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

Abstract

To identify the contributing factors for discharge against medical advice (DAMA) among pregnant women in Sistan and Balouchestan Province, southeastern Iran. This hospital-based case-control study included a total of 168 DAMA pregnant women and 191 pregnant women who left hospital with medical approval. The participants were recruited between August 2012 and August 2013. Logistic regression models were used for data analysis. Factors that increased the chance of DAMA in pregnant women included older age, younger spouse age, low level of education, low income level and having a health insurance. History of DAMA in previous hospitalizations, referral from other clinics, emergency admission and admission advice from non-physician individuals for hospitalization, and giving birth at home during previous pregnancies, were associated with an increase in the risk of DAMA. The most common hospital-related reason for DAMA was the teaching environment of the hospital (26.2%) followed by hospital staff misconduct (23.8%) and overcrowding in the hospital wards (23.2%). The most frequent patient-related factors for DAMA were willingness of the patients to continue treatment at home (58.9%) and feeling relative improvement (58.3%). 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.