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Comprehensive Evaluation and Rehabilitation of Chronically Ill Ambulatory Patients

CYNTHIA B. DUTTON, M.D.; and ROBERT E. DUTTON, M.D.
Ann Intern Med. 1968;68(5):1028-1038. doi:10.7326/0003-4819-68-5-1028
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SUMMARY:

A clinic is described that was designed to carry out functional evaluation of patients with chronic medical and psychiatric disabilities and to plan for their vocational rehabilitation. The results obtained in 100 patients evaluated in the clinic during the past 7 years are presented and discussed. Thirty-five of these patients were successfully rehabilitated. Success in rehabilitation varied inversely with the severity of the disability, regardless of specific diagnosis. Statistically significant adverse factors included increasing age, education limited to eighth grade or less, a nonsupportive family environment, unemployment, and dependence upon public welfare assistance. Therefore, assessment of all these factors appears to be essential for effective and efficient rehabilitation planning. Adequate follow-up is necessary to maintain the improvements that have been achieved. Perhaps locating such a clinic in a neighborhood setting would improve the quality of referrals and facilitate follow-up care. The team approach to comprehensive evaluation is readily adaptable for use in outpatient clinics. This approach would permit one responsible physician to be fully and currently informed in regard to all aspects of a given patient's problems and thus to improve greatly the quality and effectiveness of medical care.

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