Non-compliance in community psychiatry: Failed appointments in the referral system to psychiatric outpatient treatment

Abstract

Knowledge about the drop-out pattern of psychiatric patients in the referral phase for outpatient treatment is limited. The aim of the present study was to investigate the importance of selected psychiatric, demographic and administrative parameters in this matter. In a newly opened community psychiatric unit with an open referral system, available relevant data concerning the referred patients were gathered over a 6-month period. Of the 137 patients included in the study, 32% did not show up for their first appointment. On making further attempts to contact the patients, the drop-out frequency dropped to 16%, demonstrating that it is worthwhile offering new appointments to the patients who do not show up. There was no demonstrable relation between the time the patients had waited for the first appointment with a psychiatrist and the drop-out frequency. For patients who had been referred with a diagnosis of psychosis (F 20-29, WHO criteria), or addiction, or had been previously admitted to psychiatric hospital, there was a significant increase in the drop-out rate.

Missed first appointments: Prevalence and associated factors in first-time attendees at an outpatient psychiatric clinic in Nigeria

“…Studies from the developed world report a first-appointment default rate of 26-50% (Carpenter, Morrow, Del Gaudio, & Ritzler, 1981;Chen, 1991;Glyngdal, Sorensen, & Kistrup, 2002;Kruse et al, 2002). The factors most identified as being associated with missed first appointments include younger age (Carpenter et al, 1981;Kruse et al, 2002;Nicholson, 1994), long waiting periods from contact to appointment (Carpenter et al, 1981;Chen, 1991;Nicholson, 1994) and previous psychiatric treatment (Carpenter et al, 1981;Glyngdal et al, 2002).…”

Compliance with Mental Health and Other Specialty Care Referrals among Medicare/Medicaid Dual Enrollees

“…Primary care providers, however, are not as effective as mental health professionals in diagnosing and treating psychiatric disorders (Mojtabai, 1999) and referral to mental health specialists remains a major pathway to mental health care. Compliance with such referrals among non-geriatric samples is rather low (Glyngdal, Sorensen, & Kistrup, 2002;Krulee & Hales, 1988). There is, however, very little information on compliance with mental health referrals, and reasons for noncompliance in the low-income geriatric population.…”

Helping alliance and early dropout from psychiatric out-patient care

“…Early dropout deserves specific attention because it is often more associated with poor outcome than late dropout (32). Psychotherapy research indicates that between 30% and 60% of psychotherapy outpatients drop out prematurely (32)(33)(34), and research on psychiatric services shows that the dropout frequency varies between 20% and 70% (35)(36)(37)(38). These varying numbers depend on methodological problems such as various settings being studied, but mostly on the fact that dropout is not a precise concept.…”

“…demographics, attitude, motivation, type of disorder, and administrative routines. Again, findings are contradictory, but common findings are addiction, low socio-economic status, low age, and negative attitude (35)(36)(37)(38)(39)(40). Reis and Brown (32) argued in a review article that research looking at interactive and multidimensional factors, such as working alliance, satisfaction, patient likeability, and expectations, has proved to be more useful for predicting dropout than research on client, therapist and administrative variables.…”