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Leaving hospital against medical advice among HIV-positive patients.

https://arctichealth.org/en/permalink/ahliterature188328
Source
CMAJ. 2002 Sep 17;167(6):633-7
Publication Type
Article
Date
Sep-17-2002
Author
Aslam H Anis
Huiying Sun
Daphne P Guh
Anita Palepu
Martin T Schechter
Michael V O'Shaughnessy
Author Affiliation
British Columbia Centre for Excellence in HIV/AIDS, Canadian HIV Trials Network, Vancouver. anis@hivnet.ubc.ca
Source
CMAJ. 2002 Sep 17;167(6):633-7
Date
Sep-17-2002
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Female
HIV Seropositivity - therapy
Humans
Length of Stay
Male
Multivariate Analysis
Patient Discharge - statistics & numerical data
Patient Dropouts - statistics & numerical data
Patient Readmission
Public Assistance
Regression Analysis
Retrospective Studies
Risk
Substance Abuse, Intravenous - complications
Abstract
Hospital discharge against medical advice, especially among substance-abusing populations, is a frustrating problem for health care providers. 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.
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.
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% Cl 3.04-8.24) and had significantly longer lengths of stay in the follow-up period.
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).
Notes
Cites: J Acquir Immune Defic Syndr. 2001 Dec 1;28(4):351-711707672
Cites: Hosp Community Psychiatry. 1976 Dec;27(12):865-81033140
Cites: Arch Gen Psychiatry. 1977 Feb;34(2):153-5843174
Cites: N Engl J Med. 1979 Jan 4;300(1):22-4758156
Cites: JAMA. 1979 Dec 21;242(25):2758501872
Cites: J Behav Med. 1979 Mar;2(1):85-92555482
Cites: Int J Soc Psychiatry. 1981 Summer;27(2):143-507228530
Cites: J Clin Psychol. 1982 Jul;38(3):550-47107917
Cites: J Chronic Dis. 1985;38(1):79-843972952
Cites: Can J Psychiatry. 1987 May;32(4):259-633607704
Cites: Psychiatr J Univ Ott. 1988 Sep;13(3):154-73054980
Cites: Hosp Community Psychiatry. 1989 Mar;40(3):299-3012917742
Cites: Am J Public Health. 1991 Feb;81(2):212-51899322
Cites: Hosp Community Psychiatry. 1991 Apr;42(4):403-52050353
Cites: J Emerg Med. 1992 Jul-Aug;10(4):513-61430994
Cites: Mil Med. 1993 Feb;158(2):69-738441499
Cites: Can J Psychiatry. 1993 May;38(4):285-98518982
Cites: Am J Med. 1999 Nov;107(5):507-910569306
Cites: J Reprod Med. 1993 May;38(5):370-48320674
Cites: J Subst Abuse Treat. 1994 May-Jun;11(3):239-458072052
Cites: J Psychosoc Nurs Ment Health Serv. 1994 Aug;32(8):36-407965954
Cites: J Gen Intern Med. 1995 Jul;10(7):403-57472691
Cites: J Natl Med Assoc. 1996 Oct;88(10):658-608918072
Cites: Acad Emerg Med. 1997 Feb;4(2):118-239043538
Cites: Am J Drug Alcohol Abuse. 1997 May;23(2):267-799143638
Cites: Gen Hosp Psychiatry. 1997 Sep;19(5):355-619328780
Cites: J Gen Intern Med. 1998 Aug;13(8):568-719734795
Cites: Psychiatr Serv. 1998 Sep;49(9):1187-929735960
Cites: J Gen Intern Med. 1999 Sep;14(9):531-610491241
Cites: Arch Gen Psychiatry. 1963 Feb;8:120-3014024937
Comment In: CMAJ. 2002 Sep 17;167(6):647-812358198
PubMed ID
12358196 View in PubMed
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Readmission rates of patients discharged against medical advice: a matched cohort study.

https://arctichealth.org/en/permalink/ahliterature131164
Source
PLoS One. 2011;6(9):e24459
Publication Type
Article
Date
2011
Author
Mark Choi
Haerin Kim
Hong Qian
Anita Palepu
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Source
PLoS One. 2011;6(9):e24459
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cohort Studies
Comorbidity
Female
Follow-Up Studies
Homeless Persons
Humans
Male
Middle Aged
Multivariate Analysis
Patient Discharge
Patient Readmission
Regression Analysis
Retrospective Studies
Time Factors
Abstract
We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period.
A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group.
AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p
Notes
Cites: Cochrane Database Syst Rev. 2010;(1):CD00031320091507
Cites: Eur Psychiatry. 2012 Oct;27(7):496-921705199
Cites: J Gen Intern Med. 2010 Sep;25(9):926-920425146
Cites: Qual Saf Health Care. 2010 Oct;19(5):420-420538627
Cites: Am J Med. 1999 Nov;107(5):507-910569306
Cites: J Gen Intern Med. 2000 Feb;15(2):103-710672113
Cites: Int J Clin Pract. 2002 Jun;56(5):325-712137437
Cites: CMAJ. 2002 Sep 17;167(6):633-712358196
Cites: CMAJ. 2003 Feb 18;168(4):417-2012591781
Cites: J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):56-914707793
Cites: Am J Public Health. 1991 Feb;81(2):212-51899322
Cites: J Emerg Med. 1992 Jul-Aug;10(4):513-61430994
Cites: J Subst Abuse Treat. 1994 May-Jun;11(3):239-458072052
Cites: J Gen Intern Med. 1995 Jul;10(7):403-57472691
Cites: J Gen Intern Med. 1998 Aug;13(8):568-719734795
Cites: Psychiatr Serv. 1998 Sep;49(9):1187-929735960
Cites: Can J Rural Med. 2004 Summer;9(3):148-5315603687
Cites: Psychiatr Serv. 2006 Aug;57(8):1192-816870972
Cites: Health Place. 2007 Jun;13(2):432-916798055
Cites: J Allergy Clin Immunol. 2007 Apr;119(4):924-917239431
Cites: Am J Public Health. 2007 Dec;97(12):2204-817971552
Cites: J Gen Intern Med. 2008 Oct;23(10):1698-70718648890
Cites: Mayo Clin Proc. 2009 Mar;84(3):255-6019252113
Cites: Clin Pediatr (Phila). 2009 Apr;48(3):263-7018832530
Cites: Stud Health Technol Inform. 2009;143:496-50019380982
Cites: J Clin Psychiatry. 2010 Jun;71(6):808-920573333
PubMed ID
21931723 View in PubMed
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