Factors Affecting Discharge Against Medical Advices: A Case-Control Study in a Treatment-Teaching Hospital

Discharge against medical advices is leaving hospital despite medical advice, which can be a sign of the patient's dissatisfaction and a significant challenge for health system managers. This study examined the reasons for discharge against medical advices and compared the results with the control group (discharge with the doctor's opinion).
The present study is a case-control study in which 280 samples were selected randomly in two groups of patients discharged against medical advices and those who discharged with doctor's opinion. Data were collected through the questionnaire measuring patient-companion satisfaction in different wards of the hospital. Data were then analyzed using Chi-square and linear regression tests by SPSS 16 software.
Results showed that patient's age, having basic and complementary insurance, day of referring to hospital, education, and occupation made significant differences between the two groups. Among these factors, the most effective ones for discharge against medical advice were basic insurance (p = 0.020), age (p = 0.020), and occupation (p = 0.030). The most important reasons for discharge against medical advice from patient's viewpoints were failure to determine the patient's status, personal problems, feeling relative relief and partial recovery, as well as lack of physician's considerations in that hospital.
It seems that patients decide to discharge against medical advices due to lack of necessary supervision over the performance of medical and nursing services, and also lack of motivation in personnel to prevent from this event.
In order to earn patient's satisfaction, managers are required to improve the hospital's services.