Rates of Criminal Legal System Involvement Among Patients Who Are Discharged Against Medical Advice

Abo-Sido, Nora; Simon, Lisa; Tobey, Matthew

doi:10.1007/s11606-018-4541-4

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…For some patients, these restrictions reminded them of being incarcerated. One prior study showed that patients with histories of incarceration are more likely to be discharged AMA, 27 and our data suggest that the association between hospitalization and incarceration may play a role. Patients with SUD experience high rates of incarceration, a traumatic and disruptive life event.…”

Section: Discussionsupporting

confidence: 67%

Understanding why Patients with Substance use Disorders Leave the Hospital against Medical Advice: A Qualitative Study

2020

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Background Hospital discharges against medical advice (AMA) is associated with negative health outcomes and re-admissions. Patients with substance use disorders (SUD) are up to three times more likely to be discharged AMA as compared to those without SUD. Studies suggest that undertreated withdrawal and a perception of stigma may increase the risk, however, to date, there are no published qualitative studies exploring the specific reasons why patients with SUD leave prematurely. Methods Semi-structured interviews with patients ( n = 15) with SUD with documented AMA discharges from our hospital between 9/2017 and 9/2018. Maximum variation sampling was employed to display diversity across gender, race, age, and type of substance use disorder (alcohol vs opioids). Patients were interviewed until no new concepts emerged from additional interviews. Two coders separately coded all transcripts and reconciled code assignments. Results Four core issues were identified as patients’ reasons for leaving the hospital prematurely: undertreated withdrawal and ongoing craving to use drugs, uncontrolled acute and chronic pain, stigma and discrimination by hospital staff about their SUD, and hospital restrictions, including not being allowed to intermittently leave the hospital floor. For patients with histories of criminal involvement, being hospitalized reminded them of being incarcerated. Conclusion These findings shed light on the reasons patients with SUD are discharged from the hospital AMA, an event that is associated with increased thirty-day mortality and hospital re-admission. AMA discharges represent missed opportunities for the health care system to engage with patients struggling with a SUD. Our findings support the need for inpatient addiction treatment, particularly for management of withdrawal and co-occurring pain, and the need to address health care provider associated stigma surrounding addiction.

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Section: Discussionsupporting

confidence: 67%

Understanding why Patients with Substance use Disorders Leave the Hospital against Medical Advice: A Qualitative Study

2020

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“…Emergency room admission protocols open opportunities for legal surveillance 30,31 . For example, Leibschutz et al 26 shared that when Black patients in an ED learned that police could and were questioning individuals arriving in municipal ambulances, their suspicion of collusion between law enforcement and health care providers peaked.…”

Section: Introductionmentioning

confidence: 99%

Negative illness feedbacks: High‐frisk policing reduces civilian reliance on ED services

Kerrison

Sewell

2020

Health Services Research

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Rates of Criminal Legal System Involvement Among Patients Who Are Discharged Against Medical Advice

Cited by 2 publications

References 5 publications

Understanding why Patients with Substance use Disorders Leave the Hospital against Medical Advice: A Qualitative Study

Understanding why Patients with Substance use Disorders Leave the Hospital against Medical Advice: A Qualitative Study

Negative illness feedbacks: High‐frisk policing reduces civilian reliance on ED services

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