pour la Région. Près de 20 % des questions étaient externes à l’ES d’origine de l’infectiologue, ce qui démontre un réel besoin d’expertise en infectiologie. Ce réseau permettrait d’améliorer la qualité et la sécurité des soins dans une démarche de maîtrise médicalisée des dépenses de santé.
    Médecine et Maladies Infectieuses 12/2013; 43(11-12). DOI:10.1016/j.medmal.2013.09.005 · 1.24 Impact Factor
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    • "Consultation to IDs, although not always performed by treating physicians, is part of hospital’s daily practice. The easy and rapid access to IDs has been identified as important factor facilitating consultation instead of seeking other sources of information, which are more time-consuming [7]. For this reason insertion of written ID recommendations in clinical records seems an strategy to be considered for rapid access to ID recommendations by treating physicians. "
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    ABSTRACT: Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital’s daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R2 Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated. Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health–economic benefits and stimulates further investigation. Trial registration Current Controlled Trials ISRCTN83234896.
    BMC Infectious Diseases 11/2012; 12(1):292. DOI:10.1186/1471-2334-12-292 · 2.61 Impact Factor
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    ABSTRACT: Infectious diseases (ID) make up a substantial part of a general practitioner's (GP's) workload. GPs frequently solicit ID specialists requesting advice on managing their patients with ID. The objectives of this study were to examine GP reasons for soliciting ID consultations and to assess the GPs' and specialists' opinions of the ID consultation service. This was a prospective study of consecutive solicited ID consultations requested by GPs from the ID specialists of a 2200-bed university-affiliated hospital, conducted between October 2008 and March 2009. Data related to GP characteristics, their reasons for requesting the consultation, the recommendations given by the specialists, and the specialists' perceptions of the exchange were collected. GPs were asked to report their adherence to recommendations and their perceptions of the consultations. A mean of 57 telephone consultations per month were requested by GPs during the study period. ID specialist recommendations were related to antibiotic treatment (66.2%), diagnostic or monitoring tests (46.5%), and a subsequent formal consultation or hospitalization (29.6%). The reasons reported for GPs requesting an ID consultation were related to patient management (96.5%), rapidity of access (86.3%), and quality of care improvement (84.2%). GPs were satisfied with the telephone consultations in 97.9% of cases and ID specialists in 94.7%. Telephone consultations with ID specialists were widely appreciated by GPs, probably due to the accessibility of these specialists. Further study is needed to assess the effects of these telephone consultations on quality of care.
    Scandinavian Journal of Infectious Diseases 08/2011; 43(11-12):912-7. DOI:10.3109/00365548.2011.598874 · 1.50 Impact Factor
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