Predictors of missed first appointments at community mental health centers after psychiatric hospitalization.
OBJECTIVE
This study was conducted to determine the practical, readily accessible predictors of missed first outpatient appointments in a community mental health setting after psychiatric hospitalization.


METHODS
Data were collected from treatment team members and from charts of 234 consecutively discharged patients from two inpatient units in a large, urban, county hospital. Data on whether the patient attended the first scheduled outpatient community mental health appointment were gathered by telephone contact with outpatient clinics. Outcome data were available for 221 patients. Bivariate tests examined a variety of demographic, psychosocial, and clinical characteristics that may be associated with nonadherence. Significant predictors were entered into a logistic regression model to determine effect estimates (adjusted odds ratios).


RESULTS
In bivariate tests, a number of variables were predictive of nonadherence with the first scheduled outpatient appointment. In the logistic regression model, the four characteristics that were independently significant predictors included involuntary legal status at discharge or leaving against medical advice, not having an established outpatient clinician, axis IV problems related to the primary support group (for example, death of a family member or health problems in the family), and number of days from hospital discharge to the follow-up appointment.


CONCLUSIONS
Clinical, policy, and programmatic implications may be elaborated by studying risk factors for nonadherence in a community mental health setting. Given the multitude of problems associated with nonadherence, interventions should be tailored around specific characteristics that elevate the risk of nonadherence, especially nonadherence in the form of failure to attend the first appointment after psychiatric hospitalization.
Compton
Michael T
MT
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Memorial Hospital, Box 26238, 80 Jesse Hill Jr. Drive, Atlanta, Georgia 30303, USA. mcompto@emory.edu
Rudisch
Bruce E
BE
Craw
Jason
J
Thompson
Tina
T
Owens
Dwight Antonio
DA
D000328:Adult; D001071:Appointments and Schedules; D003155:Community Mental Health Centers / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D014481:United States