Factors Associated with Leaving Hospital against Medical Advice among People Who Use Illicit Drugs in Vancouver, Canada

Abstract

BackgroundLeaving hospital against medical advice (AMA) is common among people who use illicit drugs (PWUD) and is associated with severe health-related harms and costs. However, little is known about the prevalence of and factors associated with leaving AMA among PWUD.MethodsData were collected through two Canadian prospective cohort studies involving PWUD between September 2005 and July 2011 and linked to a hospital admission/discharge database. Bivariable and multivariable generalized estimating equations were used to examine factors associated with leaving hospital AMA among PWUD who were hospitalized.ResultsAmong 488 participants who experienced at least one hospitalization, 212 (43.4%) left the hospital AMA at least once during the study period. In multivariable analyses, factors positively and significantly associated with leaving hospital AMA included: unstable employment (AOR = 1.92; 95% confidence interval [CI]: 1.22–3.03); recent incarceration (AOR = 1.63; 95%CI: 1.07–2.49); ≥ daily heroin injection (AOR = 1.49; 95%CI: 1.05–2.11); and younger age per year younger (adjusted odds ratio [AOR] = 1.04; 95%CI: 1.02–1.06).ConclusionsWe found a substantial proportion of PWUD in this setting left hospital AMA and that various markers of risk and vulnerability were associated with this phenomenon. Our findings highlight the need to address substance abuse issues early following hospital admission. These findings further suggest a need to develop novel interventions to minimize PWUD leaving hospital prematurely.

Impact of Medications for Opioid Use Disorder on Discharge Against Medical Advice Among People Who Inject Drugs Hospitalized for Infective Endocarditis

“…AMA discharges are associated with higher mortality rates, more frequent readmissions, and greater likelihood of future AMA discharges 5 . Reasons for the AMA discharge may include the desire to use drugs, opioid withdrawal, poor pain control, poor communication with staff, or feeling stigmatized 6,7 . In a study of 488 people who used illicit drugs with at least one prior hospitalization, almost half (43.4%) reported experiencing at least one AMA discharge 7 …”

“…5 Reasons for the AMA discharge may include the desire to use drugs, opioid withdrawal, poor pain control, poor communication with staff, or feeling stigmatized. 6,7 In a study of 488 people who used illicit drugs with at least one prior hospitalization, almost half (43.4%) reported experiencing at least one AMA discharge. 7 Prior studies have identified a number of factors that reduce AMA discharges among PWID, including the use of methadone during and prior to the hospitalization and the implementation of an addiction consultation service.…”

“…6,7 In a study of 488 people who used illicit drugs with at least one prior hospitalization, almost half (43.4%) reported experiencing at least one AMA discharge. 7 Prior studies have identified a number of factors that reduce AMA discharges among PWID, including the use of methadone during and prior to the hospitalization and the implementation of an addiction consultation service. 4,7 Medications for opioid use disorder (MOUD) have been shown to reduce opioid cravings, suppress illicit opioid use, and reduce mortality.…”

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

“…Compared with conventionally discharged patients, AMA patients are younger, more likely to be male, and more likely a marginalized ethnic or racial minority. [10][11][12][13][14] Patients with mental illnesses and addiction issues are overrepresented in AMA discharges, and complicated capacity assessments and limited resources may strain providers. 7,8,15,16 Studies have repeatedly shown higher rates of readmission and mortality for AMA patients than for conventionally discharged patients.…”

Caring for patients with opioid use disorder in the hospital

“…[45][46][47][48] Qualitative research and one systematic review found that opioid withdrawal, inadequate pain management, younger age, daily heroin injection and unstable employment were factors contributing to discharges against medical advice among patients with substance use disorders. 29,49,50 Available evidence suggests that opioid agonist therapy, when paired with referral to outpatient addiction services, may reduce discharge against medical advice and increase engagement in postdischarge addiction treatment. [51][52][53][54][55] One observational study of in patients with opioid use disorder showed that initiation of methadone during the hospital stay, coupled with linkage to an outpatient addiction program, led to a high rate (82%) of postdischarge follow-up.…”