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 main objective of this study is to determine the factors associated with discharge against medical advice among patients in Buea Regional Hospital.  In order to achieve the study objectives, a simple random. Convenience and purposive techniques was employed. A sample of 40 participants of age 15years and above were selected from the Buea Regional Hospital by the help of a Structure questionnaires data was collected and analyse using SPSS version 21.0.

Descriptive statistics was calculated, regression analysis was also calculated to determined factors that determine patients discharge against medical advice. Results show that the rate of DAMA was 72.22%. Major reasons for discharged include financial difficulties (41.0%), Dissatisfaction with medical or nursing care (41.0%), Long waiting time (18.0%), external obligations (38.0%) and Delay in diagnostic and therapeutic procedures (16.0%), which were statistically significant at p-value 0.005 level.

Measures on how to prevent DAMA includes training of health care, Informing patients and their companions about the nature of the disease, the treatment procedure, and the treatment side effects and reduction of hospital stayed. Based on the findings of the study, it was concluded that; Patients’ factors, Medical staff factors and Hospital environmental factors have a significant relationship with discharge against medical advice.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Discharge against medical advice (DAMA), a situation in which a patient chooses to leave the hospital before the treating physician recommends discharge, is a problem for many physicians who treat hospitalized patients. Leaving the hospital against the physician’s advice may expose a patient to risk of inadequately treated medical problem which may result in the need for readmission. (Carrese, 2006).

According to Corley and Link, (1981) Patients who discharge themselves AMA probably still need further care, this is probably because, after premature discharge there is lack of follow-up care, this making most of these patients to be at increased risk for morbidity and mortality

The process of discharge is a critical phase in hospital management, and correction of it is a major strategy around which all hospital functions are defined and implemented. Thus, Discharge Against Medical Advice (DAMA) is a critical problem in hospitalization of patient in which a patient despite medical advice leaves the hospital earlier than due time (Carrese, 2006)). The outcomes of DAMA for the patient can be deterioration of his/her situation, even up to the point of death or also there might be side effects which cannot be cured in long time and render the therapeutic result unsatisfactory (Rangraz et al., 2010).

According to Kabirzadeh et al., (2011) failure to complete the hospitalization can lead to re-lapse of disease, readmission, and increase in medical costs for the patient (Hwang et al., 2003).  Moreover, readmission of the patient because of his/her severe condition imposes extra costs on the health care system and the family and the individuals. According to Jones and Himmelstein (1979), Patients leave AMA for a variety of reasons, including dissatisfaction with the care received, family responsibilities and a sense that their health has improved (Al-Ayed, 2009). Identification of these factors and the characteristics of patients who are at risk for discharge AMA may help alert physicians to patients intending to leave AMA and thus to use strategies intended to keep the patient in hospital.

Similar studies have also shown that personal and family problems, feeling better to leave the hospital, dissatisfaction with treatment, dullness, boringness of medical environment are among other causes of DAMA (Hwang et al, 2003). If medical staffs are able to early detect patients with high risk of DAMA, they will then provide necessary advices to continue treatment (Hwang et al, 2003).

Adel (2012) have shown that, the rate of discharged against medical advice to be 4.0%. Similar studied have shown that the rate of discharged against medical advice to be 2% (Ibrahim et al., 2007; Saitz et al., 2000). A systematic review of studies of discharge against medical advice among patients admitted to psychiatric departments found a mean rate of 17% (range, 3-51%) (Brook et al., 2007).

1.2 Statement of problems.

Universally, and in the contemporary health care setting hospital is a second home for the sick. Therefore, the environment should be stimulating and exciting such that, creating good interpersonal relationship with the patient will go a long way to give the patient a sense of belonging.

Providing high-quality medical care is difficult, especially to patients who may not wish to adhere to the treatments and protocols prescribed by their care-team. Discharge against medical advice (DAMA) is a major form of non-adherence affecting one out of every 50 hospital visits, and can be defined as either patients actively leaving their care in an unscheduled fashion; or by patients signing release forms that they are leaving in spite of their doctor’s orders (Hwang et al, 2005).

DAMA is a form of noncompliance by the patient and that limits the effectiveness of appropriate and comprehensive treatment given at the hospital. Such patients may face many personal, economic and social pressures, but may also be subject to pressures that are provider and environment-related (Onukwugha et al., 2010).

A discharge against medical advice can place the patient at risk for adverse health outcomes by disrupting the normal course of therapy. It thwarts the relationship between the patient and the care-team and can affect their morale, is a waste of healthcare resources, and can expose the hospital to legal liability (Ernest Moy & Barbara A. Bartman, 1996).

According to Brook et al., (2006)Various studies have shown that leaving against medical advice increases the likelihood for further health-complications and re-admission to the hospital, which can place their care-team and hospital at legal liability and financial risk. These prior studies also attempted to assess effects, more generally, but were focused on specific types of patients, and/or restricted to smaller samples and particular care-settings (Garland et al., 2013).

A discharge against medical advice, whenever it occurs, is a break in the contract by the patient, and is motivated by different reasons and factors. Such an action can have harmful consequences for both the patient and provider; as well as others. Thus this study aims to add new knowledge by exploring the associations between DAMA and its associated factors in the Cameroon context the case of the Buea Regional Hospital.

1.3 General objective

The main objective of this study is to determine the factors associated with discharge against medical advice among patients in Buea Regional Hospital.

1.4 Specific objectives

1. To determine the prevalence of patients discharge against medical advice in Buea Regional Hospital
2. To determine the factors associated with discharge against medical advice among patients in Buea Regional Hospital

• To find out what strategies can be put in place to prevent discharge against medical advice among patients at the Buea Regional Hospital.

1.5 Research questions

1. What is the prevalence of discharge against medical advice in among patients the Buea Regional Hospital?
2. What are the factors associated with discharge against medical advice among patients in Buea Regional Hospital?
3. What strategies can be put in place to prevent patients discharge against medical advice in the Buea Regional Hospital?

1.6 Scope of the study

The scope of this study would be limited to the Buea Regional Hospital, in Cameroon and it would be concerned with factors associated with discharge of patients against medical advice, its prevalence and strategies that could be put in place to prevent patients discharge against medical advice.

1.7 Significant of the study

The study of discharges against medical advice is addressing an important and timely issue because it not only involves quality of care, patient safety, and engagement of clinical human resources, but also the hospital care of a vulnerable population that is oftentimes associated with drug abuse, mental health comorbidities, and lower socio-economic status. The research is thus significant to the following stakeholders;

Patients, it may serve as a corrective measure and enable them adopt safe practice of using the hospital for treatment that will prevent infection, protect and preserve the lives of their babies and mothers.

The health personnel, it may add to their body of knowledge and stand a better chance of advising where necessary.

The nurses, to intensify efforts in health education classes to patients to adopt safe practices especially in the hospitalization of patients.

Researchers, the information to be generated from this study may be of help to other upcoming researchers interested in working in this field as it will serve as a reference material for further research.

1.8 Definition of key terms

Non adherence: the extent to which patients are able to follow the recommendations for prescribed treatment.

Patient: a person who is ill and in need of medical or nursing attention

Physician: a health professional who has earned a qualification after a course of  undergraduate  study at an approved university or medical school, and three years postgraduate study at an approved teaching hospital.

Beneficence: actions that can be taken to help prevent or remove harm or simply to improve the situation of others.

Autonomy: it is an individual’s capacity for self-determination or self-governance.

Providers: a person who helps in identifying or preventing or treating illnesses or disability.

Phenomenon:  a fact or situation that is observed to exist or happen, especially one whose cause or explanation is in question.