Document Type : Original Article
Authors
- Mohammad Hossein Yarmohammadian 1
- Farrokh Mojahed 2
- Reza Gholi Vahidi 3
- Kamal Gholipour 4
- Azad Shokri 5
- Vahid Rasi 4
1 Associate Professor, Educational Planning Management, Health Management and Economic Research Center, School of Health Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc Student, Student Research Committee, Healthcare Management, Tabriz University of Medical Sciences, School of Health Services Management and Medical Information, Tabriz, Iran
3 Associate Professor, Health Services Management, Tabriz Health Services Management Research Center, School of Health Services Management and Medical Information, Tabriz University of Medical Sciences, Tabriz, Iran
4 MSc Student, Student Research Committee, Healthcare Management, School of Health Services Management and Medical Information, Tabriz University of Medical Sciences, Tabriz, Iran
5 MSc Student, Student Research Committee, Healthcare Management, School of Health Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Introduction: Discharge against medical advice (DAMA) may expose patients to an increased risk of
adverse medical outcomes. We conducted an intervention based on the factors associated with discharge
against medical advice for reducing DAMA.
Methods: This was a pretest-posttest intervention conducted in Dr. Soulati Hospital in Urmia, Iran, in
2011-2012. We analyzed the data extracted from the clinical governance office forms about self-discharge.
After determining causes of discharge against medical advice (DAMA) according to data in 2011, we
designed an intervention in clinical governance team to reduce the rate of self-discharges. Interventions like
effective relationship among physician and patient, financial support in DAMA cases, and assessing patients’
decision-making capacity were designed. Four months after implementing, we analyzed self-discharges
prevalence rate and result was compared with the previous year. Data were analyzed using the Excel
software and information presented by descriptive statistics.
Results: The rate of DAMA in the study hospital was found to be 4.6% which decreased to 2.8 percent of
all the discharged patients 4 months after the intervention. Among patients who discharged against
medical advice in this study, family or financial obstacle, patient’s healthy feeling, dissatisfaction with
their care, dislike of the hospital environment, prolonged hospitalization, and patient judgment of
improvement were the most important factor for their decision.
Conclusion: Discharge against medical advice comes from many factors and information about the
reasons for DAMA is necessary for identifying implementable strategies to reduce the likelihood and
adverse health consequences of DAMA. Enhancement of doctor-patient communication, improvement of
hospital environment and social workers could reduce the DAMA rate. The need for a clearly documented
system or guidelines for assessing and managing such patients is highlighted.
Keywords
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