Television and telephone communications were randomly used to compare their effectiveness in allowing consultation between a hospital-based physician and remote nurse practitioners. Visits using television for consultation averaged 50 minutes as compared with 40 minutes for telephone. This difference was caused by longer work-ups before the consultation, longer delays after it was requested, and longer consultations, themselves, on television. However, television consultations resulted in significantly fewer immediate referrals of patients to hospital physicians: 6 plus or minus 1 as compared to 12 plus or minus 1 per cent (mean plus or minus S.E.M) OF ALL TELEPHONE CONSULTATIONS (P SMALLER THAN 0.005). Although no overall difference in satisfaction was documented between the results of television and telephone consultations, participants preferred the former for medical decision making and cited it for allowing more social interaction than telephone. These findings suggest that television may have its greatest value in remote sites where the sense of isolation is great and the need to reduce long-distance referrals offsets the costs of the system.

No abstract

No abstract

Studies assessing quality of general pediatric care are handicapped by (1) lack of explicit criteria, (2) the broad spectrum of medical needs presented, and (3) the need to distinguish between influence of patient and provider factors. In this study, part of a comprehensive study of utilization of pediatric services at five sites (three neighborhood health centers, an emergency room, and a hospital-based primary care program), we selected three measures sampling different aspects of quality of care, including (1) immunization status, (2) screening procedures, and (3) ongoing care for ten tracer conditions. Adequacy of follow-up of the tracer conditions was assessed along two dimensions: (1) whether a return appointment was scheduled, and (2) whether the patient kept the appointment ("compliance"). Results indicate that attainment of fully immunized status varies inversely with age, while for the tracer conditions, arrangement of follow-up (provider factor) was associated with site, and compliance (patient factor) was associated with both site and pattern of use. Accomplishment of follow-up was better for patients diagnosed in a primary care facility than in the emergency room and for patients with close ties to a primary care facility than for those with limited or no involvement with primary care. These findings support the value of continuity of care in a setting designed to deliver comprehensive care.