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Leaving hospital against medical advice among HIV-positive patients

Aslam H Anis1, Huiying Sun, Daphne P Guh

  • 1British Columbia Centre for Excellence in HIV/AIDS, Canadian HIV Trials Network, Vancouver. anis@hivnet.ubc.ca

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|October 3, 2002
PubMed

Insights

HIV-positive patients who leave hospital against medical advice, particularly those with a history of injection drug use, face more frequent readmissions. Preventing these discharges can improve patient health and reduce healthcare system costs.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Health Services Research

Background:

  • Hospital discharge against medical advice (AMA) is a significant challenge, especially in vulnerable populations.
  • Injection drug use is prevalent among HIV-positive patients, complicating hospital care and discharge planning.

Purpose of the Study:

  • To investigate factors associated with hospital discharge against medical advice (AMA) in HIV-positive patients in Vancouver.
  • To determine the impact of AMA discharge on readmission rates, frequency, and length of hospital stay.

Main Methods:

  • Retrospective review of 981 index admissions for HIV/AIDS patients at St. Paul's Hospital, Vancouver (1997-1999).
  • Analysis of patient records for one year post-index admission.
  • Application of multivariate models to identify determinants of AMA discharge and its impact on readmission and length of stay.

Main Results:

  • 13% of HIV-positive patients left hospital against medical advice (AMA).
  • Departure on welfare cheque issuance day and a history of injection drug use were significant predictors of AMA discharge.
  • AMA discharge was associated with more frequent readmissions (frequency ratio 1.25), higher likelihood of 30-day readmission with a related diagnosis (odds ratio 5.00), and longer overall hospital stays.

Conclusions:

  • Discharge against medical advice (AMA) in HIV-positive patients is linked to increased readmissions for the same diagnosis.
  • Interventions to prevent AMA discharges can improve patient outcomes and reduce healthcare system burden through decreased readmissions.
Abstract

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