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LETTERS TO EDITOR  
Year : 2020  |  Volume : 62  |  Issue : 6  |  Page : 745-747
Reasons for not following up in patients with psychiatric illnesses: A telephonic cross-sectional study


Department of Psychiatry, Sri Siddhartha Medical College and Hospital, Tumakuru, Karnataka, India

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Date of Submission06-Oct-2019
Date of Decision29-Dec-2019
Date of Acceptance16-Sep-2020
Date of Web Publication12-Dec-2020
 

How to cite this article:
Nayok SB, Thimmaiah SM. Reasons for not following up in patients with psychiatric illnesses: A telephonic cross-sectional study. Indian J Psychiatry 2020;62:745-7

How to cite this URL:
Nayok SB, Thimmaiah SM. Reasons for not following up in patients with psychiatric illnesses: A telephonic cross-sectional study. Indian J Psychiatry [serial online] 2020 [cited 2021 Jan 23];62:745-7. Available from: https://www.indianjpsychiatry.org/text.asp?2020/62/6/745/303162




Sir,

Long-term follow-up is essential for successful treatment outcomes in psychiatric disorders.[1] It is low in India and ranges between 21% and 59%.[2] Reasons may be the symptoms themselves, poor insight, attitude toward mental illnesses, drug adverse effects, and logistic challenges.[2],[3],[4] Compliance is evaluated using various scales. However, many western scales may not incorporate our relevant cultural factors. Indian patients may not understand them well.[5] Moreover, the patient had to be present in the facility for such an evaluation. We, therefore, miss the patients' perspectives regarding noncompliance in those who do not follow up. Thus, we aimed to evaluate the reasons for not following up as given by the patients (or their family members) who were lost to follow-up.

A cross-sectional telephonic study was done at a general hospital attached to a private medical college in Karnataka with ethical clearance. Records of all the patients with psychiatric illnesses visiting the psychiatry outpatient department from January 2016 to December 2017 were evaluated. Only those who had not come for follow-up even after 3 months of their scheduled follow-up dates were included. We found 200 patients meeting this criterion. The primary investigator (SBN) dialed available phone numbers of 173 such patient profiles on 7 consecutive days, from 4 pm to 7 pm. Those who were unreachable, switched off, busy, or had not received at the first attempt were called again on 2 successive days. Preference of order was given to the patient's number, their first-degree relatives, and then other relatives. We spoke to 90 patients or relatives but could not contact 83 patients even after three attempts. At the beginning of each phone call, SBN introduced himself and requested consent after explaining the purpose of calling the patients or their relatives. The conversation was held in either Kannada, Hindi, or English, as per the preferences of the responders. Information was collected from the relatives only if the patient was not available. Adverse effects of treatment were specifically asked to all. After analyzing the speech samples of the respondents, “complete improvement,” “some improvement,” “no improvement,” “relapse,” and “death” groups were created.

The mean age of the sample was 40.22 (standard deviation [SD] = 14.98) years, for those who spoke was 41.12 (SD = 14.34), and for those whom we failed to contact was 40.22 (SD = 14.98). Their relevant sociodemographic data and diagnoses are given in [Table 1].
Table 1: Sociodemographic details and diagnoses

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Of those whom we could not contact, 41 (49.39%) were unreachable, 24 (28.91%) did not answer, and 18 (21.68%) were wrong numbers. Overall, 27 (30%) patients spoke directly with us. Uncle/aunt/cousin spoke the most (60%) for those with alcohol dependence syndrome (ADS). Overall, the reasons for not following up were given as “no symptoms/complete improvement” by 41 (45.55%), “some improvement” by 21 (23.33%), “no improvement” by 21 (23.33%), and “relapse” by 3 (3.33%) responders. The highest “complete improvement” was reported by patients with ADS (85.71%). “No improvement” was highest (38.09%) in patients with schizophrenia. Only four patients mentioned difficulty in logistics. No one reported adverse effects even after asking for it specifically. Overall, 62 (68.88%) patients who did not follow up with us went for further consultation elsewhere. Most patients (66.66%) did not follow-up after their first visit.

About one-third of the patients reported “complete improvement” as the reason for not following up. This initial improvement, although at times partial, is seen in other studies too.[6] In our study, none mentioned side effects to be a reason, like another qualitative study in the community.[7] Most of those who did not follow up in the schizophrenia cluster gave “some improvement” or “no improvement” as their reason. Initial treatment response for schizophrenia is often poor, leading to poor follow-up and compliance.[1] Again, this was not due to side effects, as seen previously.[4] Previous studies have also not found ADS as much.[3],[6] We found a large number of ADS patients as we called those who did not follow up. However, we do remain skeptical of their reports of total abstinence.

As a limitation, we could not contact 83 patients. This study shows that symptom reduction was more important for further follow-ups for most. The initial visit may also be the only time we have to provide the maximum impact.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chakrabarti S. What's in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World J Psychiatry 2014;4:30-6.  Back to cited text no. 1
    
2.
Grover S, Dua D, Chakrabarti S, Avasthi A. Dropout rates and factors associated with dropout from treatment among elderly patients attending the outpatient services of a tertiary care hospital. Indian J Psychiatry 2018;60:49-55.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kalucha S, Mishra K, Gedam S. Noncompliance in psychosis. J Datta Meghe Inst Med Sci Univ 2017;12:61.  Back to cited text no. 3
  [Full text]  
4.
Grover S, Mehra A, Chakrabarti S, Avasthi A. Dropout rates and reasons for dropout from treatment among elderly patients with depression. J Geriatr Ment Health 2018;5:121-7.  Back to cited text no. 4
  [Full text]  
5.
Grover S, Chakrabarti S, Sharma A, Tyagi S. Attitudes toward psychotropic medications among patients with chronic psychiatric disorders and their family caregivers. J Neurosci Rural Pract 2014;5:374-83.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Taj R, Khan S. A study of reasons of non-compliance to psychiatric treatment. J Ayub Med Coll Abbottabad 2005;17:26-8.  Back to cited text no. 6
    
7.
Reddy SK, Thirthalli J, Channaveerachari NK, Reddy KN, Ramareddy RN, Rawat VS, et al. Factors influencing access to psychiatric treatment in persons with schizophrenia: A qualitative study in a rural community. Indian J Psychiatry 2014;56:54-60.  Back to cited text no. 7
[PUBMED]  [Full text]  

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Correspondence Address:
Sathyanarayana Malleshwara Thimmaiah
Department of Psychiatry, Sri Siddhartha Medical College and Hospital, Tumakuru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_285_20

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