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'I Just Stopped Going': A Mixed Methods Investigation Into Types of Therapy Dropout in Adolescents With Depression
What does it mean to âdrop outâ of therapy? Many definitions of âdropoutâ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the clientâs experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether this refined categorization of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioral Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11â17 years. Thirty-two were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. Sixty-seven cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analyzed using ideal type analysis. Three types of dropout were constructed: âdissatisfiedâ dropout, âgot-what-they-neededâ dropout, and âtroubledâ dropout. âDissatisfiedâ dropouts reported stopping therapy because they did not find it helpful. âGot-what-they-neededâ dropouts reported stopping therapy because they felt they had benefitted from therapy. âTroubledâ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of âdropoutâ cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment
Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals.
BACKGROUND: Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH).
METHOD: Readmissions during the calendar year 2006 were examined using hospital in-patient enquiry data. Associations with clinical and demographic factors were determined using univariate and multivariate analyses.
RESULTS: The medical emergency readmission rate to GUH, after correction for death during the index admission, was 19.5%. Age 65 years or more, male gender, length of stay more than 7 days and primary diagnoses of chronic obstructive pulmonary disease, myocardial infarction, alcohol-related disease and heart failure during the index admission were significantly associated with readmission in univariate and multivariate analyses.
CONCLUSION: The medical emergency readmission rate in GUH is comparable to other acute hospitals in Ireland and Britain. Further evaluation is needed to estimate the proportion of readmissions that are potentially avoidable
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