Dropping out of care: inappropriate terminations of contact with community-based psychiatric services

Rossi, Alberto; Amaddeo, Francesco; Bisoffi, Giulia; Ruggeri, Mirella; Thornicroft, Graham; Tansella, Michele

doi:10.1192/bjp.181.4.331

Cited by 90 publications

(97 citation statements)

References 31 publications

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“…Socioeconomic status and marital status had no significant effect on levels of early engagement. Whereas some studies have previously suggested that divorce, living conditions and socioeconomic status are significant predictors of disengagement (Baekeland and Lundwall, 1975;Bender and Pilling, 1985), our results are consistent with studies which show no association (Edlund et al, 2002;Rossi et al, 2002;Wang, 2007). The SOLES has good predictive value for eventual disengagement but further research is required to assess engagement scores in these groups at serial time points.…”

Section: Discussionsupporting

confidence: 88%

Predictors of engagement in first-episode psychosis

Casey

Brown

Gajwani

et al. 2016

Schizophrenia Research

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Engagement with psychiatric services is critical for ensuring successful outcomes in patients experiencing a first episode of psychosis (FEP). However, it is not known how sociodemographic factors and patient beliefs about the causes of mental illness affect engagement. This study explored predictors of engagement in a cohort of 103 FEP patients presenting to an early-intervention service. Beliefs that mental illness is caused by social stress or thinking odd thoughts predicted higher engagement scores. Patients with no qualifications were found to have higher engagement scores than those educated to a higher level. Ethnicity, gender, age and socioeconomic factors were not significantly correlated with engagement scores. Duration of untreated illness (DUI) significantly predicted higher engagement scores, but only for values greater than 1220 days. Duration of Untreated Psychosis (DUP) was not a significant predictor of patient engagement scores. Patient beliefs about the causes of mental illness are an important factor to be taken into consideration and may represent a target of interventions to increase engagement in FEP.

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Section: Discussionsupporting

confidence: 88%

Predictors of engagement in first-episode psychosis

Casey

Brown

Gajwani

et al. 2016

Schizophrenia Research

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“…17,18 Logistic regression analysis showed that those who were either moderately or very satisfied with their outpatient care were less likely to default. However, the specific aspects of outpatient care defaulters found unsatisfactory were not explored and this is one of the limitations of this study.…”

Section: Discussionmentioning

confidence: 99%

Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

Adelufosi¹,

Ogunwale²,

Adeponle³

et al. 2013

Afr. J. Psych

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Objective: To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. Method: This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default. Results: Overall, 20.4% respondents were defaulters, with a median duration of clinic nonattendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20km from the hospital, missing previous appointments and dissatisfaction with outpatient care. Conclusion: Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.

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“…Alguns estudos [35][36][37] registraram taxas de abandono significantemente mais elevadas entre pacientes solteiros, enquanto que o contrário foi registrado por outros autores 38,39 . Pacientes mais jovens tiveram maiores taxas de abandono nos estudos de Young et al 38 , Edlund et al 40 e Rossi et al 37 . Melo & Guimarães 41 encontraram taxas de abandono signifi cantemente mais elevadas em pacientes que não recebiam passes de ônibus para a consulta com especialistas.…”

Section: Avaliação Do Abandono Ou Continuidade De Tratamentounclassified

Comparação da assistência em saúde mental em unidades básicas de saúde com ou sem equipe do Programa de Saúde da Família

Ribeiro

Alves

Silva³

et al. 2009

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃO: O objetivo deste estudo foi comparar o perfil de assistência em saúde mental realizado por unidade básica de saúde (UBS) com equipe de Programa de Saúde da Família (PSF) e sem equipe de PSF. MÉTODO: Estudo observacional, avaliando pacientes encaminhados por UBS da área de abrangência de um serviço especializado de saúde mental no período de abril de 2003 a março de 2006. RESULTADOS: A UBS com equipe de PSF apresentou melhor padrão global de registros de dados, maior responsabilidade exclusiva do médico em suas referências ao nível especializado (p = 0,000), menor capacidade de retenção dos usuários na UBS (p = 0,099), maiores taxas de abandono de tratamento em nível secundário (p = 0,060) e menor percentual de contrarreferência pela equipe especializada (p = 0,028). A taxa de concordância diagnóstica global foi semelhante entre os dois modelos de UBS, com razoável nível de concordância (índice kappa de 44,5 e 43,0%, respectivamente, para UBS com e sem equipe PSF). CONCLUSÃO: A UBS com equipe de PSF não apresentou resultados compatíveis com o que seria de se esperar, em função de sua hipotética melhor qualidade de estrutura.

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Dropping out of care: inappropriate terminations of contact with community-based psychiatric services

Abstract: In a CPS targeted to patients with severe mental illnesses, those who drop out of care are younger patients without psychoses who are generally satisfied with their treatment.

Cited by 90 publications

References 31 publications

Predictors of engagement in first-episode psychosis

Predictors of engagement in first-episode psychosis

Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

Comparação da assistência em saúde mental em unidades básicas de saúde com ou sem equipe do Programa de Saúde da Família

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