Dropout Rates and Factors Associated with Dropout from Treatment among Elderly Patients Attending the Outpatient Services of a Tertiary Care Hospital

By Grover, Sandeep; Dua, Devakshi et al. | Indian Journal of Psychiatry, January-March 2018 | Go to article overview

Dropout Rates and Factors Associated with Dropout from Treatment among Elderly Patients Attending the Outpatient Services of a Tertiary Care Hospital


Grover, Sandeep, Dua, Devakshi, Chakrabarti, Subho, Avasthi, Ajit, Indian Journal of Psychiatry


Byline: Sandeep. Grover, Devakshi. Dua, Subho. Chakrabarti, Ajit. Avasthi

Aim: This study aimed to evaluate the dropout rates from treatment and associated factors among elderly patients attending a tertiary care psychiatry outpatient facility. Materials and Methods: Data of 1422 patients aged ≥60 years, attending the walk-in clinic were evaluated. Results: Out of 1422 patients, 406 (28.55%) belonged to the "dropout" group. In the dropout group, the age of patients was significantly higher than the followed-up group, and a higher proportion of patients were >70 years old. Significantly lower proportion of patients with diagnosis of depressive disorders belonged to the "dropout" group and significantly higher proportion of patients with "other" diagnoses belonged to the "dropped out" group. In patients with depressive disorders, a higher proportion of the patients in the "dropout" group were Hindu by religion (68.7% vs. 58.7%; ?2 = 4.26; P = 0.03). In patients with bipolar disorder, patients in the "dropout" group had significantly higher income (Rs. 13,323 [standard deviation [SD] = 16,769] vs. 5681 [SD = 9422]; t-test value: 2-25; P = 0.028) and lesser proportion of patients were of the male gender (63.15 vs. 86.95%; Mann-Whitney U value = 257.5; P = 0.039). In the group of other diagnoses, a higher proportion of patients in the "dropout" group were currently single (32.3% vs. 18.7%; ?2 = 4.12; P = 0.042), from rural locality (63.1% vs. 46.72%; ?2 = 4.33; P = 0.037) and were not prescribed medications (40% vs. 22.4%; ?2 = 6.05; P = 0.04). Conclusion: Dropout from treatment among elderly patients is associated with higher age, not being prescribed medications, and diagnosis other than the affective disorders, psychotic disorders, and the cognitive disorders.

Introduction

Adherence to treatment and clinical appointments is an important area of the study in the field of health. Treatment adherence is defined as "the extent to which a person's behavior, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider."[1] It is often understood as medication adherence; however, it also encompasses adherence to the nonpharmacological treatments and other advices such as following the dietary and lifestyle modifications. In addition, treatment adherence also involves conforming to the appointments given by clinicians.[1]

Accordingly, adherence is divided into adherence to treatment(s) and clinical appointments. Compared to treatment/medication adherence, appointment adherence has received less attention. Appointment nonadherence is further understood as missed appointments, partial adherence, dropouts, and completers of the treatment.[2] Patients with missed appointments do not turn up on the scheduled appointment with or without any information. Patients who miss their follow-up appointment due to lapses and later reschedule their appointments are considered as partially adherent. Dropout of treatment basically means total disengagement from the treatment, without either clinical resolution of symptoms or a agreed upon treatment termination.[2],[3] Accordingly, dropout from treatment is defined as "having attended at least one session for diagnostic assessment or treatment and discontinuing the assessment or treatment process on the patient's own initiative by failing to attend any further planned visit."[4],[5]

Nonadherence to appointments in psychiatry is a rule, rather than an exception. Appointment nonadherence is a common problem faced in most health-care facilities. In terms of missed appointments, data from general adult clinics suggest that the rates range from 14% to 64%.[4],[6],[7],[8] The dropout rates reported across various studies also suggest that about 31%-64% of patients do not come back for their first outpatient appointments after hospitalization, with an average nonattendance rate being 50% for the initial appointments. …

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