Worse Outcomes Seen When Patients Leave Hospital Against Medical Advice08/26/13
MONDAY, Aug. 26 (HealthDay News) -- Patients who leave the
hospital against medical advice are more likely to be readmitted or
die than other patients, a new long-term study finds.
Canadian researchers examined 1.9 million adult hospital
admissions and discharges over nearly 20 years in the province of
Manitoba. In 1.1 percent of those cases, patients left the hospital
against medical advice.
People who left the hospital against medical advice were three
times more likely than other patients to be readmitted within 30
days, according to the study, which appears Aug. 26 in the
CMAJ (Canadian Medical Association Journal).
One-quarter of those readmissions occurred within a single day
and 75 percent within two weeks. Those most likely to be readmitted
were older, male, poorer and had been hospitalized multiple times
in the previous five years.
Patients who left the hospital against medical advice were two
and a half times more likely to die within 90 days than other
patients, according to a journal news release.
"For both hospital readmission and death, the elevated rates among patients who left against medical advice started out high and then declined, but remained elevated to at least 180 days," wrote Dr. Allan Garland, of the faculty of medicine at the University of Manitoba, and colleagues.
The increased risk of readmission and death among patients who
leave the hospital against medical advice may be linked to both the
illness for which patients were hospitalized and their health
behaviors, such as ignoring medical advice or medication orders,
the researchers said.
Although the study found a link between leaving against medical
advice and worse outcomes for hospital patients, it did not
establish a cause-and-effect relationship.
"Although strategies targeted at trying to convince patients not to leave prematurely might diminish the early effects of leaving against medical advice, reducing the persistently elevated risk will likely require longitudinal interventions extending beyond hospital admission," the researchers concluded.
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