Outpatient Requests, Initial Sessions and Attrition

Abstract

Treatment attrition in a psychiatric outpatient department was evaluated. Of eighty-two consecutive new patients, fifty-three (65%) showed up for a second appointment while twenty-nine (35%) failed to return. None of the demographic variables or specific categories of patient requests differentiated continuers from non-continuers; nor was attrition significantly influenced by feeling one's problems were understood, symptomatic improvement or receiving the kind of intervention originally desired. Treatment continuers were more likely to have been referred by other hospital clinics or psychiatric care facilities, and more often had previous outpatient contact, but these differences did not reach statistical significance. The only outcome measures significantly related to continuation were: perceiving one's feelings understood in the initial session, feeling satisfied with the interview, and planning to return for the next appointment. Theoretical and practical implications of these findings are discussed.

A Comparison of Usa and New Zealand Patients' Requests and Clinicians Understanding of Patients' Requests

“…When a patient enters the initial interview with specific treatment requests which are ignored, this may interfere with future adherence to treatment recommendations (Eisenthal et al 1979;Eisenthal, Koopman & Lazare, 1983). However, thus far, the limited research attempting to determine whether understanding patients' requests (or other factors of the &dquo;negotiated approach&dquo;) leads to improved adherence to treatment has produced mixed findings (Eisenthal et al 1979;Zisook al. 1979b) and warrants further investigation.…”

“…1979;Eisenthal, Koopman & Lazare, 1983;Hornstra, Lubin & Lewis, 1972;Tracey, 19~6), but at this time, this is not clearly demonstrated by the available research (Zisook al. 1979b).…”

Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad.

“…Dissatisfaction with services or therapists is frequently mentioned by UTs as their reason for quitting (Acosta, 1980; DuBrin & Zastowny, 1988; Gill, Singh, & Sharma, 1990; Pekarik, 1983b, 1992). UTs’ levels of satisfaction with therapy or therapist tend to be significantly lower than are continuers’ or completers’ (McNeill, May, & Lee, 1987; Papach-Goodsitt, 1986; Zisook, Hammond, Jaffe, & Gammon, 1978).…”

Does Informing Referring Practices About Visit Non-Compliance Improve Subsequent Show Rates to a Pediatric Cardiology Practice?

“…14 In contrast to the multitude of studies characterizing patient factors resulting in missed appointments, there are few studies evaluating how NSs are viewed and managed by the primary care team. [15][16][17][18] Although data are limited, survey and focus group data of primary practices suggested that patient factors were perceived as the main determinant for visit non-compliance as opposed to any practice factors. 17 Such attitudes by health care teams may correlate with design of interventions that implement consequences for NSs (penalty or fine) rather than implementing changes at a practice level.…”

“…Indeed, some patients who were not seen may have reasonable justifications especially if they believed the visit was unnecessary or were dissatisfied with a previous encounter. 16 Regardless, greater patient communication, even if as simple as visit reminders, leads to fewer NSs compared to no communication. 18 To this end, by providing NS notification, the referring physician may play a critical role in investigating the NS, reassessing the need for the referral, and/or helping to eliminate barriers to keeping the visit.…”