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.
This is a preview of subscription content, log in via an institution to check access.
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 Nottingham: Unpublished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