Examination the rate, causes and consequences of treatment discontinuation in patients with Covid 19- a cross-sectional study

Abstract

Abstract

Background:Refusal to continue treatment and hospitalization and Discharge against Medical Advice (DAMA) is one of the examples of unsafe discharge of patients.This problem has consequences such as increased mortality, occurrence of new complications, increased re-hospitalization rates and the need to receive intensive care.

Methodology: This is a descriptive-analytical study that was conducted on patients with Covid-19 who were discharged against medical advice from the beginning of 2020 to the end of 2021.the data related to the rate of discharge against medical advice was obtained by referring to the hospital information system and the data related to the causes of discharge with personal consent and its consequences were extracted using a questionnaire and through telephone interviews with patients. The sampling method was census. The data was analyzed with SPSS 22 software.

Findings: According to the results of the study, 612 patients (9.9%) in inpatient departments and 1405 patients (15.6%) in the emergency department refused to continue treatment and hospitalization. The most important factors affecting discharge against medical recommendations include "inclination to continue treatment at home and use traditional medicine"and then "overcrowding of patients in the ward" and "lack of trust in medicine and treatment methods and fear of its side effects".According to the results, 36.8% of the patients had repeated visits. Among all patients who were discharged against medical advice, 139 patients (27.4%) were re-hospitalized .The mortality rate among patients who left the center against the doctor's recommendations was 8.1%.

Conclusion:discharge from the hospital against medical advice, especially from the emergency department, not only has irreparable clinical consequences for the patients, but also has a negative effect on the management indicators of the hospital, including the readmission rate.

Keywords: refusal of treatment-discharge against medical advice-Covid-19-rehospitalization-death