Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.
OBJECTIVE
Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics.


METHODS
This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables.


RESULTS
The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge.


CONCLUSIONS
The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.
Psychiatry and Behavioral Sciences research center, Mazandaran university of Medical Sciences. fmoonesi@yahoo.ca.
Fatemeh
F
Sheikhmoonesi
Mohammad
M
Khademloo
Samaneh
S
Pazhuheshgar
D000328:Adult; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007492:Iran; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012621:Seasons; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013406:Suicide, Attempted / Q000706:statistics & numerical data