Factors Associated with Discharge Against Medical Advice from Emergency Department, Universiti Kebangsaan Malaysia Medical Centre
- Author:
Ismail AK
;
Mohamad Ali S
;
Che’ Man Z
- Publication Type:Journal Article
- Keywords:
DAMA;
emergency;
hospital;
treatment;
discharge
- MeSH:
Patient Discharge
- From:Medicine and Health
2016;11(1):29-37
- CountryMalaysia
- Language:English
-
Abstract:
Patients who self-discharge against medical advice (DAMA) are susceptible to
life-threatening consequences. By understanding the factors associated with
DAMA, healthcare centres can build strategies to assist patients to receive optimal
medical care and prevent unfavourable outcome. The objective of this study was
to determine the factors associated with DAMA from the Emergency Department
(ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a
prospective unmatched case control study conducted over a 4-month period. For
every DAMA episode, two patients who were admitted on the same day were
randomly selected as control. Following patient consent, data was collected using
a standardized questionnaire. Patients were contacted by the investigator for
information regarding hospitalization within two weeks of DAMA. Ninety three
patients were recruited; 31 DAMA patients and 62 admitted patients. Payment
method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01).
The likelihood of self-paying patients to take DAMA was three times higher than
those who had a guarantor letter from their employer or insurance provider. Other
factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-
15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total
of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6%
DAMA patients were admitted to hospital within two weeks of the DAMA episode.
Payment method significantly influences DAMA. Payment planning, social welfare
services, non-governmental organization funds and the introduction of a national
health policy scheme may aid hospital payment, alleviate financial limitation of
patients and reduce DAMA episodes.
- Full text:P020160606369787868260.pdf
