Patients Leaving Against Medical Advice-A National Survey

Area of Science:

• Critical Care Medicine
• Health Services Research
• Public Health

Background:

• Leaving Against Medical Advice (LAMA) is a global healthcare challenge with varying incidence and causes.
• Factors influencing LAMA rates include disease type, geographic location, and healthcare system structure.

Purpose of the Study:

• To survey anesthesiologists and intensivists on their opinions regarding Leaving Against Medical Advice (LAMA).
• To identify the incidence, primary reasons, and patient demographics associated with LAMA.
• To explore potential strategies for reducing LAMA rates in healthcare settings.

Main Methods:

• A survey of 22 questions was distributed to anesthesiologists and intensivists via ISA and ISCCM contact databases.
• The survey utilized Monkey Survey, gathering data on geographical area, healthcare system, LAMA incidence, reasons, disease types, and patient outcomes.
• Responses were analyzed from 1154 participants, with a focus on those who answered all questions (584) and the sector of practice (government vs. private).

Main Results:

• Leaving Against Medical Advice (LAMA) occurred most frequently from Intensive Care Units (ICUs) at 45%, followed by wards (32%) and emergency departments (25%).
• Financial constraints were cited as the most common reason for LAMA by 80% of respondents, with advanced malignancy or disease present in approximately 40% of patients.
• A significant majority (nearly two-thirds) believed that insurance coverage could decrease LAMA rates.

Conclusions:

• Leaving Against Medical Advice (LAMA) is prevalent among ICU patients, particularly after prolonged stays (>1 week).
• Major contributors to LAMA include financial difficulties, terminal illnesses, malignancy, and sepsis.
• Recommendations for reducing LAMA involve implementing robust national health policies, enhancing patient-provider communication, integrating palliative and end-of-life care, and promoting advance directive awareness.