Patient's Reasons for Discharge against Medical Advice in University Hospitals of Kashan University of Medical Sciences in 2008

Patients who leave hospital against medical advice may be at risk of adverse health outcomes and readmission. In this study we examined reasons of discharge against medical advice (DAMA) in University hospitals of Kashan University of Medical Sciences and Health Services in a six month period in 2008. We conducted a descriptive-cross sectional study on 865 patients who left the hospitals against medical advice. Patients were selected by systematic random sampling, data was gathered by telephone survey with a valid (split-half, r =0.78) and reliable (face and content) structured questionnaire consisting of four sections of: reasons related to patient's problem, personnel's problems, hospital conditions and demographic data. Data were analyzed using descriptive statistics methods. Of 865 patients, 829 (95.84%) responded 460 (55.5%) were male. 506 (61.04%) of DAMAs were due to patients problems, 207(24.96%) were due to personnel's reasons and 116 (13.99%) were due to hospital conditions. There was a significant difference among the gender of patients discharged against medical advice in the group of reasons relating to personnel (P<0.01). Most DAMAs were from Emergency ward (30.28%). The total rate of DAMA was 10.3% (9.9% -10.75%, α = 0.5). D AMA rate was high and the most common reasons were patient's problems. Employing clinical social workers in wards, increasing patients’ knowledge about adverse effect of DAMA, planning outpatient services for those who leave against medical advice and providing convenient environment for patients in the hospital are recommended solutions to decrease DAMA.