Factors Associated With Noncompliance With Psychiatric Outpatient Visits
ABSTRACT 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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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 · 2.90 Impact Factor
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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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ABSTRACT: Non-compliance with pharmacotherapy among persons suffering from schizophrenia disorders stands at an average rate of 42% and is the subject of numerous studies. However, no studies to date have addressed the specific question of non-compliance with psychosocial treatment. The present study therefore aimed to determine the rate of drop-out from psychosocial treatment and to assess the influence of factors on this rate. A meta-analysis was conducted based on 74 studies of randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder. A drop-out rate of 13% was obtained. Age, gender, duration of illness, duration of treatment, treatment setting and study quality affected drop-out rates. The 13% rate of drop-out from psychosocial treatment is markedly lower than the drop-out rate from pharmacotherapy studies. This finding supports the feasibility of evidence-based psychosocial treatment - which has, moreover, clearly been shown to be clinically effective - as part of a complete care program for schizophrenia.Schizophrenia Research 05/2010; 121(1-3):266-70. DOI:10.1016/j.schres.2010.04.003 · 4.43 Impact Factor