Electronic Letters to:
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eLetters: Electronic letters published:
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Phenomenon of disappearing patient?
- Fabida Noushad (24 January 2009)
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The importance of appointment adherence in developing countries
- S M Singh (24 January 2009)
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Re: Phenomenon of disappearing patient?
- Ademola B. Adeponle (4 March 2009)
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Fabida Noushad Assertive Outreach Team, Leicestershire Partnership Trust
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fabida{at}gmail.com Fabida Noushad
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The recent article by Adeponle et al highlights family participation in treatment and how this may affect adherence to follow up appointments and medication adherence. (1) In the given study, only 81 out of 387 patients met study criteria, and this could have significantly altered results. Could the reason for this be the stringent inclusion criteria where patient's families must have visited once every 2 weeks? For patients with longer inpatient stay, families may have been unable to visit every 2 weeks for many months due to various commitments. This is reflected also by the finding by authors that for 69.1% of patients, illness duration was more than or equal to a year. Other involvements such as telephone contact; visits by close friends may have replaced the visits, and this could have been included in the inclusion criteria. Inclusion criteria should not be made too restrictive, as the study may lose representative ness and the ability to examine differences in the patient group, and may well suffer from the ‘disappearing patient’ phenomenon. (2 ) References 1 Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian hospital. Ademola B. Adeponle, Brett D.Thombs, Moruf L.Adelekan and Laurence J Kirmayer. 2 Stephen M. Lawrie, Andrew M. McIntosh, Sanjay Rao. Critical Appraisal for Psychiatry,Elsevier Churchill Livingstone,2000 |
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S M Singh, Psychiatrist GSMCH, Banur, India
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chotu66{at}rediffmail.com S M Singh
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The study by Adeponle et al. (1) raises the important issue of family involvement in the maintenance of appointment adherence and management of patients with mental illness. As has been pointed out by the authors, the family is an underutilized and unsung resource in developing countries and may be a particularly important factor responsible for the reportedly better outcomes of patients with disorders such as schizophrenia. The issue of appointment adherence as opposed to treatment adherence is a neglected facet in psychiatric research and data are scarce. For instance, in a follow-up study of patients from North India who had been admitted with substance use disorders, appointment adherence significantly predicted better outcomes as opposed to other measures such as prophylactic agents or length of in-patient stay (2). Whereas similar data from developing countries are not available for non-substance-use related psychiatric disorders, it is possible that appointment adherence may be an independent and important factor that predicts outcomes through a variety of pathways including treatment adherence, or better psychosocial support mechanisms. This is particularly so in developing countries such as India where doctors are generally looked up to as figures of authority. 1. Adeponle A, Thombs BD, Adelekan ML, Kirmayer LJ. Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital. Br J Psychiatry. 2009;194:86 -7. 2. Singh S, Mattoo SK, Dutt A, Chakrabarti K, Nebhinani N, Kumar S, Basu D. Long-term outcome of in-patients with substance use disorders: A study from North India. Indian Journal of Psychiatry. 2008;50:269-73. |
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Ademola B. Adeponle, Physician Division of Social and Transcultural Psychiatry, McGill University
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dradeponleab{at}yahoo.com Ademola B. Adeponle
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Dr. Noushad was concerned that due to our "stringent inclusion criteria where patient's families must have visited once every 2 weeks" many otherwise eligible patients were excluded. Dr. Noushad indicated that "only 81 out of 387 patients met study criteria, and this could have significantly altered results." Neither of these assertions is correct. As stated in the article (1), all patients "admitted between July and December 2004 and taking their medications as prescribed at discharge were eligible for the study." Family visitation frequency was used to determine extent of study involvement, not study eligibility. Furthermore, the article states, "There were 81 patients who met study criteria and all consented to take part in the study." We do not know why Dr. Noushad believed that only 81 out of 387 patients met study criteria, although we did use the number 387 to describe an altogether different study in the introduction. (1) Adeponle A, Thombs BD, Adelekan ML, Kirmayer LJ. Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital. Br J Psychiatry. 2009;194:86 -7. |
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