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

Abstract

Abstract: BACKGROUND: 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.