[Treatment dropout as failed utilization--development of a predictive model for inpatient psychosomatic rehabilitation].
Premature discontinuance of rehabilitative measures can be considered a revised decision by the patient concerning participation or a revised decision by the clinic concerning admittance. Such termination of therapy suggests that the individual need for rehabilitation (defined as the fit between the patient's need for rehabilitation and the treatment offered by the rehabilitation facility) is not (or no longer) present, at least at this point in time. Assuming that the individual need for rehabilitation actually existed when treatment was requested or approval for rehabilitative measures was granted, the question arises as to when and how the need changed in such a way that would prevent the treatment from continuing as planned and being concluded in a regular fashion. This question will be taken into focus in the present article by developing a model for the prediction and explanation of prematurely discontinued treatment. This model will give central significance to the intention to co-operate, which is considered a dependent variable by reference to individual symptoms and treatment related expectations. Furthermore, various factors of influence during the stay in the clinic are formulated, which, firstly, have a presumed effect on the intention to cooperate and, secondly, have an influence on whether the intention to prematurely terminate treatment develops from a specific intention to cooperate and whether this is then realized. The model is discussed with regard to its practicability and possibilities for operationalization.
Lang
K
K
Abt. für Medizinische Psychologie Universitäts-Krankenhaus Eppendorf, Hamburg. klang@uke.uni-hamburg.de
Schulz
H
H
Lotz-Rambaldi
W
W
Koch
U
U
D005858:Germany; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D009313:National Health Programs / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011379:Prognosis; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000534:rehabilitation*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D017211:Treatment Failure