Killapsy, Helen Therese; (2001) A prospective study of psychiatric outpatient non-attenders. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Psychiatric clinics have high non-attendance rates and failure to attend may be a sign of deteriorating mental health, but there have been no prospective studies of psychiatric outpatient non-attendance in the United Kingdom. Good communication between professionals following outpatient appointments is essential for well coordinated management of community patients but has not been researched for follow-up patients. Aims 1. To investigate why psychiatric outpatients miss appointments and the consequences of non-attendance. 2. To examine the quality of communication between GP's and psychiatrists following outpatient appointments. Method A prospective cohort study of randomly selected attenders and non-attenders at general adult psychiatric outpatient clinics in a geographically defined area of inner London. Subjects were interviewed at recruitment and severity of mental disorder and degree of social adjustment were measured. General practitioners were interviewed to assess their opinion on the quality of communication received from the psychiatrist following outpatient appointments. The quality of general practitioners' referral letters and psychiatrists' clinic letters were compared. Subjects' engagement with the clinic and any psychiatric admissions were noted six and twelve months later. Results Of the 365 patients included in the study, 30 were untraceable and 224 consented to participate (a response rate of 66% for those traceable and 61% overall). The most common reasons given for non-attendance were having forgotten (27%) and being too psychiatrically unwell to attend (14%). Follow-up patients were more psychiatrically unwell than new patients For follow-up patients, non-attenders had lower social functioning and more severe mental disorder than those who attended and at twelve months, those who missed their appointment were more likely to have been admitted than those who attended (42 [33%] versus 27 [20%], χ2=5.5, df 1, p=0.018). There was no difference in the quality of referral letters of attenders and non- attenders. Psychiatrists were less likely to write to GPs about follow-up patients than new patients and they were least likely to write when a follow-up patient did not attend. Conclusions Those who miss psychiatric follow-up outpatient appointments are more unwell and more poorly socially functioning than those who attend. They have a greater chance of subsequent admission yet psychiatrists communicate poorly with the GP about them.

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