Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.

Fatemeh Sheikhmoonesi,Samaneh Pazhuheshgar,Mohammad Khademloo

doi:10.5539/gjhs.v6n3p213

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.

Highlights

Discharge against medical advice (AMA) is a prevalent and vexing problem for patients and their psychiatrists (Wung, CC Chen, FC Chen, & Lin, 2010)
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
Awareness of the factors involved in AMA discharge is important because of the potential to identify those at higher risk and thereby intervene earlier to prevent adverse consequences

Summary

Introduction

Discharge against medical advice (AMA) is a prevalent and vexing problem for patients and their psychiatrists (Wung, CC Chen, FC Chen, & Lin, 2010). Patients who leave hospital against medical advice may be at risk of adverse health outcome and readmission. Stephen, Hwang, Rajesh, Vince and Rochelle (2003) identified increased risk of readmission among general medicine patients who leave hospital AMA is concentrated in the first two weeks after discharge. Some reasons for AMA discharge are dissatisfaction with care, personal, family and financial problems and subjective improvement in symptoms (Said et al, 2007). We intended to find the proportion of patients who leave hospital against medical advice and some of their characteristics in the year 2011.Very little www.ccsenet.org/gjhs

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