Henzen Alexandre, Moeglin Clotilde, Giannakopoulos Panteleimon, Sentissi Othman
Mental Health and Psychiatry Department, University Hospitals of Geneva, CAPPI Jonction: 35, rue des Bains, 1205, Geneva, Switzerland.
Psychiatric Department, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, CH- 1225, Chêne-Bourg, Switzerland.
BMC Psychiatry. 2016 Apr 19;16:111. doi: 10.1186/s12888-016-0819-4.
Dropping out during the course of medical follow up is defined as an early therapy withdrawal without the agreement of the therapist. In a psychiatric crisis unit in Geneva, we empirically observed that almost 50% of the patients were not showing up to their first appointments, which were scheduled for 3 to 7 days post discharge.
The aim of this naturalistic descriptive cohort study is to identify the demographic, patient and care-related predictive factors of dropout in a community-based psychiatric crisis centre. We included 245 consecutive outpatients followed-up for 4 to 6 weeks of intensive outpatient psychiatric treatment. Logistic regression models were built to examine the association between dropout and demographic, care and patient-related variables.
Among the 245 outpatients, dropout occurred in 37.5% of cases, and it most frequently occurred (81.8%) in the first 2 days of follow-up. Among care-related variables, referral by hospital units or private psychiatrists led to significantly lower levels of dropout compared to patients referred by the psychiatric emergency unit (respectively: OR = .32; p = .04; 95% CI [.10, .93]; OR = .36; p = .04; 95% CI [.13, .96]; OR = .22; p = .002; 95% CI [.08, .58]). Among patient-related variables, younger age increased the risk of dropout (OR = .96; 95%; p = .002; 95% CI [.94, .99]). Anxiety and personality but not mood disorders were also related to higher rates of dropout (respectively: OR = 2.40; p = .02; 95% CI [1.14, 4.99]; and OR = 1.98; p = .02; 95% CI [1.09, 3.59]). Unipolar depression (72.2%; OR = 1.47; p = .48; 95% CI [.34, 1.21]) was the most frequent primary diagnosis in this sample.
This study makes clear the need for increased efforts to improve care adherence in young patients with anxious or personality disorders seen in emergency rooms because they are prone to early discontinuation of treatments. Future studies in this field are warranted to gain a better understanding into the complex reasons that surround discontinuation of care in outpatient settings.
在医学随访过程中退出被定义为未经治疗师同意而提前终止治疗。在日内瓦的一个精神科危机单元，我们凭经验观察到，几乎50%的患者未按预定时间前来参加出院后3至7天的首次预约。
这项自然主义描述性队列研究的目的是确定社区精神科危机中心中退出治疗的人口统计学、患者及护理相关预测因素。我们纳入了245名连续的门诊患者，对其进行了4至6周的强化门诊精神科治疗随访。构建逻辑回归模型以检验退出治疗与人口统计学、护理及患者相关变量之间的关联。
在245名门诊患者中，37.5%的患者出现了退出治疗的情况，且最常发生在随访的前两天（81.8%）。在护理相关变量中，与由精神科急诊单元转诊的患者相比，由医院科室或私人精神科医生转诊的患者退出治疗的水平显著更低（分别为：OR = 0.32；p = 0.04；95% CI [0.10, 0.93]；OR = 0.36；p = 0.04；95% CI [0.13, 0.96]；OR = 0.22；p = 0.002；95% CI [0.08, 0.58]）。在患者相关变量中，年龄较小会增加退出治疗的风险（OR = 0.96；95%；p = 0.002；95% CI [0.94, 0.99]）。焦虑症和人格障碍而非情绪障碍也与较高的退出治疗率相关（分别为：OR = 2.40；p = 0.02；95% CI [1.14, 4.99]；以及OR = 1.98；p = 0.02；95% CI [1.09, 3.59]）。单相抑郁症（72.2%；OR = 1.47；p = 0.48；95% CI [0.34, 1.21]）是该样本中最常见的主要诊断。
本研究明确表明，需要加大力度提高对在急诊室就诊的患有焦虑症或人格障碍的年轻患者的治疗依从性，因为他们容易过早中断治疗。该领域未来的研究很有必要，以便更好地理解门诊环境中治疗中断背后的复杂原因。
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