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Evaluation of factors associated with psychiatric patient dropout at a university outpatient clinic in Japan

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patient dropout from treatment can lead to a deterioration in clinical condition, thereby increasing the need for more intensive therapy that incurs substantial social and economic losses. The aim of this study was to identify factors related to psychiatric patient dropout at a university outpatient clinic in Japan.

Methods: We retrospectively examined the medical charts of new psychiatric patients who were diagnosed with either a mood disorder (International Classification of Diseases, 10th revision, code: F3) or an anxiety disorder (F4) in the outpatient clinic at Kyoto Prefectural University of Medicine Hospital in Kyoto, Japan, between April 2010 and March 2013. The baseline characteristics of the patients (age, sex, Global Assessment of Functioning score, Clinical Global Impression–Severity of Illness score, education, occupation, marital status, duration of treatment, and prior treatment history), treating psychiatrist experience in years, and sex concordance between the patients and their treating psychiatrists were analyzed using Cox regression models.

Results: From among 1,626 eligible new patients during the study period, 532 patients were enrolled in the study (F3: n=176; F4: n=356). The dropout rate was 35.7%, which was similar to that of previous studies. Higher educational level, being married, and lower Global Assessment of Functioning scores were associated with a lower dropout rate. Although psychiatrist experience was not significantly associated with patient dropout in the multivariate analysis, patients treated by less experienced psychiatrists had a higher hazard ratio for dropout (1.31; 95% confidence interval: 0.94–1.85).

Conclusion: In order to reduce the dropout rate, special focus should be placed on patients with the factors identified in this study, and young psychiatrists should undergo further education to foster adherence.

No MeSH data available.


Patient selection.Abbreviations: MRI, magnetic resonance imaging; KPUM, Kyoto Prefectural University of Medicine.
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f1-ppa-10-1903: Patient selection.Abbreviations: MRI, magnetic resonance imaging; KPUM, Kyoto Prefectural University of Medicine.

Mentions: In this study, patients diagnosed as having mood disorders (International Classification of Diseases, 10th revision, code: F3) and anxiety disorders (F4) were included in the study if they were aged 18 years or older and had visited KPUM for the first time between April 2010 and March 2013.24 F3 disorders are mood (affective) disorders, which include manic episodes, bipolar affective disorder, depressive episodes, recurrent depressive disorder, persistent mood disorder, and other mood disorders. F4 disorders are neurotic, stress-related, and somatoform disorders, which include phobic anxiety disorders, other anxiety disorders, obsessive compulsive disorder, reaction to severe stress and adjustment disorders, dissociative (conversion) disorders, somatoform disorders, and other neurotic disorders. Patients who had visited KPUM for nontreatment purposes (eg, to obtain a second opinion, medical certificate, or medical examination) were excluded from analysis; in addition, we also excluded patients who were diagnosed as not needing treatment for more than 2 months. Psychosocial therapies, including education and supportive interventions, were provided in combination with pharmacotherapy in daily practice, but patients who received cognitive behavioral therapy in special settings (specialized outpatient clinic in Figure 1) were excluded because the time and frequency of their hospital visits substantially differ from those of other patients. Patient selection is summarized in Figure 1.


Evaluation of factors associated with psychiatric patient dropout at a university outpatient clinic in Japan
Patient selection.Abbreviations: MRI, magnetic resonance imaging; KPUM, Kyoto Prefectural University of Medicine.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036564&req=5

f1-ppa-10-1903: Patient selection.Abbreviations: MRI, magnetic resonance imaging; KPUM, Kyoto Prefectural University of Medicine.
Mentions: In this study, patients diagnosed as having mood disorders (International Classification of Diseases, 10th revision, code: F3) and anxiety disorders (F4) were included in the study if they were aged 18 years or older and had visited KPUM for the first time between April 2010 and March 2013.24 F3 disorders are mood (affective) disorders, which include manic episodes, bipolar affective disorder, depressive episodes, recurrent depressive disorder, persistent mood disorder, and other mood disorders. F4 disorders are neurotic, stress-related, and somatoform disorders, which include phobic anxiety disorders, other anxiety disorders, obsessive compulsive disorder, reaction to severe stress and adjustment disorders, dissociative (conversion) disorders, somatoform disorders, and other neurotic disorders. Patients who had visited KPUM for nontreatment purposes (eg, to obtain a second opinion, medical certificate, or medical examination) were excluded from analysis; in addition, we also excluded patients who were diagnosed as not needing treatment for more than 2 months. Psychosocial therapies, including education and supportive interventions, were provided in combination with pharmacotherapy in daily practice, but patients who received cognitive behavioral therapy in special settings (specialized outpatient clinic in Figure 1) were excluded because the time and frequency of their hospital visits substantially differ from those of other patients. Patient selection is summarized in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patient dropout from treatment can lead to a deterioration in clinical condition, thereby increasing the need for more intensive therapy that incurs substantial social and economic losses. The aim of this study was to identify factors related to psychiatric patient dropout at a university outpatient clinic in Japan.

Methods: We retrospectively examined the medical charts of new psychiatric patients who were diagnosed with either a mood disorder (International Classification of Diseases, 10th revision, code: F3) or an anxiety disorder (F4) in the outpatient clinic at Kyoto Prefectural University of Medicine Hospital in Kyoto, Japan, between April 2010 and March 2013. The baseline characteristics of the patients (age, sex, Global Assessment of Functioning score, Clinical Global Impression–Severity of Illness score, education, occupation, marital status, duration of treatment, and prior treatment history), treating psychiatrist experience in years, and sex concordance between the patients and their treating psychiatrists were analyzed using Cox regression models.

Results: From among 1,626 eligible new patients during the study period, 532 patients were enrolled in the study (F3: n=176; F4: n=356). The dropout rate was 35.7%, which was similar to that of previous studies. Higher educational level, being married, and lower Global Assessment of Functioning scores were associated with a lower dropout rate. Although psychiatrist experience was not significantly associated with patient dropout in the multivariate analysis, patients treated by less experienced psychiatrists had a higher hazard ratio for dropout (1.31; 95% confidence interval: 0.94–1.85).

Conclusion: In order to reduce the dropout rate, special focus should be placed on patients with the factors identified in this study, and young psychiatrists should undergo further education to foster adherence.

No MeSH data available.