The Rate, Reasons and Predictors of Hospital Discharge against Medical Advice among Inpatients of a Tertiary Health Facility in North-Central Nigeria

Abstract

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.