Treatment dropout of patients in National Continuing Management and Intervention Program for Psychoses in Guangdong Province from 2006 to 2009: Implication for mental health service reform in China

Abstract

AbstractIntroductionIn 2005, China commenced its mental health reform by establishing a national program to move from a hospital‐based service model to an integrated hospital and community treatment model for psychoses, adopting the key principles of and provisions for continuity of care, treatment accessibility and equitable mental health care. This paper reports the rate and associated factors of treatment dropout for patients with psychoses in the national program in Guangdong Province from 2006 to 2009.MethodsAdult patients with psychoses followed‐up in two demonstration sites in Guangdong Province were grouped as treatment dropout if they were lost to follow‐up for three consecutive months. Dropout rate was estimated, and associated factors were explored with multifactor binary logistic regression analysis.ResultsOf 1,386 patients followed up from 2006 to 2009, 73 patients (5.29%) dropped out (five deceased patients were excluded). Poor adherence to medication, having no medication, and having worse global clinical outcome contributed to increased risk of dropout by 12.765 (P = 0.0017), 7.400 (P = 0.0063) and 6.385 times (P = 0.0207), respectively. When course of illness increased by five years, the risk of dropout increased by 1.322 times (P = 0.0031).DiscussionTreatment dropout rate for patients with psychoses in Guangdong Province appears to be low. Implications for mental health service reform in China include assertive follow‐up for patients with history of poor adherence with treatment, free medications to poor patients to increase access to appropriate and affordable treatment, and active psychoeducation for patients with poor insight and their families.