Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

Abstract

Methods: The UNTH's admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P , 0.05 (one degree of freedom) was considered statistically significant. Results: Of the 64,856 admissions (45.2% male, 54.8% female), 113 (0.002%; males: 54%, females: 46%) were discharged against medical advice. DAMA rate was highest in Surgery (0.4%), and lowest in Obstetrics and Gynecology (0.1%) and Pediatrics (0.1%). Infections (32.7%), trauma (29.2%), and cancer (16.8%) were the leading diagnoses in patients DAMA. Financial constraints (37.2%), unsatisfactory response to treatment (17.7%), and dissatisfaction with hospital environment (15.0%) were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P , 0.05), patients having high levels of formal education (P , 0.05), and those who had not been previously hospitalized (P , 0.05); but not with age (P = 0.398), gender (P = 0.489), or employment (P = 0.091). Conclusion:Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate.

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

“…We also could not identify patient who DAMA and later were readmitted to another hospital or patient who left our hospital with physician approval after DAMA elsewhere. Furthermore, our analysis is restricted to the patient chief diagnosis code and may have underestimated the number of patient with comorbid conditions as reported in earlier studies [24][25]. Unlike most studies that associate DAMA among those of unsound mind (psychiatric illnesses) [26], our series only had one such person whose primary diagnosis is schizophrenia.…”

Discharge against medical advice: Experience from a rural Nigerian hospital

“…The mean age of patients of 50.8 ± 18.3 years is higher than that found in other studies. [12,20] This is likely due to the fact that these other studies included the pediatric age group while ours concentrated mainly on adults. Another plausible reason is that the largest age sub-group among our sample was that of patients above 60 years.…”

“…[7,12] This is likely due to the overall majority of male patients. The mean age of patients of 50.8 ± 18.3 years is higher than that found in other studies.…”

“…A retrospective hospital-based study from Enugu, south-eastern Nigeria involving the adult and pediatric populations gave prevalence of 0.002% while the prevalence rate of DAMA among pediatric patients in Abakalilki, Benin and Lagos were 1.5%, 5.7%, and 1.2%, respectively. [12][13][14][15] Another study carried out in the Accident and Emergency Department of a Teaching Hospital in Calabar, South-South Nigeria gave a rate of 2.6% while a rate of 2.8% was found in a study from Sagamu, South-West Nigeria. [16,17] Several factors have been implicated as causes or contributing to DAMA, some of which are financial constraints, lack of health insurance, deteriorating clinical condition of patient, problematic doctor-patient relationship and substance abuse.…”

“…[1,2,18] Other factors that may influence the decision to self-discharge include race, severity of disease condition (diagnosis), quality of hospital and lack of the attending physician. [6,12,19] Knowing the profiles of DAMA on the medical wards is very important as it allows for evidence-based interventions to reduce to a minimum this problem. To the knowledge of the authors, there is no study on DAMA specifically among medical inpatients in West Africa.…”