FACTORS THAT INFLUENCE THE DECISION TO BE DISCHARGED AGAINST MEDICAL ADVICE AT THE FEDERAL MEDICAL CENTRE, OWO, ONDO STATE

Abstract

Objectives: To determine (a) the prevalence of DAMA at Federal Medical Centre, Owo, (b) the knowledge of patients about the medical condition that brought them to the hospital, (c) the knowledge of patients about the implications of DAMA, (d) the reasons for DAMA and (e) the clinical status of patients at the time of DAMA. Methodology: A total of six hundred and seventy six patients who were on admission in all the wards of Federal Medical Centre, Owo, during the three months study period (May-July 2004) were recruited for the study. A researcher-administered questionnaire was filled for each of the participants. Data analysis was carried out by means of a microcomputer running Epi-Info Version 6.0 software. Initial analysis was done using simple frequency proportions. Further analysis exploring relationships between variables was done using chi-squared test and logistic regression. Test of significance was set at p<0.05. Result: The result showed that six hundred and seventy six patients participated in the study. Fifty patients were discharged against medical advice; giving a prevalence of 7.4%. DAMA was found to be more common among the age group 20 years to 35 years (62.1%) with male to female ratio of about 1:1. More of the Yorubas (67.2%) were discharged against medical advice than any other tribe but the Hausas had more tendency to DAMA than any other tribe (72 fold more than the Yorubas). Majority of the patients that DAMA were from the emergency department (69.0%), while about 94.8% of DAMA patients had secondary education and below. Traders and those with no occupation accounted for about 88.0% of DAMA patients. Financial constraint was the reason for DAMA in about 51.7% of patients while 25.8% of the patients decided to seek traditional care. Most of the patients that were discharged against medical advice understood the medical condition that brought them to the hospital and were aware of the implications of DAMA. The factors that were found to be significant in the decision to be discharged against medical advice in this study included the age group (p= 0.0001), tribe (p= 0.0001), educational level (p= 0.002), ward (p= 0.0001), occupation (p=0.038), condition of patient on admission (p= 0.016), type of illness (p= 0.0003), patient’s compliance with treatment (p= 0002), condition of patient on discharge (p= 0.0001), affordability of the bill (p= 0.0001), doctor’s attitude (p= 0.0001), adviser (p= 0.0001) and hospital experience (p= 0.014). Conclusion: The prevalence of DAMA at Federal Medical Centre, Owo, is very high when compared with other studies. Majority of the patients that sought DAMA were well informed about the condition that brought them to the hospital and the implication of DAMA. Financial constraint was the major reason for seeking DAMA at Federal Medical Centre, Owo. Other reasons were as follows; preference for traditional care, lack of improvement, patients’ wish to seek medical care in another hospital and when all hope was lost in the patients’ condition. The condition of most of the patients that were discharged against medical advice did not improve or worsen at the time of discharge. The factors that were found to influence the decision to be discharged against medical advice are a) the status of health worker that advised the patient, b) the tribe of the patient, c) ability of the patient to pay hospital bill, d) the condition of the patient on discharge, e) patient’s compliance with treatment, f) the ward in which the patient was admitted. Recommendations: The government at all levels should increase the
budgetary allocation to health institutions in order to take care of
emergency services. National Health Insurance Scheme (NHIS) being
implemented by the Federal Government should be pursued vigorously
and all hands must be on deck to make it work. Low literacy rate should be addressed by the government. Education of the patients and their
relations on the findings on examination, investigations, diagnosis,
treatment options, prognosis and follow up should be done. Patients and
their relations need to be carried along and be involved in the
management of their illness. Patient-doctor relationship should be
strengthened.
Alternative medical practice should be regulated by government
laid down rules and laws as well as coordinating body. Referral should be
offered to the patients whenever it is appropriate. Genuine attempt should
be made to follow up the patient. Good record keeping and proper
documentation of every aspect of the patient’s management is important.
The patient should be committed to sign an undertaken if eventually he or
she decides to DAMA.

FACTORS THAT INFLUENCE THE DECISION TO BE DISCHARGED AGAINST MEDICAL ADVICE AT THE FEDERAL MEDICAL CENTRE, OWO, ONDO STATE