Causes of missing doctor's appointments in children and adolescents with ADHD at the psychiatric outpatient department Chiangrai Prachanukroh Hospital
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Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is a condition among school-aged children in Thailand that requires continuous treatment, including medication and behavior therapy. Chiangrai Prachanukroh Hospital has the missing appointments ADHD patients, that caused hospital staff make follow-up phone calls to ensure the continuation of patients’ treatments. There hasn't been a study on the reasons for missed appointments. Therefore, researchers conducted this study to identify the causes of missed appointments to develop an appropriate care system.
Objective: To determine the rate of missed appointments and identify the causes behind these missed appointments in children and adolescents with ADHD at the Child Learning Problem Clinic, Department of Psychiatry, Chiangrai Prachanukroh Hospital.
Methods: A descriptive, analytical cross-sectional study was conducted among parents of children and adolescents with ADHD who were under 18 years of age. Missed appointments were collected from outpatient medical records between September 1, 2021, and April 30, 2023. Parents of children and adolescents with ADHD who missed appointments who can be contacted and consent to participate in the research were interviewed by phone. The data on the reasons for missed appointments and other relevant information were analyzed using descriptive statistics. Subgroup analysis was performed to compare reasons of missed appointment in patient residing in the capital district with other districts or other provinces using an Exact probability test. The statistical significance level set at p-value < 0.05.
Results: A total of 1,053 ADHD patients had 3,655 appointments, out of which 484 appointments (13.24%) were missed. The average age of 139 ADHD patients who missed their appointments was 10.34 ± 2.15 years. The reasons for missing doctor's appointments showed were as follows: fear of the COVID-19 epidemic (62.59%), having leftover medication due to irregular usage (47.48%), long-distance travel (27.34%), inconvenience for coming to the hospital on the day of the appointment (20.14%), problems with travel expenses (19.42%), symptoms already improved (18.71%), inadequate communication of information by hospital staff (7.19%), treatment ineffectiveness (5.76%), having side effects from medication (5.04%), long waiting times for examination (2.88%), and patients refusing to take medication (1.44%). In subgroup analysis, compared to patients residing in Amphur Muang (capital district), those who live in other districts and provinces faced significant problems of traveling long distances (p-value <0.001) and travel expenses (p-value =0.005).
Conclusions and recommendations: The study identified various causes of missed appointments among children and adolescents with ADHD. To address this issue, it is recommended to provide more comprehensive services and increase channels for receiving treatment, such as telemedicine and medication delivery through postal services. Additionally, providing care services for ADHD in remote areas is suggested. Such services should prioritize educating patients and parents about the importance of consistent medication use, behavior therapy, monitoring of treatment side effects, and attending appointments.
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