title: [Assessment of self-discharge of homeless patients with tuberculosis].
abstract: OBJECTIVE
  Factors responsible for the premature self-discharge of homeless tuberculosis (TB) patients from the hospital and the association between the self-discharge and treatment interruption were assessed.
  
  
  METHODS
  A total of 205 homeless patients with TBs who were newly registered between January, 2007 and June, 2008 were evaluated. The subjects were divided into two groups (those who were discharged themselves from the hospital prematurely ["case" group] and those who were not [control group]), and the difference between the groups regarding the factors possibly responsible for the self-discharge was evaluated.
  
  
  RESULTS
  i) Patient's characteristics: The subjects were all men; there were 45 in the "case" group and 160 in the control group. The proportion of subjects aged under 60 years was significantly higher in the "case" group (84.4%) than in the control group (52.5%). The proportion of subjects who consumed 360 mL or more of sake a day was significantly higher in the "case" group (64.4%) than in the control group (38.8%). ii) Questionnaire survey on admission: All of the patients were hospitalized for treatment of TB. In the interview on admission, more "case" group patients reported "I do not know much about TB" or "I am dissatisfied with my hospitalization", as shown by multiple logistic regression analysis. A review of troubles with inmates or healthcare workers over alcohol drinking or smoking showed that the proportion of subjects who had such troubles was significantly higher in the "case" group (55.6%) than in the control group (5.0%). iii) The association between the treatment outcomes and the self-discharge: The proportion of subjects with treatment outcomes of "cured" or "treatment completed" was significantly lower in the "case" group (46.7%) than in the control group (78.8%). The proportion of subjects with a treatment outcome of "defaulted" was significantly higher in the "case" group (42.2%) than in the control group (3.8%).
  
  
  CONCLUSIONS
  The patients who were aged under 60 years or who consumed 360 mL or more of sake a day were shown to be significantly more likely to discharge themselves prematurely, which warrants a more careful handling of such problems. The poor understanding of disease necessitates more adequate explanation of TB, or education, considering each patient's level of understanding. In addition, the patients' dissatisfaction with their hospital stay, as seen in the case group, should be more carefully addressed in order to avoid the higher rate of trouble.
authors.affiliation: Osaka City Public Health Office, Osaka, Japan. ke-matsumoto@city.osaka.lg.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Chika
authors.initials: C
authors.lastname: Hotori
authors.forename: Saori
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Arima
authors.forename: Jun
authors.initials: J
authors.lastname: Komukai
authors.forename: Katsura
authors.initials: K
authors.lastname: Danno
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirota
authors.forename: Shinichi
authors.initials: S
authors.lastname: Koda
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Terakawa
authors.forename: Akira
authors.initials: A
authors.lastname: Shimouchi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D012944:Social Support; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult