Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
PLoS One. 2021 Nov 19;16(11):e0260431. doi: 10.1371/journal.pone.0260431. eCollection 2021.
Regular visit to psychiatric clinic is essential for successful treatment of any psychiatric condition including attention-deficit/hyperactivity disorder (AD/HD). However, cancellation of outpatient appointments in patients with AD/HD, which represents a significant medical loss, has not been systematically investigated to our knowledge.
A systematic chart review was conducted for patients visiting the Shimada Ryoiku medical Center for Challenged Children in Japan at the age of ≤15 years from January to December 2013. The primary outcome measure was the cancellation rate, defined as the number of missed visits divided by the number of scheduled visits. The cancellation rates during 24 months after the first visit were compared between outpatients with AD/HD and other psychiatric disorders, including pervasive developmental disorders (PDD), and developmental coordination disorders and/or communication disorders (DCD-CD). A generalized linear model with binomial distribution was used to examine factors associated with cancellation rates exclusively in the AD/HD group.
We included 589 patients (mean ± SD age, 5.6 ± 3.4 years; 432 males) in the analysis. The cancellation rate in patients with AD/HD was 12.3% (95% confidence interval [CI]: 10.0-15.1), which was significantly higher than in those with PDD (5.6%, 95% CI: 3.8-8.3) and DCD-CD (5.3%, 95% CI: 3.6-7.8). Prescriptions of osmotic-release oral system-methylphenidate (OROS-MPH) and antipsychotics were associated with fewer cancellations in AD/HD patients (odds ratios: 0.61, 95% CI: 0.39-0.95 and 0.49, 95% CI: 0.25-0.95, respectively), although these significances did not find in the subgroup analysis including only patients with ≥ 6 years old.
Patients with AD/HD were more likely to miss appointments compared to those with other psychiatric disorders. The impact of AD/HD medications as well as potential psychiatric symptoms of their parents or caregivers on appointment cancellations needs to be evaluated in more detail in future investigations.
定期到精神病诊所就诊对于成功治疗任何精神疾病（包括注意缺陷/多动障碍（AD/HD））都至关重要。然而，据我们所知，尚未系统地调查 AD/HD 患者取消门诊预约的情况，这代表着重大的医疗损失。
对 2013 年 1 月至 12 月期间在日本岛田良育医学中心就诊的年龄≤15 岁的患者进行了系统的图表回顾。主要观察指标是取消就诊率，定义为错过就诊次数与预约就诊次数的比值。比较了 AD/HD 患者与广泛性发育障碍（PDD）、发育协调障碍和/或沟通障碍（DCD-CD）等其他精神障碍患者在首次就诊后 24 个月内的取消就诊率。采用二项分布的广义线性模型来检验 AD/HD 组中与取消就诊率相关的因素。
我们共纳入 589 名患者（平均年龄 5.6 ± 3.4 岁；432 名男性）进行分析。AD/HD 患者的取消就诊率为 12.3%（95%置信区间[CI]：10.0-15.1），明显高于 PDD 患者（5.6%，95% CI：3.8-8.3）和 DCD-CD 患者（5.3%，95% CI：3.6-7.8）。AD/HD 患者中，口服渗透型控释制剂-哌甲酯（OROS-MPH）和抗精神病药物的处方与较少的取消就诊相关（比值比：0.61，95% CI：0.39-0.95 和 0.49，95% CI：0.25-0.95），尽管在仅包括≥6 岁患者的亚组分析中，这些差异无统计学意义。
与其他精神障碍患者相比，AD/HD 患者更有可能错过预约。未来的研究需要更详细地评估 AD/HD 药物以及患者父母或照料者的潜在精神症状对取消预约的影响。
