Profile of nonattending patients at psychiatric outpatient clinics before (in-person model) and during COVID-19 pandemic (telepsychiatry model): A comparison study

© 2024 Odisha Journal of Psychiatry. Published under a Creative Commons licence: https://journals.lww.com/odjp/fulltext/2023/19020/profile_of_nonattending_patients_at_psychiatric.4.aspxBACKGROUND: Missed appointments in mental health services have been a concern; as nonattendance may be associated with various clinical risk factors. AIMS: We intended to compare the profile of nonattenders at psychiatric outpatient clinics before (in-person model) and during the COVID-19 pandemic when the services changed to remote consultations (telepsychiatry model). MATERIALS AND METHODS: Clinical features (diagnosis, medical and psychological treatment, care program approach, and first contact), risk to self and others, and demographic variables (age, gender, ethnicity, accommodation, occupation, and benefits) were collected from the electronic records. The outcomes after the missed appointment were also noted. RESULTS: The sample consisted of 23 nonattenders in January 2020 (pre-COVID-19) and 32 nonattenders in November 2020 (during COVID-19); with an overall rate of nonattendance of 20% and 22%, respectively. Nonattenders during COVID-19 were significantly (P < 0.05) younger (36.4 ± 10.2 vs. 45.3 ± 15.0), and had more male patients (68.8% vs. 31.3%) compared to pre-COVID-19. There were no differences in other demographic variables, diagnoses, treatment received, or level of care. Risk to self was significantly more during COVID-19 (34.4% vs. 8.7%, P < 0.05) and risk to others was less (0.0% vs. 17.4%, P < 0.05). Significantly more (P < 0.05) nonattenders were contacted by letters during COVID-19 (81.3%) than pre-COVID-19 (52.2%); a higher (P < 0.05) proportion of nonattenders were discharged from services during COVID-19 (34.4%) compared to pre-COVID-19 period (8.7%). CONCLUSIONS: During COVID-19, when psychiatric outpatient services changed to remote consultations, there were differences in the profile of nonattenders and their risks. The results suggest that telepsychiatry services should explore the profile of nonattenders and their risks for arranging appropriate support

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes