Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

Abstract

Objective: To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. Method: This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default. Results: Overall, 20.4% respondents were defaulters, with a median duration of clinic nonattendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20km from the hospital, missing previous appointments and dissatisfaction with outpatient care. Conclusion: Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.

Aderência ao seguimento no cuidado ao recém-nascido exposto à sífilis e características associadas à interrupção do acompanhamento

“…In some cases, factors such as the distance between the residence and the health service have influenced the continuity of follow-up. In Nigeria, for example, children with schizophrenia did not attend the medical appointments owing to the long distances 33 . In our study, there was no statistically significant difference for the abandonment of the follow-up by mothers living in Curitiba, Paraná, or in the cities near the metropolitan region.…”

Correlates of attendance in mental health services for individuals with psychotic disorders: A critical review

“…Length of time to appointment 1 0 n/a Adelufosi et al, 2013 Satisfaction with treatment 1 1 Dissatisfaction predicts less attendance (Adelufosi et al, 2013) Number of past missed appointments 1 1 More missed appointments predicts less attendance (Adelufosi et al, 2013) Type of treatment (group or individual) 1 1 Varied by month (Carrion et al, 1993) Sustained substance use during study 4 4…”

“…Ongoing substance use is one variable which seems to consistently predict risk for lowered attendance or dropout; demographic variables and employment seem to be of References of previous related reviews searched 51 potentially relevant articles identified  22 excluded due to inappropriate focus  12 excluded because not enough information was provided  11 excluded because sample was not appropriate  1 excluded because they were unpublished/not peer reviewed  3 excluded because outcome measure was subjective 2 relevant articles included Adelufosi et al, 2013;Adeponle et al, 2009;Conus et al, 2010;Schimmelman et al, 2006;Stowkowy et al, 2012;Svettini et al, 1998;Turner et al, 2007;Ucok et al, 2007 Race/Ethnicity 2 0 n/a Kurtz et al, 2011;Turner et al, 2007 Sex 8 0 n/a Adelufosi et al, 2013;Adeponle et al, 2009;Conus et al, 2010;Kurtz et al, 2011;Schimmelman et al, 2006;Stowkowy et al, 2012;Svettini et al, 1998;Turner et al, 2007 Education 5 Living away from family 6 2 Predicted less attendance (Conus et al, 2010;Schimmelman et al, 2006) Adelufosi et al, 2013;Stowkowy et al, 2012;Svettini et al, 1998;Turner et al, 2007 Distance from service site 2 2 Greater distance predicts less attendance (Adelufosi et al, 2013;Adeponle et al, 2009) Other psychosis diagnosis predicts less attendance as compared to schizophrenia (Conus et al, 2010;Stowkowy et al, 2012); substance use diagnosis predicts less attendance (as compared to affective diagnosis; (Adeponle et al, 2009)); PTSD and/or substance abuse diagnosis predicts less attendance (as compared to schizophrenia, major depression, bipolar, dysthymic disorder …”

“…The two studies which assessed two different outcomes were both rated as high quality, for a total of 13 separate high quality outcomes. Of high-quality studies, four examined time engaged (Conus et al, 2010;Schimmelman, Conus, Schacht, McGorry, & Lambert, 2006;Stowkowy et al, 2012;Ucok et al, 2007), six examined attendance (categorical) (Adelufosi, Ogunwale, Adeponle, & Abayomi, 2013;Adeponle, Thombs, Adelekan, & Kirmayer, 2009;Carrion, Swann, Keller-Cecil, & Barber, 1993;Sparr, Moffitt, & Ward, 1993;Stowkowy et al, 2012;Svettini et al, 1998), and three examined dropout (Kurtz, Rose, & Wexler, 2011;Turner, Smith-Hamel, & Mulder, 2007;Ucok et al, 2007).…”

“…313 Duration of prodrome 1 1 Shorter predicted less attendance (Conus et al, 2010) Duration of illness 4 0 n/a Adelufosi et al, 2013;Adeponle et al, 2009;Kurtz et al, 2011;Svettini et al, 1998 Age at onset 5 1 Older age predicts less attendance (Ucok et al, 2007) Conus et al, 2010Kurtz et al, 2011;Stowkowy et al, 2012;Svettini et al, 1998 Insight 4 (Ucok et al, 2007) …”