Non-compliance - awareness and attitude of psychiatric patients regarding out patient follow-up at civil hospital, Karachi

ABSTRACT

To determine the awareness, attitude and causes of non-compliance of psychiatric patients attending the out patient follow up treatment at Psychiatry Department, Civil Hospital, Karachi. A cross-sectional study. The study was conducted from July 2003 to February 2004 at Civil Hospital, Karachi. A pre-coded pre-tested questionnaire especially designed for this study was used. Non-complaint patients attending the Out Patient Department [OPD] were selected by systematic random sampling method. Non-compliance was defined as attending the OPD after a lapse of 15 days or more from the previous visit. Variables were described in percentages, mean and standard deviation. Proportions were compared using chi-square test. Non-compliance in follow-up was recorded as 18% in the 100 selected patients. Majority [65%] patients were of the middle age group i.e. 30-49 years with mean age 32.71 +/- 10.85 years. Similarly majority of the patients were illiterate [54%], belonged to low-income group [64%] and were unskilled workers [34%]. Family history of the same disease was found in 24% patients. Satisfaction of family members from the treatment compared to non-medical faith-healers were statistically significant at p<0.01. The main reasons for non compliance of follow-up treatment were [i] the patients denial of having any psychiatric disease [14%], [ii] irregular intake of medicines [14%] and [iii] lack of money for either commutation or purchase of medicine [11%]. Only 41% patients were taking the medicines regularly in the prescribed doses and 32% patients could not afford the cost of the prescribed medicine. Among the studied cohort of psychiatric out patients, non-compliance was 18%. Patients' denial of his disease and non affordability of patient regarding his treatment expenditures were the major causes. Awareness and satisfaction of patients and their family members regarding the increase efficacy and reliability of medical doctors compared to non-medical faith healers, had significant impact over the patients compliance