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Results for “Patient Dropouts”

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At least 19 recordsLinked to original sources
PubMed1995

[Tuberculosis and patient compliance: proposition for a study methodology of patient dropouts].

Patient dropouts are one of the main concerns of tuberculosis programme in high prevalence countries. Perception of renunciation factors are generally weak or/and feeble from the part of agents working within programmes, while there are some a priori and confusions. This work proposes the setting up of a malagasy study, after the adequate definition of some hypothesis, then the writing of a survey form. The aim is to draw remedial behaviours and to make physicians and paramedical working close to tubercular patients, aware of the importance of a good mutual comprehension.

Attitude to Health↗
PubMed2000

Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.

BACKGROUND: Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased. METHODS: In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential. RESULTS: This article highlights the significance of "informative censoring" when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis. CONCLUSION: In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on the estimated trend. This analysis demonstrates that among PD patients, both the starting GFR and the rate of decline in GFR are associated with patient dropout. Consequently, future studies aimed at estimating the rate of decline in GFR among PD patients should also account for any dependencies between dropout and GFR. Similarly, data analyzing for apparent differences in the rate of decline of GFR between PD and HD should also adjust for possible informative censoring.

Glomerular Filtration Rate↗
PubMed2006

Protecting low-income children's access to care: are physician visits associated with reduced patient dropout from Medicaid and the Children's Health Insurance Program?

OBJECTIVE: Dropout among patients who are enrolled in Medicaid and the Children's Health Insurance Program contributes to a lack of health care access among millions of Americans. The purpose of this study was to determine which, if any, types of clinical contact with physicians are associated with reduced dropout among children who are enrolled in Medicaid and the Children's Health Insurance Program. METHODS: The data are from the nationally representative Medical Expenditure Panel Survey, 1998-2002. The sample is composed of all children (n = 3043) who were reported to have Medicaid or Children's Health Insurance Program coverage throughout their first year in the survey and who did not acquire other insurance during the study period. The outcome measure is whether an individual remained enrolled in Medicaid or the Children's Health Insurance Program by the end of the following year. Exposure variables were clinical contact during an individual's first year in the survey: numbers of office visits, hospital outpatient department visits, emergency department visits, inpatient hospital stays, and dental visits. The analysis uses multivariate logistic regression to control for patient and family characteristics-most important, health status, functional status, and overall health care expenditures. RESULTS: Eight percent of the children in the sample had left Medicaid/the Children's Health Insurance Program by the end of the second year in the survey. More frequent contact with clinicians in an office setting was associated with a significantly lower risk for dropping out of Medicaid/the Children's Health Insurance Program among children, even controlling for demographics, health and functional status, and overall health care expenditures. After multivariate adjustment, more frequent contact in hospital outpatient departments also was associated with reduced dropout, with a borderline statistically significant odds ratio. Notably, emergency visits and inpatient stays were not associated with any significant change in the risk of Medicaid/Children's Health Insurance Program dropout. CONCLUSIONS: These results suggest that some but not all types of clinician visits are serving an important function in maintaining Medicaid and the Children's Health Insurance Program coverage among low-income patients. Two possible approaches to improve access to care among low-income children therefore would be (1) increased awareness among clinicians, especially in hospitals and emergency departments, regarding Medicaid/Children's Health Insurance Program retention as an issue in the ongoing care of their patients and (2) Medicaid/Children's Health Insurance Program reimbursement of clinicians and their staff for assisting patients with the public insurance renewal process.

Aid to Families with Dependent Children↗
PubMed1979

The dropout patient.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1997

Patient dropout in an assisted reproductive technology program: implications for pregnancy rates.

OBJECTIVE: To study patient dropout and its impact on crude and cumulative pregnancy rates (PRs) after assisted reproductive technology (ART). DESIGN: Retrospective cohort study. SETTING: University hospital-based tertiary care fertility clinic. PATIENT(S): Two hundred two couples applying for their first ART treatment cycle. MAIN OUTCOME MEASURE(S): Drop-out rate and PR per cycle, cumulative drop-out rate and cumulative PR. RESULT(S): After three treatment cycles, the cumulative drop-out rate was 126 of 202 (62.4%); 13.9% (n = 28) was due to active censoring. Active censoring was shown to flatter cumulative PRs by life-table analysis. CONCLUSION: Dropout from ART is high, even when ART costs are covered by health cost insurance. Life-table analysis overestimates cumulative PRs in ART.

Cohort Studies↗
PubMed1988

Demystifying the patient dropout: a study of 122 brief-stay day-treatment center admissions.

Past studies examining the dropout from treatment phenomenon have failed to identify comparable populations or a standardized definition of the term "patient dropout." Although the phenomenon is widespread, few investigators have studied the problem within day-treatment programs serving subacutely disturbed clients in need of socialization or prevocational services. The primary purpose of the present study was to determine the reasons for brief Day Treatment Center (DTC) stays of 10 sessions or fewer and to ascertain implications of these findings for admission screening processes. Analysis of demographic information revealed that the average brief-stay patient was in his mid-thirties, was single (65%), was schizophrenic (39%) or suffering a mood disorder (27%), and had attended up to 4 days (63%) before leaving treatment. A retrospective review of 122 brief stay records revealed six categories of reasons for leaving the DTC: (1) a desire to return to work, (2) exacerbation of psychiatric symptoms, (3) resistance to treatment recommendations, (4) negative reaction to the treatment milieu, (5) a desire for less intense treatment, and (6) a belief that problems were resolved during the brief stay. The authors concluded that admission screening interviewers would benefit from complete past school and work records. Strategies for reducing dropout rates should include (1) longer transition periods for newly referred patients, (2) obligatory meetings with the patient and his family and therapist before inpatient discharge, and (3) improved orientation to the DTC program.

Day Care, Medical↗
PubMedDate not supplied

Cardiac rehabilitation programs and the problem of patient dropout.

As one of the leading causes of death in the United States, coronary atherosclerotic heart disease (CAHD) has been shown to have a reduced incidence if the principles of primary prevention are instituted to reduce cardiac risk factors. In people who already suffer from CAHD, employing secondary prevention such as controlling hypertension, reducing serum lipid levels, eliminating nicotine intake, reducing stress, losing weight, and increasing exercise habits can decrease recurrence of problems related to CAHD. Cardiac rehabilitation programs are a way to help CAHD patients restore optimal medical, physiological, psychological, social, and vocational performance following an acute cardiac event. A major problem in cardiac rehabilitation programs is patient dropout. For any cardiac rehabilitation program to be a success, the CAHD patient must become invested in the maintenance of health and, therefore, committed to participation in the program. The author reviews the current literature, including discussions of the history of cardiac rehabilitation, current trends in cardiac rehabilitation programs, factors that influence patients' investment in these programs, and ways in which the cardiac rehabilitation nurse might intervene to make an impact on patients' participation.

Coronary Disease↗
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↗
PubMed1984

Factors associated with patient dropout from an outpatient alcoholism treatment service.

Treatment dropout was studied in 172 patients (40 women) of an outpatient alcoholism treatment program. The best predictors of dropout were the length of delay between appointments, and variables related to symptom levels such as the number of prior alcohol-related arrests, the use of illicit drugs and scores on the Michigan Alcoholism Screening Test. Of lesser importance, but in line with previous findings, were sociodemographic variables such as age, the level of social stability and the presence of dependents at home. No personality variables were found to be relevant. It is suggested that treatment programs can improve attendance by reducing the delay with which services are offered and by changing certain characteristics of treatment personnel.

Adolescent↗
PubMed2003

Is patient dropout from a longitudinal study of lung function predictable and reversible?

Predictive factors for individuals dropping out from a longitudinal study of lung function have not been described, nor have methods for re-recruiting dropouts been developed. Our aims were to identify factors predictive of dropout and methods of re-recruiting dropouts from a longitudinal study of lung function. Details at enrollment into a longitudinal birth cohort study were compared between those who dropped out and those who were assessed 6 and 11 years later. Strategies for identifying individuals successfully contacted at 11 but not 6 years were described. Of 253 infants enrolled prenatally, 123 (49%) were followed up at age 6 and 194 (77%) at age 11 years. At 6 years, independent risk factors for a child dropping out were: no other sibling enrolled (OR, 4.0; 95% CI, 1.6, 10.1; P = 0.003); being first-born (OR, 2.8; 95% CI, 1.5, 5.2; P = 0.001); mother completing education at age 15 years (OR, 2.5; 95% CI, 1.3, 4.9; P = 0.007); and mother born overseas (OR, 2.3; 95% CI; 2.8; P = 0.01). The following were predictive of a child dropping out at 11 years: mother born overseas (OR, 4.8; 95% CI, 2.2, 10.2; P < 0.001); paternal smoker (OR, 3.1; 95% CI, 1.5, 6.5; P = 0.003); no other sibling enrolled (OR, 4.1; 95% CI, 1.1, 15.7; P = 0.04); and being first-born (OR, 2.1; 95% CI, 1.0, 4.3; P < 0.05). Of the 74 families successfully followed up at 11 but not 6 years, 35 (47%) were contacted by using data already held in study records, and 32 (43%) were contacted by databases available to the public. In conclusion, factors present at enrollment and predictive of dropout from a longitudinal cohort study can be identified. Using a variety of methods, re-recruitment is possible for many individuals who previously dropped out.

Australia↗
PubMed1999

The causes of patient dropout from penile self-injection therapy for impotence.

PURPOSE: Penile self-injection therapy, a second line treatment for erectile dysfunction, is the most efficacious means of reestablishing functional erections when first line therapies fail and the patient wants to avoid penile prosthesis implantation. Despite high efficacy rates, injection therapy has high dropout rates. To our knowledge studies to date analyzing patient attrition have reviewed small numbers of patients followed for only short periods. We elucidate the main reasons for patient dropout in a large penile self-injection program with long-term followup. MATERIALS AND METHODS: A questionnaire was mailed to 1,424 patients who completed the office training and home use phases of a penile self-injection program. RESULTS: The overall attrition rate was 31% of the 720 men who completed the questionnaire, with a mean followup of 38 months. The main reasons for dropout were cost of therapy, patient and partner problems with the concept of penile injection, lack of partner availability and spontaneous improvement in erections. Lack of efficacy of therapy was the primary reason for only 1 of 7 dropouts. Furthermore, adverse effects of penile injections (priapism, penile nodules, pain) appeared to be only minor contributors to dropout. CONCLUSIONS: To our knowledge this study is the largest published, single center cohort of patients treated with injection and followed for an analysis of dropout rates. Based on study data a reduction in dropout rates may be achieved by keeping the cost of therapy low, and ensuring patient and partner education as well as continued support throughout treatment.

Adult↗
PubMed1999

Patient dropouts before completion of optimal dose, multiple allergen immunotherapy.

BACKGROUND: Many patients don't complete the recommended 3 to 5-year course of immunotherapy. Why? OBJECTIVE: Determine the percentage of our patients receiving optimal dose, multiple-allergen immunotherapy from 1982 to 1996 who discontinued their immunotherapy prior to completion of the recommended 3 to 5-year immunotherapy protocol. Second, assess the reasons for these premature dropouts. Third, determine any differences related to the clinic location where injections are given. DESIGN AND METHODS: The medical records of patients who dropped out of our immunotherapy program before 3 years were analyzed by the author. SUMMARY OF RESULTS: Our dropout rate before 3 years was 12%. The five commonest reasons for early dropout were concurrent medical problems, noncompliance, change of residence, inconvenience, and allergic reactions. The systemic reaction rate for the 3-year dropout group was 1.00% compared with 0.9% for our overall study group. Eighty-eight percent of the systemic reactions were mild. About 1% of our immunotherapy patients quit early due to allergic reactions secondary to immunotherapy. CONCLUSIONS: The dropout rate for our optimal-dose patients is similar to/that reported previously by Tinkelman who apparently used a lower than optimal maintenance dose. (2) Many of our dropouts were predictable and avoidable. Few patients quit early due to allergic reactions secondary to our immunotherapy program.

Adolescent↗