scholarly journals Factors Influencing Patients to Make the Decision to Discharge Themselves Against Medical Advice at Tertiary Hospitals: A Cross-Sectional Study

2021 ◽  
Author(s):  
Malak AL Sharif ◽  
Aeshah Alatawi ◽  
Abdulhadi M. Alqahtani ◽  
Mohammed Alufi ◽  
Faisal Alghamdi
Keyword(s):  
Wait Time ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
The Past ◽  
Tertiary Hospitals ◽  
Discharge Against Medical Advice ◽  
Study Participants

Abstract Background:DAMA is defined as any instance when a patient wants to leave the hospital against the managing physician's decision.This study aimed to identify the most common factors that influence patients to decide to choose DAMA.Results: Between March and April 2021, 510 responses were collected from participants and included in the analysis. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants have had taken discharge against medical advice in the past.Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.

scholarly journals Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study

2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Manish Nath Pant ◽  
Saswat Kumar Jha ◽  
Sauravi Shrestha
Keyword(s):  
Emergency Department ◽  
Informed Consent ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice

Introduction: Left against medical advice is a worldwide phenomenon. Patients leaving against Left against medical advice do not provide the health professionals with legal impunity. A well-informed consent should be present with surety that they are well understood by the patient before they leave. The study was undertaken to study the prevalence of patients that leave against medical advice. Methods: This is a descriptive cross-sectional study done in the emergency department of a tertiary care hospital from 1st February 2020 to 31 July 2020. Ethical approval was taken from the Institutional Review Committee (ref. no. 130120205). The sample size was calculated and the convenient sampling method was used. Data were analyzed in the Statistical Package of the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 5834 visits, 332 (5.96%) (4.70-7.22 at 95% Confidence Interval) patients left against medical advice. The mean age was 36.48 years (3 days-91 years) and males 173 (52.3%) were prone to leave than females. Only 50 (15.1%) cases had well-informed consent with complications documented. Hundred (30.5%) patients had wanted to come on follow up the next day in the out-patient department while 41 (12.4%) had to leave because of financial reasons. Only seven (2.9%) of well-oriented patients gave their consent and the remaining 233 (97.1%) were by the kin present. Only 76 (23%) patients were sent home with a well-documented medicine prescription. Conclusions: The proportion of patients who left against medical advice was more than the studies done in a similar setting.

scholarly journals Leave Against Medical Advice amongst Pediatric Patients Admitted in a Tertiary Teaching Hospital in Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (241) ◽  
pp. 897-901
Author(s):  
Sahisnuta Basnet ◽  
Ganesh B.K ◽  
Aslam Ansari ◽  
Suraj Adhikari
Keyword(s):  
Confidence Interval ◽  
Teaching Hospital ◽  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Sectional Study ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Introduction: Leave against medical advice has a potentially deleterious effect on the health of a child. This is particularly alarming in case of pediatric patients as they are unable to understand the implications of it and rely on parents to make decisions regarding their health. This study was undertaken to find out the prevalence of leave against medical advice among pediatric patients admitted in a tertiary teaching hospital in Nepal. Methods: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Manipal Teaching Hospital between August 2019 and July 2020. Ethical clearance was obtained from the Institutional Review Committee (Ref: 256). Convenient sampling method was used. Data entry and analysis was done on Statistical Package for Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.Results: Out of 1608 pediatric admissions taken in our study, the prevalence of leave against medical advice was found to be 67 (4.2%) at 95% Confidence Interval (3.22-5.18). Maximum 22 (33%) and minimum 6 (9%) patients respectively belonged to the age group from birth to 7 days and more than 10 years. Out of 67 cases, there were 36 (54%) males and 31 (46%) females.Conclusions: The prevalence of leave against medical advice among admitted pediatric patients in our study was similar to that of other studies. It is a social health problem which can be prevented by increasing the awareness and facilitating the use of health insurance schemes. More effective communication is required between the treating physicians and the parents to prevent this detrimental practice.

scholarly journals The Effect of Occupational Stress on Depression and Insomnia: a Cross-sectional Study Among Employees in a Ghanaian Telecommunication Company

2020 ◽  
Author(s):  
Emma Edinam Kploanyi ◽  
Duah Dwomoh ◽  
Mawuli Dzodzomenyo
Keyword(s):  
Occupational Stress ◽  
Work Experience ◽  
Cross Sectional Study ◽  
Background Characteristics ◽  
Sectional Study ◽  
Probit Regression ◽  
Cross Sectional ◽  
The Past ◽  
Telecommunication Company ◽  
Study Participants

Abstract Background Depression and insomnia are major psychiatric conditions that are predicted by occupational stress. However, the influence of occupational stress on these two conditions is under-explored in telecommunication companies, especially in Africa. This research was conducted to assess occupational stress in a Ghanaian telecommunication company and its effect on depression and insomnia. Methods An analytical cross-sectional study was conducted among employees at a telecommunication company in Accra. Structured self-administered questionnaires were used in collecting data from 235 respondents using simple random sampling. Chi-square test of independence and the Wilcoxon Rank-Sum test were employed to assess the significance of associations with subsequent sensitivity analysis using Multiple logistic, Poisson and Probit regression models. Occupational stress was matched on three variables: age of the workers, responsibility for dependents and work experience, to improve on the estimation of its impact on symptomatic depression and insomnia using the coarsened exact matching procedure. Results More males (52.8%) than females participated in this study. The age range for study participants was 20-49 years with a mean of 30.8 ± 6.9 years. The prevalence of occupational stress among the employees was 32.8% (95% CI= 26.7-38.8). More than half of respondents (51%) reported depressive symptoms in the past week and only a few (6%) reported being diagnosed with insomnia in the past year. Age, responsibility for dependents and work experience were the only background characteristics that were significantly associated with perceived occupational stress. After controlling for background characteristics, the estimated risk of reporting symptoms of depression among employees who perceived stress from work was only 5% higher [ARR; 95% CI=1.05 (0.94-1.17)] whereas it was 2.58 times the risk of reporting insomnia [ARR; 95% CI=2.58(0.83-8.00)] compared to those who did not perceive stress from their jobs. The relative risk reduced to 2.46[ARR; 95% CI=2.46(0.77-7.87)] and 1.03[ARR; 95% CI=1.03(0.91-1.17)] for insomnia and depression respectively after employing Poisson regression with CEM. Conclusion The study found a higher risk of insomnia among employees who reported occupational stress compared to those who did not. However, there was not enough statistical evidence to conclude that occupational stress was associated with depression among the study participants.

Discharge against medical advice from a Tehran emergency department

2016 ◽  
Vol 29 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Azar Hadadi ◽  
Patricia Khashayar ◽  
Mojgan Karbakhsh ◽  
Ali Vasheghani Farahani
Keyword(s):  
Emergency Department ◽  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Medical Advice ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Policy Makers ◽  
Content Type ◽  
Discharge Against Medical Advice

Purpose – The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran. Design/methodology/approach – This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA. Findings – In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA. Practical implications – Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate. Originality/value – To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

scholarly journals Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e024291
Author(s):  
Ali Taghizadieh ◽  
Saber Azami-Aghdash ◽  
Reza Piri ◽  
Mohammad Naghavi-Behzad ◽  
Hossein Jabbari Beyrami
Keyword(s):  
Cross Sectional Study ◽  
Medical Advice ◽  
Public Confidence ◽  
Two Phase ◽  
Related Factors ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
North West ◽  
Discharge Against Medical Advice ◽  
Healthcare Transformation

ObjectiveDischarge against medical advice (DAMA) is a critical problem in hospitals and has several consequences for healthcare systems. The aim of this study was to determine and compare the rate of DAMA and its related factors before and after executing the healthcare transformation plan (HTP) in Iran.MethodsIn a two-phase, cross-sectional study, the DAMA information of 200 patients in 2016 (after HTP) and the patients of a previous study in 2012 (before HTP) was compared. Samples were randomly selected from the main referral centre in the north-west of Iran. Data were collected using a validated and reliable questionnaire and analysed using the SPSS V.16 software.ResultsIn the post-HTP plan period, the rate of DAMA was 3.9%, while this rate was 5.49% in 2012 (p=0.029). A total of 15% (108 out of 721) of patients in the postreform group and 13.5% (101 out of 747) in the prereform group were rehospitalised (p=0.411). The three main categories of reasons for DAMA in 2012 and 2016 were as follows: patient-related factors, 27% vs 45%; staff-related factors, 33% vs 30%; and hospital-related factors (basic amenities), 40% vs 25%. In both periods, the average scores of patient satisfaction were almost the same; however, satisfaction regarding environmental and human factors in hospitals had changed significantly after HTP (p<0.05).ConclusionsThere was a decrease in the rate of DAMA after HTP in Iran. Considering DAMA as a multifactorial phenomenon, this might be due to the higher relative satisfaction after HTP, indicating an increase in public confidence in general hospitals.

scholarly journals The Effect of Occupational Stress on Depression and Insomnia: a Cross-sectional Study Among Employees in a Ghanaian Telecommunication Company

2019 ◽  
Author(s):  
Emma Edinam Kploanyi ◽  
Duah Dwomoh ◽  
Mawuli Dzodzomenyo
Keyword(s):  
Occupational Stress ◽  
Work Experience ◽  
Cross Sectional Study ◽  
Background Characteristics ◽  
Sectional Study ◽  
Probit Regression ◽  
Cross Sectional ◽  
The Past ◽  
Telecommunication Company ◽  
Study Participants

Abstract Background Depression and insomnia are major psychiatric conditions that are predicted by occupational stress. However, the influence of occupational stress on these two conditions is under-explored in telecommunication companies, especially in Africa. This research was conducted to assess occupational stress in a Ghanaian telecommunication company and its effect on depression and insomnia.Methods An analytical cross-sectional study was conducted among employees at a telecommunication company in Accra. Structured self-administered questionnaires were used in collecting data from 235 respondents using simple random sampling. Chi-square test of independence and the Wilcoxon Rank-Sum test were employed to assess the significance of associations with subsequent sensitivity analysis using Multiple logistic, Poisson and Probit regression models. Occupational stress was matched on three variables: age of the workers, responsibility for dependents and work experience, to improve on the estimation of its impact on symptomatic depression and insomnia using the coarsened exact matching procedure.Results More males (52.8%) than females participated in this study. The age range for study participants was 20-49 years with a mean of 30.8 ± 6.9 years. The prevalence of occupational stress among the employees was 32.8% (95% CI= 26.7-38.8). More than half of respondents (51%) reported depressive symptoms in the past week and only a few (6%) reported being diagnosed with insomnia in the past year. Age, responsibility for dependents and work experience were the only background characteristics that were significantly associated with perceived occupational stress. After controlling for background characteristics, the estimated risk of reporting symptoms of depression among employees who perceived stress from work was only 5% higher [ARR; 95% CI=1.05 (0.94-1.17)] whereas it was 2.58 times the risk of reporting insomnia [ARR; 95% CI=2.58(0.83-8.00)] compared to those who did not perceive stress from their jobs. The relative risk reduced to 2.46[ARR; 95% CI=2.46(0.77-7.87)] and 1.03[ARR; 95% CI=1.03(0.91-1.17)] for insomnia and depression respectively after employing Poisson regression with CEM.Conclusion The study found a higher risk of insomnia among employees who reported occupational stress compared to those who did not. However, there was not enough statistical evidence to conclude that occupational stress was associated with depression among the study participants.

scholarly journals Undernutrition and associated factors in orphan children aged 6–59 months in Gambella Southwest, Ethiopia: A community-based cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045892
Author(s):  
Solomon Feleke ◽  
Gudina Egata ◽  
Firehiwot Mesfin ◽  
Gizachew Yilak ◽  
Abebaw Molla
Keyword(s):  
Associated Factors ◽  
Wealth Index ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Orphaned Children ◽  
Access To Health ◽  
Study Participants ◽  
Children Under 5

ObjectiveThe study aimed to assess the prevalence of stunting, wasting, underweight and associated factors in orphaned children under 5 years old.DesignA cross-sectional study.SettingGambella City, Ethiopia.ParticipantsA sample of 419 under 5 orphaned children included in the study. Eligible households with orphans had selected using a systematic random sampling method. The lottery method was used when more than one eligible study participants live in the household. An OR with 95% CI was performed to measure the strength of association between each dependent variable and independent variables. Variables with p<0.05 were declared statistically significant.Primary outcomeThe main outcome of this study was the prevalence of undernutrition among orphaned under 5 and its associated factors.ResultsPrevalence of stunting, wasting and underweight in orphan children under 5 were 12.2%, 37.8% and 21.7%, respectively. The prevalnce of wasting peaks among age group of 36–47 months (42.5%), whereas underweight peaks in 48–59 months (27.7%). Food insecurity, wealth index, family size, vitamin A supplementation, diarrhoea, fever 2 weeks before the survey, children under 5 and parents’ death were associated with undernutrition.ConclusionThe prevalence of stunting, wasting and underweight among orphan children under 5 was significantly high. Multisectoral collaborative efforts towards access to health services, improving income-generating activities, micronutrient supplementation and social support and protection targeting orphan and vulnerable populations have to be built up.

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