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Discharge against medical advice in culturally and linguistically diverse Australian children

Xin Yue Guo1,2, Susan Woolfenden2,3, Gordon McDonald4

  • 1Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Archives of Disease in Childhood
|June 24, 2019
PubMed

Insights

Culturally and linguistically diverse (CALD) children have higher rates of discharge against medical advice (DAMA). This study highlights the need for tailored health services to ensure equitable care and reduce DAMA for CALD children.

Area of Science:

  • Pediatric Health Outcomes
  • Health Disparities Research
  • Health Services Research

Background:

  • Discharge against medical advice (DAMA) presents significant challenges in pediatric healthcare.
  • Culturally and linguistically diverse (CALD) populations may face unique barriers to accessing and adhering to medical care.

Purpose of the Study:

  • To quantify the prevalence and rates of DAMA in CALD children.
  • To assess the independent association between CALD status and DAMA in pediatric patients.
  • To identify demographic confounders influencing DAMA in a diverse pediatric population.

Main Methods:

  • Prospective data collection from electronic medical records (2010-2018) for admitted, outpatient, and emergency department (ED) patients.
  • CALD status defined by preferred language other than English.
  • DAMA measured through various indicators across different care settings (e.g., 'discharge at own risk', 'no show', 'left without being seen').
  • Statistical analysis included chi-squared tests, bivariate analysis, and multivariate logistic regression.

Main Results:

  • DAMA prevalence varied by setting: 1.34% (admitted), 19.31% (outpatient), and 12.64% (ED).
  • CALD children exhibited higher DAMA rates across all settings compared to non-CALD children.
  • CALD status was independently associated with increased DAMA risk in admitted (OR=1.30), outpatient (OR=1.55), and ED (OR=1.60) pediatric patients.

Conclusions:

  • Children from CALD backgrounds face elevated risks of DAMA.
  • Implementing targeted health service interventions is crucial for ensuring equitable care.
  • Addressing DAMA in CALD children can improve health outcomes and reduce associated healthcare burdens.
Abstract

Keywords:
clinical procedurescomm child healthepidemiologyhealth servicehealth services research

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