Promoting follow-up attendance among mental health patients at a primary healthcare center in Lebanon: A randomized controlled trial.

Abstract

In 2015, the Lebanese Ministry of Public Health launched the 2015-2020 National Mental Health Strategy in an effort to integrate Mental Health into Primary Healthcare centers. One of the key objectives of the strategy was to increase the detection, assessment, and management of mental disorders including depression. In addition to diagnosis and patient education, a successful management of depression requires that patients systematically follow-up with their healthcare provider to ensure that they are on the optimal path to recovery. This study evaluates the impact of a visual self-assessment card to increase patients' attendance to a follow-up appointment with their healthcare provider. A clustered randomized controlled trial was implemented at a Primary Healthcare center located in South Lebanon. The final sample consisted of 405 patients (209 treated and 196 untreated patients) who were diagnosed with mild-to-severe depression using the Patient Health Questionnaire (PHQ-9 > 4). Patients were asked to attend a follow-up appointment with their health provider 2-3 weeks following the initial assessment. Treated patients were provided with a visual self-assessment card that tracked their daily mood changes and reminded them of their follow-up appointment. Overall, the results provide evidence supporting the use of the self-assessment card to remind mental health patients of their follow-up appointments. Patients who received the card were 9 percentage points more likely to attend their follow-up appointment (p = 0.05), with new patients (vs existing patients) exhibiting a 15 percentage points increase (p < 0.05). Efforts focused on increasing compliance with follow-up appointments should be at the cornerstone of mental health integration approaches. Not only do our findings suggest a great potential for cost-effective interventions but also highlight new avenues to optimize on the use of reminders to promote compliance.