RT Journal Article
SR Electronic
T1 Leaving hospital against medical advice among HIV-positive patients
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 633
OP 637
VO 167
IS 6
A1 Aslam H. Anis
A1 Huiying Sun
A1 Daphne P. Guh
A1 Anita Palepu
A1 Martin T. Schechter
A1 Michael V. O'Shaughnessy
YR 2002
UL http://www.cmaj.ca/content/167/6/633.abstract
AB 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).