Patients Discharged Against Medical Advice from a Psychiatric Hospital in Iran: A Prospective Study

Abstract

Aim:Self- discharged patients are at high risk for readmission and ultimately higher cost for care. We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics.Methods:This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables.Results:The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge.Conclusion:The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.

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

“…Substance abuse is one of the established personal factors that significantly increases the risk of DAMA [3,6,[21][22][23], particularly in psychiatric patients [24]. However, we found no significant differences in the proportion of substance abuse between cases and controls.…”

Discharge against medical advice (DAMA): Causes and predictors

“…DAMA, on the one hand, leads to dire consequences for patients and, on the other hand, has an increased likelihood of the need for readmission, which creates increased costs for patients and the healthcare system. The results of studies conducted in Iran confirmed the high rate of DAMA and readmission due to this issue ( 13 , 23 , 24 ). Investigating the current situation and also being aware of the causes as well as predictor variables can be useful in planning in order to reduce the rate of DAMA, make patients more satisfied, and improve the quality of services.…”

“…The readmission of this class of patients is different among countries; the study conducted in Canada has estimated the readmission rates about 10%, while in other countries 24.4% and 3.7% were reported ( 6 , 10 – 12 ). This rate in the United States was reported 0.8%–2.2% ( 12 ) and in Iran for the psychiatric patients was 3%, and 20% for the emergency sector ( 13 ). DAMA also can increase healthcare costs of patients and the health system up to 56%.…”

A Study of Sociodemographic and Clinical Profile of Inpatients Leaving Against Medical Advice in Psychiatry Ward in a Tertiary Care Teaching Hospital

“…A review of studies from pub med database between 1963 and 2019 using keyword discharge against medical advice revealed that prevalence rates of DAMA, in an inpatient psychiatry based hospital study to be around 39% [7], a prospective study reported 34.4% of DAMA [8] ,some studies found that it was higher among patients with mental illness than patients with other medical problem [9,10]. According to a detailed literature review by Brook M [11] the prevalence of DAMA ranged from 3 to 51 % with an average of 17%.…”

“…Studies were done to evaluate the predictors of DAMA which were broadly divided into two groups as patient variables and provider variables [11]. Although the findings were variable, younger age group, male sex , lower socioeconomic status, substance abuse, previous history of DAMA, failure to establish a good provider-patient relationship were the most common findings [7,8,13]. Since substance abuse is a common predictor, a study was done to understand why these patients undergo DAMA [14].…”