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. 2008 Apr;70(2):68-72.
doi: 10.1007/s12262-008-0018-8. Epub 2008 May 21.

Clinical spectrum of discharges against medical advice in a developing country

A Abdulrasheed Nasir  1 , O Misbaudeen Babalola
Affiliations

Clinical spectrum of discharges against medical advice in a developing country

A Abdulrasheed Nasir et al. Indian J Surg. 2008 Apr.

Abstract

Background: Patients who leave the hospital before clinician certification of fitness are referred to as discharge against medical advice (DAMA). This phenomenon of discharges against medical advice is an undesirable but relatively common occurrence worldwide. Professional liability and harmful effect of this practice to individual health are of concern.

Aims: The essence of this study is to determine the spectrum of patients who DAMA in a Nigerian teaching hospital.

Design: Descriptive study over a two-year period in an urban teaching hospital in Nigeria.

Materials and methods: All consecutive patients who discharge against medical advice at the surgical emergency room of University Teaching Hospital, Ilorin from January 2004 to December 2005 were studied prospectively. The patients' demographic details, diagnosis, reason for discharge, signatory to discharge and length of hospital stay were studied.

Statistical analysis: Analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 11.

Results: Prevalence rate of DAMA was 4.2%, comprising 110 of a total of 2,617 patients admitted during the study period. Male to female ratio was 3.8:1, the mean age was 30.0 years (range, 4-70 years). Trauma accounted for the highest number of patients 102(97.2%) out of whom 52 (51%) had long bones fracture. Patients who wish to seek alternate medical care accounted for 43.6%, while financial constraint contributed to 29.1% DAMA. Forty-five out of forty-eight (93.7%) of patients who DAMA to seek alternate medical care had fracture.

Conclusion: Trauma was the most common clinical condition for patients who DAMA. Most common reason for DAMA was to seek alternate treatment followed by financial constraint. Health education on potential benefit of orthodox treatment of fracture, treatment subsidy and full implementation of national health insurance scheme will reduce incidence of DAMA.

Keywords: Discharge; Health education; Medical advice; Trauma.

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References

    1. Heidi S.M., William E.O. Discharges against medical advice: a community hospital experience. CJRM. 2004;9:148–155. - PubMed
    1. Len D. Surgical ethics. In: Russel R.C.G., Williams N.S., Bulstrode C.J.K., editors. Bailey and Love: Short Practice of Surgery. 23rd edn. London: Arnold; 2000. pp. 1327–1332.
    1. Ohanaka E.C. Discharge against medical advice. Trop Doct. 2002;32:149–151. - PubMed
    1. Akiode O., Musa A.A., Shonubi A.M.O., Salami B.A., Oyelekan A.A.A. Trends of discharges against medical advice in a suburban surgical practice in Nigeria. Trop Doct. 2005;35:51–52. - PubMed
    1. Pennycook A.G., McNaughton G., Hogg F. Irregular discharge against medical advice from the accident and emergency department — a cause for concern. Arch Emerg Med. 1992;9:230–238. - PMC - PubMed

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