Changes in loss to follow-up among elderly patients with schizophrenia during the COVID-19 pandemic: A study from a specialized center in Peru

TL;DR

This study examines why elderly schizophrenia patients in Peru stopped attending mental health appointments, finding that starting treatment during the pandemic or in emergency settings increased the risk.

Contribution

The study identifies specific risk factors for loss to follow-up in elderly schizophrenia patients during the pandemic, emphasizing the impact of telemedicine and treatment initiation context.

Findings

The overall survival function for continued follow-up was 47% at the end of the study period.

Patients who started treatment after telemedicine implementation had a 49% survival rate, compared to 75% for those before telemedicine.

Loss to follow-up was significantly linked to starting treatment in the Emergency Department or post-COVID-19.

Abstract

To estimate the survival function and identify risk factors for loss to follow-up (LTFU) among elderly patients with schizophrenia treated at the National Institute of Mental Health (INSM) in Peru. A retrospective cohort study was conducted using clinical records from 138 randomly selected patients diagnosed with schizophrenia. Eligible patients had attended at least one appointment between April 15, 2018, and April 15, 2022. Clinical and attendance data were recorded for each psychiatric appointment until the end of the follow-up period or LTFU. The survival function for LTFU was estimated, and associations with type of appointment (telemedicine vs. face-to-face) and period of first appointment (pre- vs. post-telemedicine implementation) were analyzed using Cox regression. The overall survival function at the end of the follow-up period was 47%. Patients whose treatment began at INSM after the implementation of telemedicine (TM) had a survival function of 49%, compared with 75% for those who initiated their treatment before TM. LTFU was significantly associated with initiating treatment in the Emergency Department (ED) rather than through outpatient care and with starting treatment post-COVID-19. Our findings indicate a higher rate of LTFU among patients who began treatment at INSM during the post COVID-19 period or through the Emergency Department. These results highlight the need for targeted interventions to address these risk factors and improve continuity of care for this vulnerable population.

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