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

Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department 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.Methods: 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.Results: 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).Conclusion: 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