Hospitalized Pregnant Women Who Leave Against Medical Advice: Attributes and Reasons

Tabatabaei, Seyed Mehdi; Moakhar, Zahra Sargazi; Pour, Fateme Behmanesh; Mollashahi, Sedighe Shaare; Zaboli, Maryam

doi:10.1007/s10995-015-1811-1

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…Compared with conventionally discharged patients, AMA patients are younger, more likely to be male, and more likely a marginalized ethnic or racial minority. [10][11][12][13][14] Patients with mental illnesses and addiction issues are overrepresented in AMA discharges, and complicated capacity assessments and limited resources may strain providers. 7,8,15,16 Studies have repeatedly shown higher rates of readmission and mortality for AMA patients than for conventionally discharged patients.…”

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confidence: 99%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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confidence: 99%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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“…The problem of LAMA has been studied in an array of patients, but most of the literature relates to psychiatric illness or illicit drug abusers,[ 7 12 ] heart disease,[ 13 14 ] trauma,[ 15 16 ] cirrhosis,[ 17 18 ] pregnant, and postpartum patients. [ 19 20 ] Some studies believe that the developing countries have higher rate of LAMA. [ 4 5 21 ] However, in our study, the incidence was similar to the most of the other studies done on mix populations.…”

Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of patients who leave against medical advice in a tertiary teaching care institute

Gautam¹,

Sharma²,

Sharma³

et al. 2018

Indian Journal of Critical Care Medicine

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Context:Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system.Aims and Objectives:The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases.Subjects and Methods:We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation.Results:A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%).Conclusions:About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.

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“…Other reasons commonly cited for AMA were perceived improvement in clinical state, personal issues, preference for other hospitals or continuing treatment at home, and dissatisfaction with hospital services. [ 13 18 21 22 23 ] Some studies have also shown unspecified reasons,[ 2 ] and some have shown more than one reason. [ 10 ] In our study, majority (37%) did not specify reasons; however, none had mentioned more than one reason.…”

Section: Discussionmentioning

confidence: 99%

What happens to patients discharged against medical advice?

Ramakrishnan

Ranganathan

Abraham

et al. 2018

Indian Journal of Critical Care Medicine

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Introduction:Discharge against medical advice (DAMA) when requested by family members of patients in Indian Critical Care Units (CCUs) leads to loss of follow-up and unknown patient outcomes. Exclusion of these patients from research analysis and quality audits confounds these results. We hence explored the proportion of patients leaving DAMA, reasons, and their outcomes at 30 and 90 days.Methods:This was a prospective study of CCU patients admitted from July 2013 to February 2014. All patients, who were DAMA during this period, were included in this study. Demographics, APACHE data, and outcomes were collected and compared to patients discharged regularly during the same period. Outcomes of DAMA patients at 30 and 90 days were gathered by telephone follow-up.Results:Among the 663 patients admitted to the CCU, 15.1% (100 patients) were DAMA. The baseline APACHE score of the DAMA group was higher than the regular discharge group (29.5 ± 8.6 vs. 26.1 ± 10.3; P = 0.002). During the 30-day follow-up, 23% were alive, 56% dead, and 21% could not be contacted. At 90 days, mortality was 62% and survivors decreased to 14%. Common reasons for DAMA were – wanting to take the patient to another hospital (21%), reluctance for further treatments (12%), financial constraints (9%), and overall poor prognosis (7%).Conclusion:A significant proportion of patients in the CCU get DAMA despite high severity of illness. Understanding the outcomes of these patients will help refine CCU quality audit reports and research study results.

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Hospitalized Pregnant Women Who Leave Against Medical Advice: Attributes and Reasons

Abstract: We found that both hospital and patient related factors contribute to DAMA among pregnant women. Early identification of women at risk of DAMA and improvement of medical staff communication skills may decrease the occurrence of DAMA and improve health outcomes of pregnant women.

Cited by 5 publications

References 25 publications

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Retrospective evaluation of patients who leave against medical advice in a tertiary teaching care institute

What happens to patients discharged against medical advice?

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