|Year : 2015 | Volume
| Issue : 2 | Page : 76-79
Profile and pattern of follow-ups of psychiatry outpatients at Christian Medical College, Ludhiana
Mamta Singla, Sandeep Kumar Goyal, Arun Sood, Arjin Philips, Sharad Philips
Department of Psychiatry, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||20-Jan-2016|
Sandeep Kumar Goyal
Department of Psychiatry, Christian Medical College, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Context: As psychiatric illness requires long-term treatment, some patients are lost to follow-up. Aims: The present study aimed to find the follow-up pattern of psychiatric patients attending psychiatry outpatient department (OPD) and to determine the correlation of follow-up with socio-demographic profile and diagnosis, if any. Settings and Design: This study was a retrospective data analysis study carried out at the OPD of Psychiatry, Christian Medical College and Hospital, Ludhiana. Subjects and Methods: New cases attending the OPD from April 2010 to March 2011 were included in this study. The data were scrutinized 1 year after the initial assessment. Socio-demographic data, diagnosis and follow-up information were obtained from the files. The collected data were statistically analyzed. Statistical Analysis Used: Chi-square and P value. Results: 53.1% of the patients dropped out after first visit, 29.4% patients had 1-3 follow-up, 14.9% had 4-10 follow-ups and only 2.6% had more than 10 follow-ups. Correlation between follow-up and various socio-demographic variables such as age, gender, place of living or distance from hospital, occupation, religion and marital status was not statistically significant. It was, however, seen that cognitive disorders, conversion disorder, mental retardation, and patients in which diagnosis was deferred, had more dropout rate after first visit. Conclusions: In our study 53.1% of the patients did not attend follow-up at all and only 2.6% had more than 10 follow ups. Correlation between follow-up and various socio-demographic variables was not statistically significant. Patients in which diagnosis was deferred had more drop out rate than patients who had a diagnosis and the difference was statistically significant.
Keywords: Drop out, follow-up, psychiatry patients
|How to cite this article:|
Singla M, Goyal SK, Sood A, Philips A, Philips S. Profile and pattern of follow-ups of psychiatry outpatients at Christian Medical College, Ludhiana. J Mental Health Hum Behav 2015;20:76-9
|How to cite this URL:|
Singla M, Goyal SK, Sood A, Philips A, Philips S. Profile and pattern of follow-ups of psychiatry outpatients at Christian Medical College, Ludhiana. J Mental Health Hum Behav [serial online] 2015 [cited 2021 Nov 28];20:76-9. Available from: https://www.jmhhb.org/text.asp?2015/20/2/76/174598
| Introduction|| |
As mental illnesses require prolonged treatment, the success of any mental health program should not be measured by the number of new cases detected, but rather by the number of patients who, duly diagnosed, continue their treatment to its end. A study of follow-up pattern reveals facts relating to community or family's perception of mental illness. It also serves as an indirect evaluation of the impact of the initial therapeutic strategies and the multifarious problems faced by the patients and their families in maintaining such follow-up. 
In general, predictors of nonattendance may be divided into environmental and demographic factors, patient factors, illness factors, and clinician factors. The latter has been least investigated. 
Killaspy et al.  in a prospective study of 365 outpatients receiving mental healthcare, found that follow-up patients who missed an appointment were more unwell and more functionally impaired than those who attended follow-up appointments.
In a comprehensive study, Nelson et al.  calculated rehospitalization rates after discharge. On the basis of the 365-day rehospitalization rate, he concluded that patients who kept a follow-up appointment had a 1 in 10 chance of being rehospitalized; for patients who did not keep (or were not offered) an appointment, the chances were 1 in 4.
In different studies 18-22% of recently discharged psychiatric patients did not attend their scheduled ﬁrst follow-up appointment. ,
Adeponle et al.  studied hospital attendance pattern, medication compliance, mental state and social functioning of 81 patients recently discharged from the hospital. Defaulters were followed up in the community. At 3 months, 49.4% had defaulted, whereas 51.5% were medication noncompliant, 15% of respondents did not attend follow-up at all, whereas over two-thirds (37%) actually defaulted within a month of discharge. Reasons for default include feeling well, ﬁnancial difﬁculty, medication side-effects and stigma. Medication noncompliant patients were more likely to reside more than 20 km away from hospital. 
Agarwal  analyzed records retrospectively of new patients who visited his outpatient department (OPD) from 1997 to 1999 and concluded that 50% of the patients dropped out after the first visit. Another 23% did so in next the two visits and 27% attended more than three visits.
Mitchell and Selmes  examined the frequency of missed appointments among 9511 initial outpatient appointments and 7700 follow-up appointments across 10 psychiatric subspecialties in a publicly funded mental health service in the United Kingdom. The pooled missed appointment rate was 15.9%. Nonattendance was lowest in geriatric psychiatry and highest for substance abuse services and community psychiatry.
Not maintaining follow-up with psychiatric services is associated with relapse of psychiatric illness leading to increased rates of re-hospitalization and increased expenses. Almost all the follow-up studies are based on samples of patients admitted to the hospital, whereas there are very few based on out-patient clinics, hence, we planned the study to find out the follow-up pattern of patients attending psychiatric OPD.
| Subjects and Methods|| |
Aims and objective
The present study aimed to find the follow-up a pattern of psychiatric patients attending psychiatry OPD and to find out the correlation of follow-up with socio-demographic profile and diagnosis, if any.
The present study was a retrospective data analysis study carried out at the OPD of Psychiatry, Christian Medical College and Hospital, Ludhiana. All new cases attending the OPD from April 2010 to March 2011 were included in the study. The data were scrutinized 1 year after the initial assessment. Socio-demographic data, diagnosis, and follow-up information were obtained from the files. The collected data were statistically analyzed.
| Results|| |
Totally 1505 patients were registered in the study period and mean age of the sample was 39 years. The number of males (58.5%) was higher as compared to the females. 72.3% of patients were married. Most of the patients were from Ludhiana (56.9%). 53.4% patients belonged to Hindu religion. Most of the patients were employed (39.1%).
53.1% of the patients dropped out after the first visit, 29.4% had 1-3 follow-ups and 14.9% had more than 3 follow-ups. Only 2.6% had more than 10 follow-ups [Table 1].
The most common psychiatric disorder were affective disorders (43.6%) followed by anxiety disorder (13.3%), psychotic disorders (9.4%) and substance abuse disorder (8.2%) [Table 2].
Correlation between follow-up and various socio-demographic variables such as age, sex, place of living/distance from the hospital, occupation, religion, and marital status was not statistically significant.
It was, however, seen that cognitive disorders, conversion disorder, mental retardation, and patients in which diagnosis was deferred, had more dropout rate after the first visit.
Patients in which diagnosis was deferred had more drop out rate than patients who had a diagnosis and the difference was statistically significant. ( P < 0.00001, χ2 =60.12) [Table 3].
| Discussion|| |
Maintaining follow-up as and when advised is an essential aspect in the treatment of psychiatric illnesses. Loss of follow-up leads to worsening of an illness, increased rates of hospitalization leading to increased financial burden.
In our study, most common psychiatric disorder were an affective disorder (43.6%) followed by anxiety disorder (13.3%), psychotic disorders (9.4%) and substance abuse disorder (8.2%). In a study by Agarwal  affective disorders (40%) was the most common which matches finding of our study. Similarly, Nayak and Sonaliya  found that majority were affected by depression (29%), schizophrenia (18%) and substance abuse psychiatric disorder (11%).
In our study, 53.1% of the patients did not attend follow-up at all, 29.4% had 1-3 follow-ups and 14.9% had more than 3 follow-ups. Only 2.6% had more than 10 follow-ups. Results are in agreement with previously reported figures by Agarwal  who concluded that 50% of the patients dropped out after the first visit. There is a gap of more than 10 years between these two studies but still the same loss of follow-up after the first visit is present. It can be a reflection of socio-cultural acceptance of mental disorders in a country that has not changed over the years.
Results are similar to study by Dodd  who found 20-57% of the patients failed to return after the first visit and 31-56% attended no more than 4 times.
In our study, percentage of loss of follow-up after first visit is much higher than findings of various studies, , which show 18-22% of recently discharged psychiatric patients did not attend their scheduled ﬁrst follow-up appointment. But, these studies were done on inpatients who are supposed to have a more severe illness as compared to OPD patients and more likely to attend follow-up.
The pooled missed appointment rate was 15.9% in a study by Mitchell and Selmes  which is very less as compared to our study. Difference may be due to the fact that their study was done in publicly funded mental health service in the United Kingdom where all treatment is free and our study was done in a hospital attached to a private medical college where patient needs to pay for travelling to hospital, consultation fees as well as medications.
Low follow-up rate in our study as compared to other studies ,, may be due to socio-culural differences.
Research indicates that patients who miss appointments tend to be younger and of lower socio-economic status.  The most common single reason for nonattendance at follow-up appointments is forgetting the appointment, followed by being too psychiatrically unwell. 
Percudani et al.  found that patients with neurotic and personality disorders were more likely to drop out of treatment than those with schizophrenia. Interestingly, if the diagnosis is unclear (or cannot be established) patients are more likely to drop out of care.  In our study also patients in which diagnosis was deferred, had maximum dropout rate (96.1%) after the first visit.
In our study, various socio-demographic variables such as age, gender, place of living/distance from hospital, occupation, religion, and marital status do not affect attendance in psychiatry OPD and this finding is in agreement with some other studies. ,
| Conclusion|| |
We conclude that in our study 53.1% of the patients did not attend follow-up at all, 29.4% had 1-3 follow-ups and only 2.6% had more than 10 follow-ups. Loss of patients to follow-up is a major clinical problem and further studies to find the cause of loss of follow-up should be done and effective strategies to prevent nonattendance are to be formed.
Since it was a retrospective study, factors leading to drop out could not be studied.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Parthasarathy R, Chandrashekar CR, Isaac MK, Prema TP. A profile of the follow up of the rural mentally ill. Indian J Psychiatry 1981;23:139-41.
Mitchell AJ, Selmes T. Why don't patients attend their appointments? Maintaining engagement with psychiatric services. Adv Psychiatr Treat 2007;13:423-34.
Killaspy H, Banerjee S, King M, Lloyd M. Prospective controlled study of psychiatric out-patients non-attendance. Characteristics and outcome. Br J Psychiatry 2000;176:160-5.
Nelson EA, Maruish ME, Axler JL. Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatr Serv 2000;51:885-9.
Kruse GR, Rohland MB. Factors associated with attendance at a first appointment after discharge from a psychiatric hospital. Psychiatr Serv 2002;53:473-6.
Adeponle AB, Baduku AS, Adelekan ML, Suleiman GT, Adeyemi SO. Prospective study of psychiatric follow-up default and medication compliance after discharge at a psychiatric hospital in Nigeria. Community Ment Health J 2009;45:19-25.
Agarwal AK. Analysis of patients attending a private psychiatric clinic. Indian J Psychiatry 2012;54:356-8.
Mitchell AJ, Selmes T. A comparative survey of missed initial and follow-up appointments to psychiatric specialties in the United Kingdom. Psychiatr Serv 2007;58:868-71.
Nayak S, Sonaliya KN. Morbidity patterns of patients attending psychiatry OPD in tertiary care hospital in Ahmedabad. Natl J Med Res 2011;1:7-9.
Dodd J. A retrospective analysis of variables related to duration of treatment in a university psychiatric clinic. J Nerv Ment Dis 1970;151:75-84.
Sharp D, Hamilton W. Non-attendance at general practices and outpatient clinics. BMJ 2001;323:1081-2.
Percudani M, Belloni G, Contini A, Barbui C. Monitoring community psychiatric services in Italy: Differences between patients who leave care and those who stay in treatment. Br J Psychiatry 2002;180:254-9.
Melo AP, Guimarães MD. Factors associated with psychiatric treatment dropout in a mental health reference center, Belo Horizonte. Rev Bras Psiquiatria 2005;27:113-88.
Kaur J, Chavan BS, Sharma A, Raj L, Bala C. Study of factors associated with drop out after first visit to psychiatric clinic. JMHHB 2009;14:87-94.
Alnamlah RA. What is interfering with attendance in adult psychiatric out patients clinics? Neurosciences (Riyadh) 2006;11:293-6.
[Table 1], [Table 2], [Table 3]
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