Factors Associated With Noncompliance With Psychiatric Outpatient Visits

Harvard University, Cambridge, Massachusetts, United States
Psychiatric Services (Impact Factor: 2.41). 04/2001; 52(3):378-80. DOI: 10.1176/
Source: PubMed


Adherence to recommended services is essential for long-term effectiveness of ambulatory treatment programs, but factors associated with such adherence are not securely established. We evaluated attendance at 896 scheduled psychiatric clinic visits for 62 patients at a major psychiatric teaching hospital. Visit adherence was found to be significantly higher among patients in an acute stage of illness, those with a personality disorder, those with a post-high-school education, and those living alone. Adherence was also higher when visits were routinely scheduled, when the intervisit interval was shorter, and when the visit entailed psychotherapy rather than pharmacotherapy.

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    • "Dropping out as a barrier to appropriate psychiatric service delivery has been the focus of several studies. Some estimate that dropping out occurs in approximately 20–60% of outpatients, and factors such as patient expectations of therapy, male gender, younger age, lower income and suboptimal health status have been identified as important predictors [5] [6] [7] [8] [9] [10] [11] [12]. Higher rates of dropouts have also been reported among patients with no history of psychiatric disorders (i.e., new cases) [13]. "
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    ABSTRACT: Background: Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment. Materials and method: In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview. Results: Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (P<.001). With regard to diagnosis, dropping out was more prevalent among patients with substance-related disorders, schizophrenia and other psychotic disorders when compared to other diagnoses (P<.001). Commonly reported reasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (P<.001). Conclusion: Patient dropout is a common problem in outpatient psychiatric treatment, particularly in psychotherapy treatment. Further research on reasons for dropping out and strategies to reduce rates of dropouts is recommended.
    General hospital psychiatry 12/2012; 35(3). DOI:10.1016/j.genhosppsych.2012.10.008 · 2.61 Impact Factor
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    • "age, ethnicity, beliefs about treatment efficacy, income level, psychiatric history), illness-related factors (e.g. the type of disorder, symptom severity, comorbidity) and treatment-related factors (e.g. treatment setting, type of treatment, treatment efficacy, adverse treatment effects, therapeutic alliance) [2,7-9]. Although some of these factors are static and can not be influenced, others are more dynamic and may therefore be targeted in interventions to enhance treatment engagement. "
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    ABSTRACT: Background Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. Methods/design The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. Discussion The current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment engagement and clinical outcomes. The identification of possible mechanisms through which changes in the outcomes occur, offers a tool for the development of more effective future interventions to improve TM and TE. Trial registration Current Controlled Trials NTR2968
    BMC Psychiatry 11/2012; 12(1):209. DOI:10.1186/1471-244X-12-209 · 2.21 Impact Factor
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    • "A major challenge with continuous relapse is that reduction after the next episode is extremely difficult to achieve (Keith et al., 2004; Addington et al., 2010). Non-compliance may be deliberate or accidental and can be as a result of numerous factors (Centorrino et al., 2001; Irani et al., 2004; Rabin et al., 2008; Bulloch and Pattern, 2009). Breen and Thornhill (1998) categorized the reasons for non-compliance into three distinct classes namely; medication, patient and provider-related reasons. "
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    ABSTRACT: The complexity of the brain and the membranous blood-brain barrier (BBB) has proved to be a significant limitation to the systemic delivery of pharmaceuticals to the brain rendering them sub-therapeutic and ineffective in the treatment of neurological diseases. Apart from this, lack of innovation in product development to counteract the problem is also a major contributing factor to a poor therapeutic outcome. Various innovative strategies show potential in treating some of the neurological disorders; however drug delivery remains the most popular. To attain therapeutic drug levels in the central nervous system (CNS), large, intolerable systemic doses are generally administered. The success of maintenance therapy in many neurological diseases depends on a number of variables, including the constant release of neurotherapeutics, a reduction in the dosing frequency, a greater antipsychotic drug bioavailability and ultimately improved patient compliance, many of which is not achievable by conventional oral or parenteral formulations. This article reviews the therapeutic implantable polymeric and transdermal devices employed in an attempt to effectively achieve therapeutic quantities of drug across the BBB over a prolonged period, to improve patient disease prognosis.
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