The pattern of engagement to care after first emergency psychiatry visit at Amanuel specialized mental hospital, Addis Ababa, Ethiopia
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Date
2018-12
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Addis Ababa University
Abstract
Background: - Aim of this study was to give an overview of how patients were engaging to
the service at the Hospital after first emergency visit to identify the gaps in the service and
factors associated with disengagement to care. Psychiatric service in Ethiopia has been
provided by Amanuel Hospital for the entire country for many years and the service was not
yet decentralized well. But there has not been systematic study conducted to see how patients
were engaging to care after visit. We believe the findings will help to plan to improve the
service and it will also raise questions for further research.
Objective: - To describe the pattern of engagement to care after first emergency psychiatry
visit at Amanuel Specialized Mental Hospital.
Methods: - A retrospective study was conducted involving those who visited emergency
outpatient department unit at ASMH from December /2015 to November /2016. Data
extraction sheet were used to collect information for the study. All cases who visited
emergency OPD of ASMH for the first time during the study period were included for
stratified simple random sampling and 385 participants were included in the study. The data
sheets were coded and data entry, cleaning and analysis was done using the Statistical
Package for the Social Sciences (SPSS) version 20.bivariate and Multivariate logistic
regression was done to see socio-demographic and other determinants of disengagement to
care
Results: -Three hundred and eighty five cases were included in the study. Of these, 57.4%
were males. The mean age of the participants was 31 years. In terms of region, majority of
the participants (near to 71%) come from either from Oromia (47%) or Addis Ababa
(23.6%).In majority of the participants (83.1%) the main reason for emergency visit was
either aggression or other behavioral disturbance and near to 76% got diagnosis of nonaffective
psychotic spectrum disorder. Near to 81% of the participants have disengaged from
care and from those who were disengaged 44.5% had no re-visit to the hospital. Among
participants 90.3% of female and 77.4% of male who were included in the study disengaged
from care. Majority of the participants (75.6%) were seen by Master or BSC psychiatry
prescriber’s and only 9.9% of the participants were seen by either psychiatrist or psychiatry
residents at first visit. Near to 95% of those participants seen by non-psychiatry professionals
were disengaged from care.
Conclusion: - disengagement from care has deleterious effect on over all prognoses of
patients and mental health care system in general. Proper emphasis should be given for
psychosocial interventions specially giving due emphasis on psycho-education about illness,
lifestyle management, family intervention and support, relapse prevention strategies.
Recommendation: - Giving proper psycho-education and patient centered care should be
the rule than the exception. Improving the referral system, working in co-ordination and
collaboration with other health institutions and religious leaders might help to improve
patient care and engagement.
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Keywords
first emergency psychiatry,disengagement