The pattern of engagement to care after first emergency psychiatry visit at Amanuel specialized mental hospital, Addis Ababa, Ethiopia

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Addis Ababa University


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.



first emergency psychiatry,disengagement