Pretreatment Attrition Research Articles

Medical withdrawal management in Vancouver: Service description and evaluation

This study evaluates a medically managed inpatient detoxification service (Vancouver Detox (VD)) and investigates its clients' characteristics over a 1-year period. We present information on the daily operation at VD, and examine accessibility and efficiency of it from five perspectives: wait time, pretreatment attrition rate, treatment completion rate, length of stay (LOS), and occupancy rate (OR). In addition, we explore the impacts of seasonality and the monthly welfare check on the utilization of the service. Among 2294 referrals, 35% dropped out without engaging in treatment. Among those who were admitted to VD, 78% completed the treatment program. Shorter wait time and lower OR were found during the welfare check issuance period, and lower OR was found during summer. In addition, the patterns of utilization of VD were changed over the welfare check issuance period. Our analysis indicates that operational accessibility and efficiency at VD could be improved by specifically addressing these factors.

Pretreatment attrition and childhood social phobia: Parental concerns about medication

Pretreatment attrition, the systematic self-exclusion of potential participants during the recruitment phase of a study, poses a significant threat to the external validity of randomized clinical trials. Very little is known about the factors that contribute to pretreatment attrition, especially among families seeking treatment for a child. The current study assessed pretreatment attrition in a randomized clinical trial of behavior therapy, fluoxetine, and placebo for child and adolescent social phobia. Reluctance toward medication treatment accounted for 44.7% of study refusals and was disproportionately common among ethnic minority families. Parents were particularly worried about the potential for side effects or physical/psychological dependency upon the medication. Results are discussed in terms of the implications for external validity in future psychopharmacological clinical trials.

Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women

The present study sought to determine whether postcessation weight gain concerns influenced pretreatment attrition differently for pre- versus postmenopausal women smokers. Participants were pre- and postmenopausal women smokers drawn from two clinical trials for smoking cessation and weight gain prevention [the Smoking Treatment/Obesity Prevention (STOP) studies]. Predictors of attrition from baseline assessment visits prior to entering smoking cessation treatment were identified among these women. Pretreatment attrition was significantly higher among the premenopausal women. The premenopausal women had significantly higher weight concern but lower restraint and disinhibition than the postmenopausal women. Weight concern explained variance in treatment attrition from the programs, while controlling for variables such as Body Mass Index (BMI), smoking rate, number of years smoking, nicotine dependence level, dietary restraint, disinhibition, and hunger, such that the higher the weight concern, the more likely women were to drop out of treatment programs prior to a quitting attempt.

Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders.

Treatment attrition represents a considerable problem for efficient delivery of care for mental disorders. The present study examined rates and predictors of pretreatment attrition and dropout from outpatient treatment for anxiety disorders. The influence of clinical, demographic, clinician and system variables on pretreatment attrition (treatment refusal or non-attendance) and dropout were analysed in a consecutive sample of 731 clients treated at an anxiety disorders clinic in Sydney. Pretreatment attrition was common (30.4%) but dropout once clients had commenced treatment was rare (10.3%). Milder pretreatment symptoms were associated with treatment dropout and comorbid depression or depressive symptoms were associated with higher probability of both pretreatment attrition and dropout. Demographic, clinician and system influences were present but less important. Targeting of individuals with comorbid anxiety and depression may reduce treatment attrition rates among individuals with anxiety disorders presenting for treatment.

Pretreatment Attrition from Couple Therapy for Male Drug Abusers

This study tracked pretreatment attrition of 120 callers, 84 of whom were potentially eligible for outpatient couple treatment for male drug abuse. Demographic, significant other, substance use, and access related variables were examined as predictors of intake and treatment entry. Results were similar to other findings regarding variables associated with initiation of individual substance use treatment, and 29% of eligible callers entered treatment. Men whose partners did not use substances or who used in moderation were more likely to attend the intake session, and couples who received referrals were more likely to enter treatment than those who responded to a newspaper advertisement.

The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders specialty clinic

Efficacious treatments for social anxiety disorder have become increasingly available, with approximately three-quarters of treatment completers showing significant improvement [Arch. Gen. Psychiatry 55 (1998) 1133.]. However, very few individuals with social anxiety disorder access these services. The present study reports on the path to initiation of treatment for social anxiety disorder among individuals contacting an anxiety disorder specialty clinic. Of 395 initial telephone inquiries, only 60 individuals (15%) started treatment. Three “critical points” associated with high pretreatment attrition were identified: scheduling an initial interview, attending a scheduled initial interview, and initiating a treatment program after receiving a principal diagnosis of social anxiety disorder. Several demographic variables (e.g., level of education, race) were related to attendance at the initial interview. However, no differences were found between those who did and did not initiate treatment on demographic variables, symptom severity, or quality of life. Given that most individuals who complete treatment for social phobia experience significant benefit, results of the current study suggest that future efforts should be devoted to increasing number of patients who access these services.

Predictors of entering a long-term drug treatment study of panic disorder.

Three hundred thirty-three consecutive individuals with panic and agoraphobic-like symptoms were evaluated as part of the screening for entry in a long-term imipramine treatment study of panic disorder with agoraphobia. The present report compares three subgroups of potential subjects--those who entered the study (n = 139, 41.7%), those who were rejected from participation based on exclusion criteria (n = 161, 48.3%), and those who qualified to enter but refused participation (n = 33, 10.0%)-in order to characterize pretreatment attrition and address two specific questions: What variables other than inclusion and exclusion criteria predict the likelihood of entering the trial?, and What variables significantly predict the likelihood of refusal to participate? Logistic regression analysis revealed that the likelihood of entering the trial was influenced significantly and independently by a number of variables that included extroversion, anxiety, and work satisfaction and performance measures. The refused and rejected groups differed significantly on a number of variables that were not a priori exclusionary criteria, such as a history of substance abuse other than alcohol and current use of alcohol to decrease anxiety, but none of these variables emerged as independent, significant predictors of refusing behavior as a separate category of nonparticipation. Findings suggest the presence of factors common to both the rejected and the refused groups that significantly influence pretreatment attrition and caution that categorizing pretreatment attrition into refused and rejected categories may not always be clear cut. Research and clinical implications are briefly discussed.