Retrospective Evaluation of Patients Leaving against Medical Advice in a Tertiary Care Teaching Hospital

Abstract

Background Leaving against medical advice (LAMA) is a worldwide healthcare problem, occurring due to various contributing factors, seen more commonly indeveloping countries like ours. Aim To retrospectively study the prevalence of LAMA along with its affectingfactors. Methods We screened the hospital record of a tertiary care teaching hospital forone year, after obtaining approval from the institutional ethicalcommittee. Patient demography, disease characteristics and status at thetime of LAMA were noted and statistically analysed. Results During the study period, 4.95% patients took LAMA. The mean age was 47.2±21years (range newborn to 103 years) with 2:1 Male: Female ratio. Forty ninepercent of patients resided in rural areas and around 1/3rd were dependenton others for their living. The mean length of stay in hospital was 6.1±9.3days. Around 60% patients required mechanical ventilation and 51% patientshad been explained guarded prognosis. About 53% of patients taking LAMAwere admitted in medical wards, trauma being the most common diagnosis(17.2%). History of alcohol abuse and poisoning with suicidal intent wasseen in 11.47% and 3.9%, respectively. Conclusion The number of patients taking LAMA from our country is quite high. This necessitates formulation and implementation of strategies to reduce the prevalence of LAMA discharges like further investigations to look into the causes contributing to patients taking LAMA, attending to substance abuseissues, recognizing psychological factors and strengthening the socialsystems, encouraging insurance cover, helping patients’ treatment expensesthrough charity care and optimizing healthcare delivery and patient centredpolicies. Key messages LAMA is a global health issue precipitated by unemployment and alcohol abuse, commonly taken due to financial reasons. This necessitates a strong social system and national health insurance schemes to reduce the cost of treatment. How to cite this article Mahajan RK, Gautam PL, et al . Retrospective Evaluation of Patients Leaving against Medical Advice in a Tertiary Care Teaching Hospital. IndianJ Crit Care Med 2019;23(3):139-142.

Characteristics of trauma patients that leave against medical advice: An eight-year survey analysis using the National Hospital Ambulatory Medical Care Survey, 2009–2016

“…Leaving against medical advice (AMA) is a substantial healthcare challenge across the world and in the United States (U.S.). 1 About 500,000 U.S. patients leave AMA annually. 2,3 While this proportion represents a small percentage of the patients' load in the U.S., 2,4 decisions to leave AMA affect the individual, the caregivers, and the healthcare system.…”

“…2,3 While this proportion represents a small percentage of the patients' load in the U.S., 2,4 decisions to leave AMA affect the individual, the caregivers, and the healthcare system. 5 Leaving AMA is associated with stigma, and incomplete medical care, 1,5 resulting in increased likelihood to be admitted in a different equidistant hospital, fragmented care, 6 and increased cost of care. 7 The most common reasons for leaving AMA are financial constraints, socioeconomic status, dissatisfaction with treatment, and poor communication with healthcare professionals.…”

Navigating the challenges of patients with substance use disorders who leave AMA

“…1,2 Leaving AMA can lead to multiple complications, including an increased risk of readmission, suboptimal treatment outcomes, and an increased use of health care resources. [1][2][3] It is critical to understand why patients elect to leave a hospital AMA. In a qualitative study, Simon et al 1 found that individuals with SUDs often leave AMA due to uncontrolled withdrawal symptoms and pain, perceived stigma and discrimination, and dissatisfaction with care.…”