Abstract

This study aimed to investigate the factors associated with discharge against medical advice (DAMA) among patients at Saint Martin de Porres Mvogbetsi Yaoundé, focusing on the causes, consequences, and strategies to reduce DAMA. A cross-sectional survey design was employed, with data collected from 40 participants using structured questionnaires. Descriptive and regression analyses were conducted using SPSS version 25.0.

The findings revealed that the primary causes of DAMA included improved health conditions (74.1%), financial constraints (55.6%), and external obligations (63.0%). Dissatisfaction with care, long waiting times, and poor hospital conditions also contributed significantly. The consequences of DAMA were severe, with 88.9% of patients experiencing worsening medical conditions, 29.2% facing increased complications, and 66.7% reporting disruptions to daily activities.

Strategies to reduce DAMA, such as improved communication (74.1%), financial assistance (55.6%), and follow-up systems (63.0%), were identified as critical interventions. The study highlights the need for targeted measures to address the root causes of DAMA, improve patient-provider relationships, and enhance healthcare delivery. These findings provide valuable insights for healthcare providers and policymakers to develop effective strategies to reduce DAMA rates and improve patient outcomes.

CHAPTER ONE

INTRODUCTION

This chapter of my research work will be looking at the background of studies, statement of problem, research questions, research objective, specific objective, scope of study, significance of study, limitations of the Study and operational definition of terms.

• 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).

• 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 my research study  is aims to add new knowledge by exploring the associations between DAMA and its associated factors in the Cameroon context in the case of the Saint martin de porres Yaounde.

Research Questions

Main Research Question

What are the Factors Associated with Discharge against Medical Advice among patients at Saint martin de porres mvogbetsi Yaounde.

• Specific Research Questions

1. What are the causes for discharge against medical advice among patients at Saint martin de porres mvogbetsi Yaounde
2. What are the consequences or the  risk factors of discharge against medical advice among patients at Saint martin de porres mvogbetsi Yaounde.
3. What strategies can be put in place to prevent discharge against medical advice among patients at Saint martin de porres mvogbetsi Yaounde.

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