Missed appointments in a hundred consecutive psychiatric patients

Objective: Non-compliance to treatment and missing control appointments is common especially in psychiatric outpatient clinics. In studies, non-compliance rates in psychiatric disorders vary widely depending on the patient population. Studies about treatment compliance had been conducted mostly in patients, who had a particular psychiatric disorder or use particular psychotropic drugs. Studies evaluating treatment compliance of patients, who had different psychiatric diagnoses or treated with different drugs seems to be scarce.

Methods: We aimed to evaluate the rates of compliance to recommended drugs and attendance to the next appointment of 100 consecutive patients, who applied to a psychiatric outpatient clinic of Gaziantep University Medical Faculty Hospital for the first time and diagnosed with a disorder and the reasons of non-attendance and factors associated with non-compliance.

Results: We grouped our patient sample in to two; Group I was named as “attendees” and included 52 patients; Group II was named as “non-attendees” and consisted of 48 patients. Mean value of the days patients did not use their medication was found to be 7.75±8.9.73. All patients were evaluated according to Morisky Medication Adherence Questionnaire; 31 patients were defined as low, 42 patients as moderate and 27 patients as high compliant to therapy. In bivariate logistic regression analysis, the patient who lives outside the city (aOR: 5.410, 95% CI: 1.751, 16.718), presence of referral (aOR:.403, 95% CI:.136, 1.195), diagnosis of bipolar disorder (aOR:.085, 95% CI:.008,935), and missed medication for more than 3 days (aOR: 5.924, 95% CI: 2.257, 15.552) were found to be the variables that mightpredict the missed appointments. With these variables, we correctly predicted the presence of treatment compliance problem as 75% and absence of treatment compliance problem as 76.9% with an overall as 76%.

Conclusions: Missed first appointment rates were reported as between 36-50%. Therefore, in the early times of a psychiatric treatment, it is important to evaluate the patient in terms of treatment compliance by having the knowledge of which factors may increase the non-compliance and reconsider our approach to the patient in order to ensure a more effective relationship that will help us to brace the patient into the course of treatment. However, the results about these factors are inconsistent and not clear. Most of the socio-demographic variables were found to be insufficient in order to estimate non-compliance in high rates. In concordance with the literature, we also found that most of the variables were not statistically significantly different between attendees and non-attendees except two as mentioned in results. In addition, it was reported that initial appointments and early times of a treatment period when the adherence between the psychiatrist and the patient was not built sufficiently increases the non-compliance. In our study, patients were meeting the psychiatrist for the first time; this can be accounted for the high non-compliance rate. Reducing the non-compliance rates, the therapeutic relationship seems to be important and focus on recognizing the factors and changing our attitudes towards those patients.