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. 2023 Jul;47(7):1671-1676.
doi: 10.1007/s00264-023-05836-4. Epub 2023 May 17.

Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa

Adetunji Mapaderun Toluse  1 , Adedamola Dele Onibonoje  2 , Adebola Biala  2 , Taofeek Olanrewaju Adeyemi  2
Affiliations

Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa

Adetunji Mapaderun Toluse et al. Int Orthop. 2023 Jul.

Abstract

Purpose: Discharge against medical advice (DAMA) is a worldwide phenomenon. It continues to challenge the healthcare system and has profound effects on outcomes of treatment. It is when a patient leaves the hospital against the treating physician's recommendation. The objectives of this study are to identify the prevalence, associated factors, and proffer recommendations to mitigate the anomaly in our local/regional healthcare system.

Methods: This was a cross-sectional study with data collected from consecutive patients who sought DAMA at the accident and emergency department of the hospital from October 2020 to March 2022. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were used for data presentation.

Results: Ninety-nine cases of DAMA out of 4608 patients seen at the Emergency Department during the study period, giving a prevalence rate of 2.14%. 70.7% (70) of these patients were aged 16-44 years with male-to-female ratio of 2.5:1. An estimated half the number of the patients who DAMA were traders 44.4% (44), 14.1% (14) were in paid employment, 22.2% (22) were unskilled workers, and 3% (3) unemployed. Financial constraint was the leading cause in 73 (73.7%) cases. The majority of patients had limited or no formal education, and this was significantly associated with DAMA (P = 0.032). Ninety-two patients (92.6%) sought discharge within 72 h of admission and 89 (89.9%) admitted to leaving to seek alternative methods of care.

Conclusion: DAMA is still a problem in our environment. Comprehensive health insurance must be mandatory for all citizens with improved scope and coverage, especially for trauma victims.

Keywords: Cross-sectional survey; Discharge against medical advice; Health insurance; Traditional bone setters.

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