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.
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References
Heidi SM, William EO (2004) Discharges against medical advice: a community hospital experience. CJRM 9:148–155
Len Doyal (2000) Surgical ethics. In: Russel RCG, Williams NS, Bulstrode CJK eds. Bailey and Love: Short Practice of Surgery, 23rd edn. London: Arnold, 1327–1332
Ohanaka EC (2002) Discharge against medical advice. Trop Doct 32:149–151
Akiode O, Musa AA, Shonubi AMO, Salami BA, Oyelekan AAA (2005) Trends of discharges against medical advice in a suburban surgical practice in Nigeria. Trop Doct 35:51–52
Pennycook AG, McNaughton G, Hogg F (1992) Irregular discharge against medical advice from the accident and emergency department — a cause for concern. Arch Emerg Med 9:230–238
Green P, Watts D, Pook S, Dhopesh V (2004) Why patients sign against medical advice (AMA): factors motivating patients to sign AMA. Am J Drugs Alcohol Abuse 30: 489–493
Aliyu ZY (2002) Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin Pract 56:325–327
Devitt JP, Devitt AC, Dewan M (2000) Does identifying a discharge as “against medical advice” confer legal protection? J Fam Prac 49:224–227
Okoromah CN, Egri-Okwaji MTC (2004) Profile of and control measures for paediatric discharge against medical advice. Niger Postgrad Med J 11:21–25
Odelowo EOO (1993) Factors affecting morbidity and mortality from road traffic accidents: a Nigeria periurban study. Afr J Med Sci 22:69–74
Solagberu BA, Adekanye AO, Ofoegbu CPK et al (2002) Clinical spectrum of trauma at a university hospital in Nigeria. Eur J Trauma 28:365–369
Alebiosu CO, Raimi TH (2004) A study of hospital patients discharge against medical advice in the Olabisi Onabajo University Teaching Hospital, Sagamu. Nig Med Pract 40:33–36
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Nasir, A.A., Babalola, O.M. Clinical spectrum of discharges against medical advice in a developing country. Indian J Surg 70, 68–72 (2008). https://doi.org/10.1007/s12262-008-0018-8
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DOI: https://doi.org/10.1007/s12262-008-0018-8