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A qualitative study to identify reasons for discharges against medical advice in the cardiovascular setting
Eberechukwu Onukwugha1, Elijah Saunders, C Daniel Mullins
1Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
Insights
Patients with cardiovascular disease (CVD) often leave the hospital against medical advice (AMA) due to preference for their own doctor, long wait times, and external factors. Improved communication and patient involvement in care planning are key to reducing AMA discharges.
Area of Science:
- Cardiology
- Health Services Research
- Patient Experience
Background:
- Cardiovascular disease (CVD) accounts for a significant number of hospital discharges against medical advice (AMA).
- Limited understanding exists regarding the specific reasons for AMA discharges within the CVD patient population.
Purpose of the Study:
- To investigate and identify the primary reasons contributing to AMA discharges among patients diagnosed with cardiovascular disease.
- To explore strategies aimed at mitigating the incidence of AMA discharges in CVD patients.
Main Methods:
- A qualitative research design employing focus group interviews (FGIs) with patients and healthcare providers.
- Participants included patients with CVD discharge diagnoses who left AMA and healthcare professionals (physicians, nurses, social workers).
- Content analysis, guided by the Health Belief Model and emergent themes, was used to interpret interview data.
Main Results:
- Patients and providers commonly cited preference for personal physicians, extended wait times, and external factors as reasons for AMA discharges.
- Patients specifically highlighted unmet expectations regarding involvement in treatment plan development.
- Enhanced communication emerged as a crucial strategy for reducing AMA discharges.
Conclusions:
- Patients with CVD expressed a desire for greater involvement in their care, a preference for their primary physician, and cited long waits and external factors as motivations for AMA discharge.
- Healthcare providers recognized similar reasons but did not emphasize the patient's desire for involvement.
- Further research is recommended to validate these findings across diverse patient and provider groups.
Background:
Cardiovascular disease (CVD) is responsible for the largest number of discharges against medical advice (AMA). However, there is limited information regarding the reasons for discharges AMA in the CVD setting.
Objective:
To identify reasons for discharges AMA among patients with CVD.
Design:
Qualitative study using focus group interviews (FGIs).
Participants:
A convenience sample of patients with a CVD-related discharge diagnosis who left AMA and providers (physicians, nurses and social workers) whose patients have left AMA.
Primary And Secondary Outcomes:
To identify patients' reasons for discharges AMA as identified by patients and providers. To identify strategies to reduce discharges AMA.
Approach:
FGIs were grouped according to patients, physicians and nurses/social workers. A content analysis was performed independently by three coauthors to identify the nature and range of the participants' viewpoints on the reasons for discharges AMA. The content analysis involved specific categories of reasons as motivated by the Health Belief Model as well as reasons (ie, themes) that emerged from the interview data.
Results:
9 patients, 10 physicians and 23 nurses/social workers were recruited for the FGIs. Patients and providers reported the same three reasons for discharges AMA: (1) patient's preference for their own doctor, (2) long wait time and (3) factors outside the hospital. Patients identified an unmet expectation to be involved in setting the treatment plan as a reason to leave AMA. Participants identified improved communication as a solution for reducing discharges AMA.
Conclusions:
Patients wanted more involvement in their care, exhibited a strong preference for their own primary physician, felt that they spent a long time waiting in the hospital and were motivated to leave AMA by factors outside the hospital. Providers identified similar reasons except the patients' desire for involvement. Additional research is needed to determine the applicability of results in broader patient and provider populations.
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