Incidence and reasons for Discharge Against Medical Advice in a tertiary health care facility in Port Harcourt, south-south Nigeria

Abstract

Background;  Disease pattern in Nigeria is changing from communicable diseases to non-communicable diseases. However, the approach to patient care has not changed; neither has the expectations of the general public for quick recovery. These have resulted in poorer treatment outcome and patients' dissatisfaction that sometime result in discharge against medical advice. This study is to ascertain the reasons for the growing incidence of discharges against medical advice in the medical wards of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Materials and Methods:  A two year review of the records of all the patients discharged against medical advice in the medical wards of the hospital was carried out. Data collected included the number and socio-demographic characteristics of the patients, the main medical condition they were treated for, the duration of their stay in hospital, the stated principal reasons for the discharge and signatories to the discharge document.
Results:  The proportion of patients discharged against medical advice during the study period was 5.4%. Out of the 118 patients whose records were available for analysis, 55.1% were males; they had an average age of 45.6 +/- 12.6 years, and half were within the middle socio-economic class. The patients spent an average of 12.9 +/- 7.6 days in the hospital before asking for the discharge; and most (75.4%) were managed for non-communicable diseases. The main reasons for asking for discharge included poor treatment outcome (42.4%), financial constraints (28.0%) and a desire to seek other treatment options (22.0%). The signatories for the discharge were mainly the relatives (22.0%), children (22.9%), spouse (25.4%), and others, including the friends and religious leaders of the patients (17.0%).
Conclusion: Discharge against medical advice is often due to poor treatment outcome. Serious efforts should be made to correct this, with the immediate adoption of the WHO's Innovative Care for Chronic Condition (ICCC) framework.

Keywords: Healer shopping, Discharge Against Medical Advice, Noncommunicable diseases, epidemiological transition, Port Harcourt, Nigeria