A Systematic Review of Factors Leading to Discharge against Medical Advice

Discharge against medical advice (DAMA), a source of ineffectiveness in the healthcare system, remains as a persistent problem in the health settings. To alleviate this problem, knowledge of the general related causative factor is crucial. Thus this study aimed to identify and rank the factors contributing to DAMA, based on a comprehensive literature survey. A systematic review of papers related to DAMA was carried out by searching literature in PubMed based on MeSH, as well as exploring Google Scholar, and SID. From the 1771 papers found, 51 which were directly related to the study objective were identified and reviewed. Descriptive statistical methods were used for summarizing the data. Patients with mental illness or a history of intravenous drug addiction were found as the most frequent DAMA patients. General hospitals and department of pediatrics and emergency face with the highest rate of DAMA. Personal or family problems, dissatisfaction with services providers, the perceived ineffectiveness of treatment, financial problems, feel of well-being, and dissatisfaction with the hospitalization conditions, were enumerated by the patients as the main causes of DAMA. On the other hand, healthcare staff identified the major factors leading to DAMA to be psychological and social problems, lack of proper communication of healthcare staff with patients, and reluctant of patients in completing the treatment period. Systematically identification of causes of DAMA in this study can be considered by the health policy-makers and hospital administrators to develop effective strategies aimed at alleviating the problem.