The Rate, Reasons and Predictors of Hospital Discharge against Medical Advice among Inpatients of a Tertiary Health Facility in North-Central Nigeria
American Journal of Health Research
Volume 3, Issue 1-1, January 2015, Pages: 11-16
Received: Dec. 1, 2014;
Accepted: Dec. 3, 2014;
Published: Dec. 14, 2014
Views 4397 Downloads 149
Samuel Adebowale Adefemi, Department of Family Medicine, Federal Medical Centre, Bida, Nigeria; Centre for Health & Allied Researches, Bida, Nigeria
Ibrahim Taiwo Adeleke, Centre for Health & Allied Researches, Bida, Nigeria; Department of Health Information, Federal Medical Centre, Bida, Nigeria; Health Informatics Research Initiatives in Nigeria, Bida, Nigeria
Philip Gara, Department of Family Medicine, Federal Medical Centre, Bida, Nigeria
Olanrewaju Oloundare Abdul Ghaney, Department of Health Information, Federal Medical Centre, Bida, Nigeria
Sunday Akingbola Omokanye, Centre for Health & Allied Researches, Bida, Nigeria; Department of Health Information, Federal Medical Centre, Bida, Nigeria; Health Informatics Research Initiatives in Nigeria, Bida, Nigeria
Aivonya Momoh Jimoh Yusuf, Department of Health Information, Federal Medical Centre, Bida, Nigeria; Health Informatics Research Initiatives in Nigeria, Bida, Nigeria
Follow on us
Objective: To determine the rate of hospital discharges against medical advice (DAMA), identify reasons for such discharges and identify factors predicting such discharges compared with controls. Methods: This is a retrospective health records review of all patients who discharged against medical advice and matched cases of those discharged normally between 2009 and 2011. Patients with DAMA were identified and relevant socio-demographic as well as clinical data were extracted from their clinical charts. We compared characteristics of case control patients using χ2 and Wilcoxon Rank Sum test as appropriate. We used multivariate logistic regression to model the correlates of discharged against medical advice. We included in the analysis each characteristics that was significant (p=0.05) in bivariate comparison. We report odds ratio (ORs) and confidence intervals (CIs) from this model. Results: The prevalence of discharged against medical advice was 0.72% over the three year period. Patients who discharged against medical advice were younger, male gender and students. In addition they were predominantly Muslims and married with no form of formal education. Furthermore, residence in Bida where the hospital is situated and payment out of pocket is associated with DAMA. Most of these patients DAMA within the first five days of admission and signatories to the discharge were mostly parents, spouse, and other family members. Reasons for DAMA include financial constraints, improved health and desire to seek other treatments (faith/traditional based). The male gender, students and those without formal education all conferred increase odds of DAMA, while persons in age range 21-30 years, and married conferred protection against DAMA. Furthermore, individuals with normal delivery (SVD) (18), followed by RTA with minor injury such as bruises/laceration (14), and RTA with fracture (12) were much more likely to DAMA. Conclusion: Comparatively, DAMA rate at Federal Medical Centre, Bida is low. The factors associated with such DAMA include younger age, male sex and being a student. In addition, residing in Bida town and payments for healthcare out of pocket increase the likelihood of DAMA. We recommend formulation of explicit DAMA guidelines for the hospital and strengthening of the existing National Health Insurance Scheme as panacea for reduction in the rate of DAMA.
Discharge against Medical Advice, Health Records Review, Predictive Factors, Reasons, Tertiary Hospital, Rate
To cite this article
Samuel Adebowale Adefemi,
Ibrahim Taiwo Adeleke,
Olanrewaju Oloundare Abdul Ghaney,
Sunday Akingbola Omokanye,
Aivonya Momoh Jimoh Yusuf,
The Rate, Reasons and Predictors of Hospital Discharge against Medical Advice among Inpatients of a Tertiary Health Facility in North-Central Nigeria, American Journal of Health Research. Special Issue: Health Information Technology in Developing Nations: Challenges and Prospects Health Information Technology .
Vol. 3, No. 1-1,
2015, pp. 11-16.
T. W. Stern, B. C. Silverman, A. S. Smith, T. A. Stern. Prior discharge against medical advice and withdrawal of consent: what they can teach us about patient management. Prim. Care Companion CNS Disord. 2011;13(1):doi:10.4088/PCC.10f01047b/u.
J. T. Berger. Discharge against medical advice: ethical considerations and professional obligations. J Hosp Med. 2008;3:403e8.
D. J. Alfandre. “I’m going home”: Discharges against medical advice. Mayo Clinic Proceedings. 2009;84:255-260.
A. P. Baptist, I. Warrier, R. Arora, J. Ager, R. M. Massanari. Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes. J Allergy Clin Immunol. 2007;19(4):924-929.
P. Green, D. Watts, S. Poole, V. Dhopesh. Why patients sign out against medical advice (AMA): factors motivating patients to sign out AMA. Am J Drug Alcohol Abuse. 2004;30(2):489-493.
Z. Y. Aliyu. Discharge against medical advice: socio-demographic, clinical and financial perspectives. Int J Clin Pract. 2002;56(5):325-327.
A. H. Anis, H. Sun, D. P. Guh, A. Palepu, M. T. Schechter, M. V. O’shaughnessy. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167:633–637.
T. W. Wong, K. M. Lee, R. Chan, C. C. Lau. A study of patients who leave an accident and emergency department against medical advice. Hong Kong Journal of Emergency Medicine. 2000;7(1): 22-26.
R. Saitz. Discharges against medical advice: time to address the causes. CMAJ. 2002;167(6):647-648.
S. A. Ibrahim, C. K. Kwoh, E. Krishnan. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007;97(12):2204-2208. Epub 2007 Oct 30.
S. W. Hwang, J. Li, R. Gupta, V. Chien, R. E. Martin. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417-420.
S. A. A. Abhari, M. M. Abbasi, N. P. Jafar, H. Zerrati. Factors associated with premature discharge of patients with psychosis against medical advice. Iran J Psychiatry. 2006;27-30.
S. N. Weingart, R. B. Davis, R. S. Phillips. Patients discharged against medical advice from a general medicine service. J Gen Intern Med. 1998;13:568-571.
I. T. Adeleke, A. O. Adekanye, K. A. Onawola, et al. Data quality assessment in healthcare: a 365-day chart review of inpatients’ health records at a Nigerian tertiary hospital. J Am Med Inform Assoc. 2012;19:1039–1042. doi:10.1136/amiajnl-2012-000823.
L. A. Rinehart-Thompson. Legal issues in health information management technology. In: Johns ML, ed. Health Information Management Technology: An Applied Approach. 2nd edn. Chicago: American Health Information Management Association, 2007:704e5.
Doyal L. Informed consent in medical research: journals should not publish research to which patients have not given fully informed consentewith three exceptions. BMJ 1997;314:1107e11.
R. Duno, E. Pousa, J. Sans, C. Tolosa, A. Ruiz. Discharge against medical advice at a general hospital in Catalonia. Gen Hosp Psychiatry. 2003;25:46–50.
H. S. Moyse, W. E. Osmun. Discharge against medical advice: a community hospital experience. Can. J. Rural Med. 2004;9(3):148-153.
C. O. Alebiosu, T. H. Raimi. A study of hospital patients’ discharge against medical advice in the Ogun State University Teaching Hospital, Sagamu, Nigeria. Nigeria Medical Practitioner. 2001;40:33–35.
A. N. Onyiruka. Discharge of hospitalised under-fives against medical advice in Benin City, Nigeria. Nig J Clin Pract. 2007;10:200–204.
P. J. Devitt, A. C. Devitt, A. Dewan. Does identifying a discharge as “against medical advice” confer legal protection? J Fam Pract. 2000;4:224–227.
N. E. Ngim, T. Nottidge, A. Oku, A. F. Akpan. Why do orthopaedic trauma patients leave hospital against medical advice? Ibom Medical Journal 2013;6(1):1-4.
A. M. Udosen, E. Glen, S. Ogbudu, E. Nkposong. Incidence of leaving against medical advice (LAMA) among patient admitted at the accident and emergency unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Nigeria Journal of Clinical Practice 2006;9(2):120-123.
B. Eze, K. Agu, J. Nwosu. Discharge against medical advice at a tertiary centre in South-eastern Nigeria: socio-demographic and clinical dimensions. Patient Intelligence. 2010:2:27-31.
L. R. Ariede. Implementation of the National Health Insurance Scheme: the dawn of a new era in healthcare financing in Nigeria? Sahel Med J. 2003;6:1–5.
E. Moy, B. A. Bartman. Race and hospital discharge against medical advice. Journal of National Medical Association.1996;88:658-660.