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Right arrow Patient safety, clinical risk, medical error
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CMAJ • September 17, 2002; 167 (6)
© 2002 Canadian Medical Association or its licensors

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Leaving hospital against medical advice among HIV-positive patients

Aslam H. Anis*{dagger}{ddagger}§, Huiying Sun{dagger}§, Daphne P. Guh{dagger}§, Anita Palepu§, Martin T. Schechter*{dagger}{ddagger}§ and Michael V. O'Shaughnessy*{dagger}§**

From *the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC; {dagger}the Canadian HIV Trials Network, Vancouver, BC; {ddagger}the Department of Health Care and Epidemiology, University of British Columbia and St. Paul's Hospital, Vancouver, BC; §the Centre for Health Evaluation and Outcome Sciences, University of British Columbia and St. Paul's Hospital, Vancouver, BC; ¶the Department of Internal Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC; and **the Department of Pathology, University of British Columbia and St. Paul's Hospital, Vancouver, BC

Correspondence to: Dr. Aslam H. Anis, British Columbia Centre for Excellence for HIV/AIDS, St. Paul's Hospital, 570-1081 Burrard St., Vancouver BC V6Z 1Y6; fax 604 806-8778; anis{at}hivnet.ubc.ca

Background: Hospital discharge against medical advice, especially among substance-abusing populations, is a frustrating problem for health care pro-viders. Because of the high prevalence of injection drug use among HIV- positive patients admitted to hospital in Vancouver, we explored the factors associated with leaving hospital against medical advice in this population.

Methods: We reviewed records for all HIV/AIDS patients admitted to St. Paul's Hospital, Vancouver, between Apr. 1, 1997, and Mar. 1, 1999. After identifying the first ("index") admission during this period, we followed the patients' records for 1 year. Multivariate models were applied to identify the determinants of discharge against medical advice and to estimate the impact of such discharge on readmission rate, readmission frequency and length of stay in hospital.

Results: Of 981 index admissions among HIV/AIDS patients, 125 (13%) of the patients left the hospital against medical advice. Departure on the day on which welfare cheques were issued and a history of injection drug use were significant predictors of leaving against medical advice. After adjusting for sex, age, severity of illness, injection drug use and homelessness, we found that patients leaving against medical advice were readmitted more frequently than those who were formally discharged (frequency ratio 1.25, 95% confidence interval [CI] 1.11–1.42), were more likely to be readmitted with a related diagnosis within 30 days (odds ratio 5.00, 95% CI 3.04–8.24) and had significantly longer lengths of stay in the follow-up period.

Interpretation: Discharge against medical advice among HIV-positive patients was associated with frequent readmissions with the same diagnosis. Preventing such discharges is likely to benefit patients (by improving their health status) and the health care system (by reducing unnecessary readmissions).




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