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 Gilead Medical Centre Yaoundé. In order to achieve the study objectives, a simple random and convenience techniques was employed to selct patients from the different hospital wards.

A sample of 40 participants of age 15years and above were selected from the Gilead Medical Centre Yaoundé by the help of a Structure questionnaires data was collected and analyse using SPSS version 25.0. 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 75.0%. Major reasons for discharged include financial difficulties (55.6%), Dissatisfaction with medical or nursing care (37.0%), Long waiting time (40.7%), external obligations (63.0%) and poor hospital cleanliness and lack of privacy (48.1%). Risks factors of DAMA include age, educational level, employment status, and gender shows positive significant risks towards DAMA.

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. The study recommended that more training should be given to staff and workers of the hospitals on how to treat patients well and provide better services to their customers.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

In health systems for more than two decades, providers and healthcare organizations, including hospitals have concluded that customers need to be satisfied, the number of patients who discharge from the hospital with a personal desire, or in other words, against medical advice can be a sign of patients’ dissatisfaction and a significant problem (Kavosi et al., 2012).

Leaving with personal consent or discharge against medical advice, the main problem in inpatient conditions is a process that the patient leaves the hospital sooner than the stipulated time and before completion of the course of treatment, and now assigned about 2% of the total hospital discharges in the world (Hwang et al., 2003).

Various factors are involved in increasing the number of discharge cases with personal satisfaction, including demographic variables, mental health variables, accompanying physical illnesses and experience of previous inpatients, lack of satisfaction with hospital services, non-payment of costs, family problems, lack of significant improvement in the process of treatment, belief in traditional medicine, long stay in the hospital, feeling of recovery and place of living (urban or rural) (Rezaeiimofrad, 2010).

Patients who discharge themselves AMA probably still need further care, this is probably because, after premature discharge there is a lack of follow-up care, thus 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 the hospitalization of patients 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 for a 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 a relapse of disease, readmission, and an 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.

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 use strategies intended to keep the patient in the hospital.

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

Adel (2012) showed that the rate of discharge against medical advice is 4.0%. Similar studies have shown that the rate of discharge against medical advice is 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% (Brook et al., 2007).

1.2 Statement of the Problem

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.

According to Brook et al., (2006), various studies have shown that leaving against medical advice increases the likelihood of further health complications and re-admission to the hospital, which can place the 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 the patient and provider; as well as others. Premature withdrawal from treatment has been shown to result in higher rates of hospital readmissions (Hwang et al., 2003). These patients are potentially susceptible to life-threatening consequences in the absence of optimal medical care (Carrese, 2006).

Readmission has been shown to lead to longer hospital stays, higher costs of care, and increased use of hospital resources, and indirectly affects the delivery and quality of care to non-DAMA patients (Ibrahim et al. 2007). This results in an increase in the burden on healthcare facilities. Thus this study aims to add new knowledge by exploring the associations between DAMA and its associated factors in the Cameroon context in the case of the Gilead Medical Centre Yaoundé.

1.3 Research Questions

1.3.1 Main Research Question

What are the Factors Associated with Discharge against Medical Advice in Gilead Medical Centre Yaoundé?

1.3.2    Specific Research Questions

1. What is the prevalence of patients discharged against medical advice in Gilead Medical Centre Yaoundé?
2. What are the causes of patients’ discharge against medical advice in Gilead Medical Center Yaoundé?
3. What are the risk factors associated with discharge against medical advice among patients in Gilead Medical Centre Yaoundé?
4. What strategies can be put in place to prevent discharge against medical advice among patients at Gilead Medical Centre Yaoundé?

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