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Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

Authors Boniface Ikenna Eze B, Agu K, Nwosu J

Published 2 September 2010 Volume 2010:2 Pages 27—31


Review by Single anonymous peer review

Peer reviewer comments 2

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Boniface Eze1, Kenneth Agu2, Jones Nwosu3

1Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria

Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA) at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.

The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom) was considered statistically significant.

Of the 64,856 admissions (45.2% male, 54.8% female), 113 (0.002%; males: 54%, females: 46%) were discharged against medical advice. DAMA rate was highest in Surgery (0.4%), and lowest in Obstetrics and Gynecology (0.1%) and Pediatrics (0.1%). Infections (32.7%), trauma (29.2%), and cancer (16.8%) were the leading diagnoses in patients DAMA. Financial constraints (37.2%), unsatisfactory response to treatment (17.7%), and dissatisfaction with hospital environment (15.0%) were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05), patients having high levels of formal education (P < 0.05), and those who had not been previously hospitalized (P < 0.05); but not with age (P = 0.398), gender (P = 0.489), or employment (P = 0.091).

Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate.

Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical characteristics, Nigeria

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