Reasons for discharges against medical advice: a qualitative study.
BACKGROUND
There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multicategory provider focus-group interviews (FGIs).


METHODS
Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical centre along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group and one nurse/social worker group were held. Focus-group interviews were transcribed, and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions.


RESULTS
Eighteen patients, five physicians, six nurses and four social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker FGIs of reasons why patients leave against medical advice: (1) drug addiction, (2) pain management, (3) external obligations, (4) wait time, (5) doctor's bedside manner, (6) teaching hospital setting and (7) communication. Solutions to tackle DAMA identified by participants revolved mainly around enhanced communication and provider education.


CONCLUSIONS
In a large, academic medical centre, the authors find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication.
Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA. eonukwug@rx.umaryland.edu
Eberechukwu
E
Onukwugha
Elijah
E
Saunders
C Daniel
CD
Mullins
Françoise G
FG
Pradel
Marni
M
Zuckerman
Matthew R
MR
Weir
D000328:Adult; D001294:Attitude to Health; D002755:Choice Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010351:Patient Discharge; D036301:Qualitative Research; D014481:United States