Abstract
Background
This study examined variables associated with patients who had a once-only contact with the out-patient department of a Community Mental Health Service (CMHS).
Methods
Using the South-Verona Psychiatric Case Register (PCR), an 8-year cohort of patients who had a new episode of care with the out-patient department of the South Verona CMHS was followed up for 3 months after the first contact, to identify those patients who had no further contact with the service. Potential determinants of once-only contact were analysed.
Results
A total of 2,446 new episodes of care met the inclusion criteria of the study. Of those, 734 (30%) were once-only contacts with the service. Compared to patients with more than one contact, patients who had a once-only contact were older, more likely to be male, had a lower socio-economic status and less severe psychiatric diagnosis. They were more likely to be referred by consultation/liaison or emergency room.
Conclusions
Multivariate analysis revealed that having a less severe psychiatric diagnosis was the most significant determinant of once-only contact with a CMHS. The results suggest that the behaviour of referring agents in selecting patients and preparing them for treatment merits further investigation.
Similar content being viewed by others
References
Henisz J, Flynn H, Levine M (1977) Clients and Patients of Mental Health Services. Arch Gen Psychiatry 34:1345–1348
Kontny EL, Cooper JE, Howat JGM (1982) The patient who is new to psychiatric services. Nottingham: Unpublished
Lavik N (1983) Utilization of mental health services over a given period. Acta Psychiatr Scand 67:404–413
Trepka C (1986) Attrition from an out-patient psychology clinic. Br J Med Psychol 59:181–186
Taube CA, Goldman HH, Burns BJ, Kessler LG (1988) High users of out-patient mental health services, I: definition and characteristics. Am J Psychiatry 145:19–24
Balestrieri M, Sytema S, Gavioli I, Micciolo R (1988) Pattern of psychiatric care in South Verona and Groningen. Acta Psychiatr Scand 80:437–444
Sytema S, Balestrieri M, Giel R, ten Horn GH, Tansella M (1989) Use of mental health services in South Verona and Groningen. Acta Psychiatr Scand 79:153–162
Chen A (1991) Noncompliance in community psychiatry: a review of clinical interventions. Hosp Community Psychiatry 42:282–287
Tansella M, Micciolo R, Biggeri A, Bisoffi G, Balestrieri M (1995) Episodes of care in first-ever psychiatric patients. A long-term case-register evaluation in a mainly urban area. Br J Psychiatry 167:220–227
Morlino M, Martucci G, Musella V, Bolzan M, de Girolamo G (1995) Patients dropping out of treatment in Italy. Acta Psychiatr Scand 92:1–6
Amaddeo F, Beecham J, Bonizzato P, Fenyo A, Tansella M, Knapp M (1998) The costs of community-based psychiatric care for first-ever patients. A case register study. Psychol Med 28:173–183
Baekeland F, Lundwall L (1975) Dropping out of treatment: A critical review. Psychol Bull 82:738–783
Tansella M, Balestrieri M, Meneghelli G, Micciolo R (1991) Trends in provision in psychiatric care 1979–1988. In: Tansella M (ed) Community-based Psychiatry: long term patterns of care in South-Verona. Psychol Med 19:5–16
Phillips M, Ali H (1983) Psychiatric Patients who discharge themselves against medical advice. Can J Psychiatry 28:202–205
Tehrani E, Krussel J, Borg L, Munk-Jorgensen P (1996) Dropping out of psychiatric treatment: a prospective study of a first admission cohort. Acta Psychiatr Scandinavica 94:266–271
Young A, Grusky O, Jordan D, Belin TR (2000) Routine outcome monitoring in a public mental health system: the impact of patients who leave care. Psychiatric Services 51:85–91
Rossi A ,Amaddeo F, Bisoffi G, Ruggeri M, Thornicroft G, Tansella M (2002) Dropping out of care: inappropriate termination of contact with community-based psychiatric services. Br J Psychiatry 181:331–338
Killaspy H, Banarjee S, King M, Lloyd M (2000) Prospective controlled study of psychiatric out-patient non-attendance. Br J Psychiatry 176:160–165
Sytema S, Micciolo R, Tansella M (1997) Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case register study. Psychol Med 27:1355–1362
Tansella M, Amaddeo F, Burti L (1998) Community-based mental health care in Verona, Italy, in: Mental Health in Our Future Cities. Edited by Goldberg D, Thornicroft G, Hove, Psychological Press
Tansella M, Amaddeo F, Pighi C (1999) South-Verona Psychiatric Case Register Data. Internal Report. Department of Medicine and Public Health, University of Verona: Verona
Amaddeo F, Beecham J, Bonizzato P, Fenyo A, Knapp M, Tansella M (1997) The use of a case register to evaluate the costs of psychiatric care. Acta Psychiatr Scand 95:189–198
Gould W (2000) Interpreting logistic regression in all its forms. Stata Tech Bulletin 53:19–29
Derksen S, Keselman HJ (1992) Backward, forward and stepwise automated subset selection algorithms: Frequency of obtaining authentic and noise variables. Br J Mathemat Statist Psychol 45:265–282
Breiman L (2001) Random forests 45:5–32
Breiman L, Friedman JH, Olshen RA (1984) Classification and regression trees. Wadsworth, Belmont
StataCorp (2001) Stata Statistical Software: Release 7.0. College Station, TX: Stata Corporation
Garrett JM (2000) SWBOOT: Stata module to bootstrap stepwise linear or logistic regression models. Statistical Software Components from Boston College Department of Economics (http://ideas.repec.org/p/boc/bocode/s415601.html)
Ihaka R, Gentleman R (1996) R: A Language for Data Analysis and Graphics, J Comput Graphic Statistic 5:299–314 (http://cran.r-project.org)
Liaw A, Wiener M (2002) random Forest for R Classification and Regression with Random Forests (http://cran.r-project.org/bin/windows/contrib/1.7/randomForest_4.0–1.zip)
Heaven C, Maguire P, Green P (2003) A patient-centred approach to defining and assessing interviewing competency. Epidemiol Psychiatr Soc 12(2):86–91
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rossi, A., Amaddeo, F., Sandri, M. et al. Determinants of once-only contact in a community-based psychiatric service. Soc Psychiatry Psychiatr Epidemiol 40, 50–56 (2005). https://doi.org/10.1007/s00127-005-0845-x
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00127-005-0845-x