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JMOOD. 2015; 5(4): 151-6


Missed appointments and medication non-compliance among consecutive psychiatric patients

Gokay Alpak, Ihsan Aksoy, Bahadir Demir, Ahmet Unal, Osman Virit, Feridun Bulbul, Haluk A. Savas.

Abstract
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 used 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 with recommended drugs and attendance to the next appointment of 100 consecutive patients who applied to psychiatric outpatient clinic of Gaziantep University Medical Faculty Hospital for the first time and diagnosed with a disorder and the reasons for non-attendance and factors associated with non-compliance.
Results: The non-attendance rate for the following appointment was 48%. We grouped our patient sample into two; Group I was named as “attenders” and included 52 patients, Group II was named as “non-attenders” and consisted of 48 patients. The mean value of the days patients did not use their medication was found to be 7.75±8.973. 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 if the patient lives outside the city (aOR: 5.410, 95% CI: 1.751, 16.718), presence of referral (aOR: 0.403, 95% CI: 0.136, 1.195), diagnosis of bipolar disorder (aOR: 0.085, 95% CI: 0.008, 0.935), and missed medication for more than 3 days (aOR: 5.924, 95% CI: 2.257, 15.552) were found to be the variables that may predict 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 adhere 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 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 attenders and non-attenders except two as mentioned in results. Also, 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 increase the non-compliance. In our study, patients were meeting with the psychiatrist for the first time; this can be accounted for the high non-compliance rate. The therapeutic relationship, focusing on the factors effecting non-compliance, and changing our attitudes towards those patients are helpful in reducing the non-compliance rates.

Key words: Non-compliance, outpatient clinic, missed appointment



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