Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review

Ti, Lianping; Ti, Lianlian

doi:10.2105/ajph.2015.302885

Cited by 160 publications

(71 citation statements)

References 35 publications

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“…1 Studies have consistently found that hospitalized PWID are discharged against medical advice (AMA) frequently, with prevalence ranging from 4.8% to 49%. [2][3][4] 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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background and Objectives The impact of medications for opioid use disorder (MOUD) on against medical advice (AMA) discharges among people who inject drugs (PWID) hospitalized for endocarditis is unknown. Methods A retrospective review of all PWID hospitalized for endocarditis at our institution between 2016 and 2018 (n = 84). Results PWID engaged with MOUD at admission, compared with those who were not, were less likely to be discharged AMA but this did not reach statistical significance in adjusted analysis (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.033‐1.41; P = .11). Among out‐of‐treatment individuals, newly initiating MOUD did not lead to significantly fewer AMA discharges (OR, 0.98; 95% CI, 0.26‐3.7; P = .98). Conclusion and Scientific Significance PWID hospitalized for endocarditis are at high risk for discharge AMA but more research is needed to understand the impact of MOUD. (Am J Addict 2020;29:155–159)

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Self-discharge has been found to be more frequent among patients using alcohol or illicit drugs [2, 6]. A US nationwide register study found rates of discharge against medical advice in the range of 10–12% among patients treated for alcohol and substance related disorders compared to 1 % in general [4].…”

Section: Introductionmentioning

confidence: 99%

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

et al. 2019

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BackgroundThough substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death.MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death.ResultsDuring one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p < 0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p < 0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6).ConclusionsSelf-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

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“…[ 8 9 10 ] The reasons for such treatment noncompletion may be varied, and may include personal and structural service delivery factors. [ 8 11 ] Moreover, the inpatient treatment of some of the patients with substance use disorders may be prematurely terminated due to the disciplinary problems faced. [ 12 ] Such premature cessation of treatment may expose the patient to the risk of relapse to substance taking behaviors and adverse health consequences.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India

Sarkar¹,

Balhara²,

Gautam³

et al. 2016

Indian Journal of Psychological Medicine

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Background and Aims:Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India.Methods:This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient.Results:A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete (n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P < 0.001), were of a greater average age (33.1 ± 10.0 years vs. 30.5 ± 9.4 years, P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers.Conclusion:Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved.

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Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review

Cited by 160 publications

References 35 publications

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

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

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India

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