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Reasons for discharges against medical advice: a qualitative study
  1. Eberechukwu Onukwugha1,
  2. Elijah Saunders2,
  3. C Daniel Mullins1,
  4. Françoise G Pradel1,
  5. Marni Zuckerman1,
  6. Matthew R Weir3
  1. 1Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
  2. 2Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Eberechukwu Onukwugha, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA; eonukwug{at}rx.umaryland.edu

Abstract

Background There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multicategory provider focus-group interviews (FGIs).

Methods Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical centre along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group and one nurse/social worker group were held. Focus-group interviews were transcribed, and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions.

Results Eighteen patients, five physicians, six nurses and four social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker FGIs of reasons why patients leave against medical advice: (1) drug addiction, (2) pain management, (3) external obligations, (4) wait time, (5) doctor's bedside manner, (6) teaching hospital setting and (7) communication. Solutions to tackle DAMA identified by participants revolved mainly around enhanced communication and provider education.

Conclusions In a large, academic medical centre, the authors find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication.

  • Discharges
  • against medical advice
  • qualitative research
  • compliance
  • decision-making
  • outcome
  • qualitative research
  • quality of care

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Footnotes

  • Funding EO is supported by a National Institutes of Health K12 Career Development Award 1K12RR023250-01.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Maryland Baltimore Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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