Predictors of Missed First Appointments at Community Mental Health Centers After Psychiatric Hospitalization

Compton, M.P.H. Michael T.; Rudisch, Bruce; Craw, Michael J.; Thompson, Barbara; Owens, Dwight Antonio

doi:10.1176/ps.2006.57.4.531

Cited by 71 publications

(54 citation statements)

References 18 publications

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“…This analysis was part of a study aimed at determining predictors of non-adherence with the first scheduled community mental health outpatient appointment following hospitalization [17]. Inclusion in the study was restricted to consecutively discharged patients with a scheduled follow-up appointment at any of 12 participating community mental health settings in a single urban county.…”

Section: Methodsmentioning

confidence: 99%

Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

Craw

Compton

2006

Soc Psychiat Epidemiol

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j Abstract Background The objective of this analysis was to determine the ways in which patients' legal statuses at hospital admission and discharge are associated with select sociodemographic and clinical variables. This study specifically investigated differences between patients who were voluntary during both admission and discharge, patients who were involuntary on admission but voluntary on discharge (having converted to voluntary status during hospitalization), and patients who were involuntary during both admission and discharge. Method Data were collected from the charts and treating clinicians of 227 consecutively discharged patients from two psychiatric units in a large, urban, county hospital in the southeastern United States. Based on results of bivariate tests, sociodemographic and clinical factors were entered into a polytomous logistic regression model to determine effect estimates (adjusted odds ratios). Results In the bivariate analyses, 15 variables were significantly associated with the trichotomous legal status. In the model, three factors were independently significantly associated with legal status, while controlling for four potential confounders: (1) whether or not the patient was experiencing psychotic symptoms at discharge, (2) whether or not the patient had documented medical problems requiring medication at discharge, and (3) the number of psychiatric medications. Conclusions A generalized lack of treatment engagement and adherence among involuntary patients likely underlies significant differences between the groups in terms of psychotic symptoms, diagnosed medical problems requiring medications, and number of psychiatric medications at discharge. Studying legal status (and the process of legal status conversion from involuntary to voluntary) and its correlates is an important topic for further research.

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Section: Methodsmentioning

confidence: 99%

Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

Craw

Compton

2006

Soc Psychiat Epidemiol

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“…A study of the management of 3923 patients with diabetes in primary care found that those with secure attachment styles (as assessed by the Relationship Questionnaire) were significantly more likely to attend than those with dismissing attachment styles (Ciechanowski et al, 2006). Compton et al (2006) collected data from team members and medical notes on 234 consecutively discharged patients from two in-patient units in a US urban county hospital. In a logistic regression model, the four characteristics that were significant predictors of missed first appointments were involuntary legal status at discharge or leaving against medical advice, not having an established out-patient clinician, an Axis IV problem relating to the patient's primary support group (for example, death of a family member or health problems in the family) and the number of days from discharge to the follow-up appointment.…”

Section: Why Don't Patients Attend Their Appointments?mentioning

confidence: 99%

Why don't patients attend their appointments? Maintaining engagement with psychiatric services

Mitchell¹,

Selmes²

2007

Adv. psychiatr. treat

243

254

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Patients miss about 20% of scheduled appointments for mental health treatment, almost twice the rate in other medical specialties. Up to 50% of patients who miss appointments drop out of scheduled care. Many who miss appointments because of slips and lapses later rearrange their appointments without adverse consequences. Those that do not are at risk of further deterioration, relapse and hospital readmission. Predictors of non-attendance are complex and linked with the predictors of missed medication. Service barriers and administrative errors are common but are often overlooked in the absence of feedback from patients. Of prime importance are the therapeutic alliance and degree of ‘helpfulness’ of the clinician but again these are rarely measured routinely. Useful markers of engagement include patient-rated trust, satisfaction and degree of perceived participation in treatment decisions. Much can be done to improve attendance in most services. Simple measures such as offering prompt, convenient appointments, offering reminders and augmenting with telephone contact have a reasonable evidence base. Scales to assess therapeutic alliance are now available. Complex interventions need to be evaluated carefully in order that the overall benefits outweigh costs. We suggest that clinicians consider accessibility, discharge policies and patient feedback when examining local rates of non-attendance.

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“…Consecutive discharges from each of these two units were studied as part of a project to examine predictors of outpatient nonadherence (9). Due to the inclusion criteria of the parent study, charts of patients discharged with follow-up appointments to clinics other than the designated clinics in the metropolitan county in which the hospital is located (e.g., to private practices or to community mental health centers in other counties) were excluded.…”

Section: Setting and Samplementioning

confidence: 99%

“…This analysis was conducted using data from a study that examined predictors of nonadherence with the first outpatient community mental health follow-up appointment after psychiatric hospitalization (9). The aim of this analysis was to investigate the predictors of LOS on two inpatient psychiatric units in a large, urban, university-affiliated, county hospital.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Inpatient Psychiatric Length of Stay in an Urban County Hospital

2006

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This study investigated predictors of length of stay (LOS) for two inpatient psychiatric units (a crisis stabilization unit and a longer-stay milieu unit) in a large, urban, university-affiliated, county hospital. It was hypothesized that three variables would be independently associated with shorter LOS: (1) higher Global Assessment of Functioning (GAF) scale scores, (2) not requiring the use of seclusion or restraints, and (3) the presence of a comorbid substance use disorder. Data were collected on consecutive discharges (n=234) from the two inpatient units. Bivariate tests were conducted, and multiple linear regression models assessed the independent effects of potential determinants of LOS. The presence of a comorbid personality disorder or substance use disorder was predictive of shorter LOS on the crisis stabilization unit (n=88). Several variables were found to be predictive of shorter LOS on the longer-stay milieu unit (n=146), including: involuntary legal status on discharge, not requiring seclusion or restraints, higher admission GAF scale score, female gender, and the presence of a comorbid substance use disorder. Findings indicate that a substantial portion of the variance in LOS in this setting can be predicted from basic sociodemographic and clinical factors available in hospital medical charts.

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Predictors of Missed First Appointments at Community Mental Health Centers After Psychiatric Hospitalization

Cited by 71 publications

References 18 publications

Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

Characteristics associated with involuntary versus voluntary legal status at admission and discharge among psychiatric inpatients

Why don't patients attend their appointments? Maintaining engagement with psychiatric services

Determinants of Inpatient Psychiatric Length of Stay in an Urban County Hospital

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