Against Medical Advice Discharges

Alfandre, David; Brenner, Jay M.; Onukwugha, Eberechukwu

doi:10.12788/jhm.2796

Cited by 28 publications

(36 citation statements)

References 21 publications

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“…These are consistent with global literature which have associated leave events with the profile of a young male patient of low socioeconomic status and medical comorbidities related to substance use disorder and mental health disease [2,[31][32][33][34]. Unfortunately, research focused on describing the characteristics of patients who leave against medical advice has served to perpetuate the notion that leave events are a deviant behaviour observed in individuals with certain characteristics [35] which can result in patient stigmatisation, and reduced access to care [35,36]. This deflects the attention from the quality gaps on the health care delivery models that disproportionally impact Aboriginal and Torres Strait Islander people [35,37].…”

Section: Discussionsupporting

confidence: 80%

Leave events among Aboriginal and Torres Strait Islander people: a systematic review

et al. 2022

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Background Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events disproportionally impact Aboriginal and Torres Strait Islander people. A systematic review was conducted to explore the causes of leave events among Aboriginal and Torres Strait Islander people and strategies to reduce them. Methods A systematic review was conducted using Medline, Web of Science, Embase and Informit, a database with a strong focus on relevant Australian content. Additionally, we examined the references of the records included, and performed a manual search using Google, Google scholar and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. Two independent reviewers screened the records. One author extracted the data and a second author reviewed it. To appraise the quality of the studies the Mixed Methods Appraisal Tool was used as well as the Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was used to report quantitative findings and an inductive thematic analysis for qualitative studies and reports. Results We located 421 records. Ten records met eligibility criteria and were included in the systematic review. From those, four were quantitative studies, three were qualitative studies and three reports. Five records studied data from the Northern Territory, two from Western Australia, two from New South Whales and one from Queensland. The quantitative studies focused on the characteristics of the patients and found associations between leave events and male gender, age younger than 45 years and town camp residency. Qualitative findings yielded more in depth causes of leave events evidencing that they are associated with health care quality gaps. There were multiple strategies suggested to reduce leave events through adapting health care service delivery. Aboriginal and Torres Strait Islander representation is needed in a variety of roles within health care provision and during decision-making. Conclusion This systematic review found that multiple gaps within Australian health care delivery are associated with leave events among Aboriginal and Torres Strait Islander people. The findings suggest that reducing leave events requires better representation of Aboriginal and Torres Strait Islander people within the health workforce. In addition, partnership with Aboriginal and Torres Strait Islander people is needed during the decision-making process in providing health services that meet Aboriginal and Torres Strait Islander cultural needs.

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Section: Discussionsupporting

confidence: 80%

Leave events among Aboriginal and Torres Strait Islander people: a systematic review

et al. 2022

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“…The concept of shared decision-making may help reduce the prevalence of DAMA and protect the pediatricians to a certain extent from ethical dilemmas arising from DAMA (20,21). Shared decision-making involves physicians and patients making healthcare decisions together by combining the patients' values and preferences for care with the physicians' expertise and knowledge of medical evidence (22). Pediatricians and health care providers involved in children's care may need to promote this concept in child care practice.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

et al. 2021

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Background: Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence. Objectives: This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria. Methods: This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23. Results: The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P

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“…However, liability protection is conferred because of proper execution of discharge process and documentation of informed declination of care, as opposed to specific designation as ‘against medical advice’ 8. In fact, some advocate now that designating a discharge as against medical advice is paternalistic, signifies low value care, stigmatises patients and is a move away from patient-centred shared decision-making 25. We also propose replacing DAMA with a more neutral description of the event as a ‘premature discharge’.…”

Section: Shared Patient–system Responsibility Model To Generate Systementioning

confidence: 99%

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

et al. 2019

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Against Medical Advice Discharges

Cited by 28 publications

References 21 publications

Leave events among Aboriginal and Torres Strait Islander people: a systematic review

Leave events among Aboriginal and Torres Strait Islander people: a systematic review

Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

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