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Citation
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Rocca P, De Leo C, Giugiario M, Marino F, Mingrone C, Mongini T, Montemagni C, Pulvirenti L. Ital. J. Psychopathol. 2007; 13(3): 324-329. |
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Abstract
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OBJECTIVES: Aims of the present study were two-fold: first, to analyze service utilisation of first-contact patients attending an outpatient mental health service; second, to identify patients and clinical variables associated with an increased probability of leaving care.
METHODS: This study was conducted in the Cognitive Disorders Service, Section of Psychiatry, Department of Neuroscience, University of Turin, between January 2004 and July 2006. During this period, 600 patients attended this outpatient service for the first time and were followed up for 3 months. Patients who failed to return after the last visit, even though a new appointment had been established, were regarded as having dropped-out, while patients who remained in contact with the service were considered "continuers". Patients who discontinued the contact, in agreement with the psychiatrist treating the case, were considered "discharged" and were not included in the final sample of the study. For each patient, the following socio-demographic and clinical features have been collected: sex, age, education, working and living situation, presence of psychiatric anamnesis, diagnosis, number of years between the diagnosis and the contact with our service, age at onset, presence of concomitant medical disorders, number of previous hospital admissions, obligatory sanitary treatments and suicide attempts. Furthermore, all patients were evaluated using Global Assessment of Functioning (GAF). Chi-square tests and t-tests were used in group comparisons, and logistic regression analysis was performed to predict service utilisation.
RESULTS: After 3 months, 23% (n = 136) of the 600 newly referred patients had dropped-out, 24% (n = 144) discontinued treatment following mutual agreement on treatment termination and 53% (n = 320) remained in contact. The final sample included 456 patients, 30% drop-out patients and 70% "continuers". Comparisons of socio-demographic and clinical features between continuing and drop-out patients are shown in Table I. No between-group differences were detected for any socio-demographic features except for age; patients leaving care were significantly younger than those continuing treatment. Patients with a diagnosis of neurotic or somatoform disorders were more likely to drop-out (Tab. II); logistic regression analysis showed an increased risk of dropping out of treatment (OR = 1.82, p = 0.027). Finally, patients continuing treatment showed a significant improvement in global functioning assessed by GAF (t = -8.49, p < 0.001).
CONCLUSIONS: The present results show that in an outpatient mental heath service the rate of drop-out is 30%. Moreover, comparison between patients leaving care and "continuers" showed that a diagnosis of neurotic or somatoform disorders is a predictor of treatment discontinuity. Identifying the extent and reasons for treatment drop-out is a critical task for several reasons.
METHODological, statistical and structural differences complicate the comparison of study results and further investigations on service utilisation are required, particularly in view of their relevance for patient's treatment outcome.
Language: it |