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PubMed2005

Factors associated with psychiatric treatment dropout in a mental health reference center, Belo Horizonte.

OBJECTIVE: To characterize an outpatient public referral center for mental health and to assess factors associated with treatment dropout. METHODS: A non-concurrent prospective study was undertaken to review 295 patient files. Patients, whose first consultation took place between January and December 1997, were followed-up for at least four months until April 1998. Patients were considered as having abandoned their treatment when, following a recommendation for at least a second visit, they did not return within four months after the first consultation. Social, demographic and clinical variables were compared to verify possible factors associated with dropout of treatment. Statistical analysis was performed using relative hazard (RR) with 95% confidence interval (CI) estimated by the Cox Regression Model. RESULTS: Cumulative incidence of treatment dropout was 39.2% while multivariate analysis indicated that the following characteristics were statistically associated with treatment interruption: to live outside the referral area (RR = 1.95), no history of previous psychiatric hospitalizations (RR = 1.88), alcohol or drug use at admission (RR = 1.72), spontaneous demand to the service (RR = 2.12), lack of bus-passes (RR = 3.68) and to have less than four clinical appointments (RR = 7.31). CONCLUSIONS: Our findings suggest that services should be aware of the high incidence of treatment interruption, especially among those with no history of previous psychiatric hospitalizations and with less institutional bonds. This may indicate that mental health services should develop and implement public policies targeted at this population.

Adult↗
PubMed1990

Effect of time-limited psychotherapy on patient dropout rates.

The authors conducted an archival study of 149 new clinic patients at a large community mental health center. The dropout rate for patients in brief psychotherapy in which the length of therapy was specified at the outset of treatment (time-limited psychotherapy) (32%) was about one-half the dropout rate for patients in brief (67%) and long-term (61%) individual psychotherapy. The difference in dropout rates could not be explained by patient demographic or diagnostic variables or by therapist characteristics measured in the study. The results suggest that setting a specific time limit on individual psychotherapy at the outset of treatment can reduce the patient dropout rate in a public mental health clinic.

Ambulatory Care↗
PubMed1982

Treatment dropouts: the effect of client and ecological variables.

Using data gathered on persons entering into alcohol treatment programs between 1974 and 1976, the study sought to develop an equation that would predict (1) Complete Successes, (2) Partial Successes, and (3) Dropouts. The predictor variables included a broad range of client-specific characteristics and ecological variables. The results indicate that both sets of influences affect our ability to predict who will fall into various categories. There appears to be a general progression in the amount of social resources held by the individual and contained within the individual's ecological environment as one moves from Dropouts to Partial Successes to Complete Successes. Results for policy makers and practitioners are identified and discussed.

Adult↗
PubMed2002

Correlates of dropout, efficacy, and adverse events in treatment with acetylcholinesterase inhibitors in Korean patients with Alzheimer's disease.

The correlates of dropout, efficacy, and adverse events in the treatment of Alzheimer's disease (AD) with acetylcholinesterase inhibitors (ChEI) are unclear. To investigate these issues, a 26-week prospective, randomized, open-labeled trial with donepezil or rivastigmine was undertaken. Sixty-four Korean patients with AD were recruited, and data on sociodemographic and clinical characteristics and several assessment scales were collected. Characteristics of available caregivers were also gathered. Information on adverse events and dropout was recorded. Thirty-five (55%) patients dropped out during treatment with ChEI, for reasons mainly related to financial burden of caregivers. Of the 29 patients who completed the 26-week trial, 16 (55%) were responsive to ChEI. Lower scores on the Clinical Dementia Rating and Blessed Dementia Scale at baseline were associated with the efficacy of ChEI. Of the total participants, 26 (41%) experienced adverse events, although these seemed to be mild and appeared to be associated with the psychological state of patients or coadministration of psychotropic drugs. In conclusion, ChEI seemed to be effective and well tolerated in the treatment of Korean patients with AD, but the use of this drug was limited mainly by the financial burden of caregivers.

Aged↗
PubMed2002

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.

Adult↗
PubMed1980

Use-effectiveness of standard-dose and low-dose oral contraceptives in Dacca.

Five hundred women accepting oral contraceptives at an urban clinic were alternately prescribed standard-dose (50 microgram of estrogen) or low-dose (30 microgram of estrogen) combined pills. Life-table continuation rates at 12 months were approximately 40% for both groups, with no significant differences between or within the two groups after controlling for sociodemographic variables and nutritional status. Approximately three fifths of those who discontinued using both formulations cited medical reasons, especially dizziness. The low-dose oral contraceptive appeared to be as acceptable to these urban Bangladeshi women as the higher-dose pill.

Adult↗
PubMed1990

Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.

An intrauterine device, releasing approximately 20 micrograms/day of levonorgestrel (LNg 20), used by 1124 women, was studied in a randomized trial of five years duration in comparison with the Copper T, model TCu 380Agm in 1121 women. At five years, the gross cumulative pregnancy rate of 1.1 +/- 0.5 per 100 among users of the LNg 20 devices was not significantly different from the rate of 1.4 +/- 0.4 per 100 experienced by users of the Copper T 380Ag. The steroid-releasing IUD had significantly higher termination rates for expulsion and amenorrhea, a significantly lower termination rate for other menstrual problems and pain, and a lower continuation rate. The five-year continuation rate among women using the TCu 380Ag was 40.6 per 100 as compared with that of 33.0 per 100 among women randomized to the LNg 20 device (P less than .001). Terminations attributed to amenorrhea with the LNg device primarily account for differences in continuation. These two intrauterine devices are the most effective long-term, reversible IUDs yet reported in the literature. No other contraceptive methods have exhibited such low long-term pregnancy rates in randomized comparative trials.

Adolescent↗
PubMed1994

Therapy termination and persistence patterns of elderly clients in a community mental health center.

Analyses were conducted on 180 community and nursing home clients, ages 60 to 98, who received psychotherapy as part of a community mental health center program. Case records were reviewed to identify factors associated with persistence in therapy and dropout patterns. Very few (less than 12%) terminated therapy appropriately (as judged by the therapist), about 59% completed at least 10 sessions, and a majority of the community residents themselves initiated termination. Persistence in treatment was associated with nursing home residence, religious beliefs, and receiving the therapy at home. Contrary to predictions, persistence was not associated with self-referral, type of psychiatric diagnosis, age, or gender.

Aged↗
PubMed1992

Psychopathology and attrition in the epidemiologic catchment area surveys.

This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.

Adolescent↗
PubMedDate not supplied

Randomized controlled trial of internet-based cognitive behavior therapy for distress associated with tinnitus.

OBJECTIVE: The aim of this study was to investigate if cognitive behavior therapy (CBT) provided via the Internet results in significant decreases of distress in individuals with tinnitus. METHODS: Participants were recruited through Web pages and newspaper articles and thereafter randomly allocated to a CBT self-help manual in six modules or to a waiting-list control group (WLC). All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence. Participants were 117 individuals with tinnitus of duration of more than 6 months. In the first randomized controlled phase of the study, 26 completed all stages of treatment (51% dropout), and 64 of the WLC group completed measures. At 1-year follow-up, all participants had been offered the program and 96 provided outcome measures (18% dropout rate from baseline). Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up. Daily diary ratings were included for 1 week before and 1 week following the treatment period. RESULTS: Tinnitus-related distress, depression, and diary ratings of annoyance decreased significantly. Immediately following the randomized controlled phase (with a WLC), significantly more participants in the treatment group showed an improvement of at least 50% on the Tinnitus Reaction Questionnaire. At the uncontrolled follow-up, 27 (31%) of all participants had achieved a clinically significant improvement. CONCLUSIONS: CBT via the Internet can help individuals decrease annoyance associated with tinnitus. High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet.

Anxiety↗
PubMed1983

Program evaluation in epilepsy rehabilitation.

The Vocational Services Program of the University of Washington Regional Epilepsy Center is described, and data relating to the first 106 clients who entered the program are examined. A major emphasis of the study was characteristic differences between those clients later competitively employed and program dropouts. Other study purposes related to examining client satisfaction ratings of different aspects of services and establishing whether a relationship existed between seizure occurrences and job loss. Stepwise discriminant function analysis indicated that "months employed in the last 24" appeared to be the stable discriminator between the employed and dropout groups. The group later employed averaged 12 of the prior 24 months in employment, whereas dropouts approximated 7. Associated psychiatric/addictions treatment was initially a key outcome discriminator, but it did not hold up on cross-validation. Subjects were more satisfied with individualized client services (e.g., counseling sessions) than with group activities (e.g., Job Club). As opposed to seizures, emotional/attitudinal difficulties with this rehabilitation population appeared to be the primary reason for job loss. A work adjustment or job station program can be critical for these individuals and others with neurological impairments. The importance of counselor follow-up after the initial job placement is also underscored. This program, with about half of its clients entering unsubsidized jobs, basically replicated the results of other community-oriented epilepsy rehabilitation programs.

Academic Medical Centers↗
PubMed2005

How do you improve compliance?

Compliance, or adherence, as it relates to health care is the extent to which a person's behavior coincides with medical or health advice. Medication compliance is critical for all aspects of pediatrics, specifically in successful treatment, disease prevention, and health promotion. Compliance depends on the patient's and physician's committing to the same objectives. It is unfortunate that numerous studies and physician accounts reveal difficulties in achieving compliance with pediatric medication therapy. Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens. Poor compliance places children at risk for problems such as continued disease, complicates the physician-patient relationship, and prevents accurate assessment of the quality of care provided. This article presents the issue in the context of its incidence of and barriers to compliance and provides general principles to improve compliance in pediatrics by improving communication and characteristics of the practice setting. A one-on-one relationship between physician and patient is needed for communication and improved compliance.

Communication Barriers↗
PubMed2004

[Assessment of an obesity clinic in a center hospital].

INTRODUCTION: Slight weight losses (5%) are consensually accepted as important in the treatment of obesity today. Some authors also consider that maintaining weight is an indicator of success in the treatment of this condition. OBJECTIVE: Characterisation and assessment of changes in weight in obese patients monitored at an obesity clinic in a hospital endocrinology department. METHODOLOGY: Retrospective analysis of the clinical files of the Endocrinology Clinic. The patients included were overweight adults (BMI = 25 kg/m2) who had been monitored since 1999 and were not suffering from thyroid dysfunction or hypercortisolism. Data were gathered on bio-demographic and anthropometric characteristics, reason for consultation, type of treatment, results achieved and dropouts. The statistical analysis included calculating central tendency measures and dispersion for the continuous variables and building frequency tables to describe the categorical variables. We used the t-test to compare average values between samples. Frequencies were compared by means of the chi-squared test or Fisher's exact test. The significance level was 5%. RESULTS: We studied 457 patients (60.6% female) with an average age of 53 years (DP +/- 15) and an average BMI of 32.4 +/- 5.1 Kg/m2. 51.9% of the patients came to the clinic because of overweight (n = 237) (Obesity Group-OBG), while the rest did so because of diabetes mellitus (35.4%) or some other disease (12.7%) (Other Cause Group-OCG). A dietary plan was prescribed for 86.1% (OBG) and 81.8% (OCG), drugs for 16.9% (OBG) and 6.4% (OCG) and physical activity for 77.6% (OBG) and 77.7% (OCG). The average weight loss was 2.1% in the OBG. The individuals who dropped out of the clinic had lost less weight (1.3% vs. 2.9%), although the difference was not significant. More than half (57.7%) of the individuals studied lost weight, 14.4% remained the same and 27.8% gained weight. CONCLUSIONS: 1) Only 50% of overweight patients come to our department to lose weight. 2) More than 75% of overweight patients have a prescribed, structured diet plan, regardless of the reason for their first visit. 3) About 75% of patients achieve acceptable objectives (maintaining or losing weight), and 25% of these have lost more than 5% of their initial weight.

Adolescent↗
PubMed1994

An application of maximum likelihood and generalized estimating equations to the analysis of ordinal data from a longitudinal study with cases missing at random.

Data are analysed from a longitudinal psychiatric study in which there are no dropouts that do not occur completely at random. A marginal proportional odds model is fitted that relates the response (severity of side effects) to various covariates. Two methods of estimation are used: generalized estimating equations (GEE) and maximum likelihood (ML). Both the complete set of data and the data from only those subjects completing the study are analysed. For the completers-only data, the GEE and ML analyses produce very similar results. These results differ considerably from those obtained from the analyses of the full data set. There are also marked differences between the results obtained from the GEE and ML analysis of the full data set. The occurrence of such differences is consistent with the presence of a non-completely-random dropout process and it can be concluded in this example that both the analyses of the completers only and the GEE analysis of the full data set produce misleading conclusions about the relationships between the response and covariates.

Age Factors↗
PubMed2000

Predictors of dropout among men who batter: a review of studies with implications for research and practice.

Identifying the characteristics of men who drop out of batterers' programs is crucial for prevention, intervention, and research. This article reviews studies of program attrition to establish a description of men who fail to complete group-based batterers' interventions. Studies indicate that men who drop out are more likely to be unemployed, be unmarried and/or childless, have lower incomes, and less education than men who remain. Dropouts are also more likely to have a criminal history, to report substance abuse or related problems, and to present with particular relationship concerns or orientations. The relationship between court referral and dropout was inconsistent across studies and may vary according to socioeconomic status. Psychopathology is consistently related to dropout, but may be associated with other factors (e.g., comorbidity or referral source). Age, race, childhood exposure to violence, and battering history are all inconsistently associated with dropping out. The implications of these findings for research and program development are discussed.

Adult↗
PubMed1984

Integrating psychosocial rehabilitation into the hospital psychiatric service.

Psychosocial rehabilitation services, while sorely needed by patients with prolonged mental illness, are not usually offered as part of hospital psychiatry. The authors describe the Veterans Resource Program (VRP), a hospital-based psychosocial rehabilitation program, as a model for introducing rehabilitation services into a hospital psychiatry system. Its perceived residential treatment environment was found to be more practically oriented and to provide more autonomy for patients than did an intensive treatment unit, while still possessing many supportive relationship characteristics. The authors found that the VRP patients had very low dropout and relapse rates; VRP patients also had better recidivism and employment rates compared with baseline rates and with patients in two comparison programs. These results suggest that integrating rehabilitation into hospital psychiatry improves patient care.

Adaptation, Psychological↗
PubMed1986

[Well-controlled comparative study on aztreonam and cefoperazone in the treatment of complicated urinary tract infections].

A well-controlled comparative study was conducted in order to evaluate the efficacy, safety and usefulness of the monobactam antibiotic aztreonam (AZT) in complicated urinary tract infections (UTI) using cefoperazone (CPZ) as the control drug. Patients with complicated UTI due to Gram-negative bacteria were examined. However, in polymicrobial infections, the cases caused by Gram-negative and Gram-positive bacteria were also examined. Both drugs were administered 1 g, twice a day by intravenous drip infusion for 5 days. Overall clinical efficacy was evaluated by the criteria proposed by the UTI committee in Japan. Of the total 394 cases, the clinical efficacy was evaluated for 152 cases in the AZT group and 143 cases in the CPZ group excluding 99 cases of exclusion or dropout. There was no statistically significant difference in the back ground characteristics between the 2 groups. The overall clinical efficacy rate was 55.3% for AZT and 55.2% for CPZ with difference not significant. As for clinical efficacy, in the monomicrobial infection after postprostatectomy (G-2), AZT was superior to CPZ (P less than 0.05), whereas in the polymicrobial infection without indwelling catheter (G-6), CPZ was superior to AZT (P less than 0.1). The overall bacteriological eradication rate was 77.2% for AZT and 74.5% for CPZ. For Gram-negative bacteria only the eradication rate for AZT (83.2%) was superior to that for CPZ (74.6%). This was probably due to the stability of AZT to beta-lactamase. Side effects were observed in 3 cases out of 201 in the AZT group and 5 cases out of 189 in the CPZ group. No severe abnormal laboratory finding was observed in any group; there was no significant difference between the 2 groups. Consequently, AZT was judged to be an antibiotic with clinical usefulness equal to, or even superior to that of CPZ.

Adolescent↗