Patient-Directed Discharge in Hand Infection Cases: Interactions Between Intravenous Drug Use, Socioeconomic Factors,...

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Patient-directed discharge (PDD) is a complex healthcare challenge.
• Prior research links PDD to socioeconomic factors, race, housing, psychiatric illness, and intravenous drug use (IVDU).

Purpose of the Study:

• Identify factors contributing to PDD in hand infection patients at a public safety-net hospital.
• Investigate the long-term consequences of PDD, including readmissions and emergency department (ED) revisits.

Main Methods:

• Retrospective analysis of 131 adult patients with hand infections over one year.
• Collected data on demographics, housing, social support, psychiatric diagnoses, and IVDU.
• Statistical analysis included Mann-Whitney U, Fisher's exact tests, and logistic regression with odds ratios (ORs).

Main Results:

• Univariate analysis showed correlations between PDD and unemployment, unstable housing, living alone, lack of phone, alcohol use, and IVDU.
• Multivariate analysis identified IVDU as the sole significant predictor of PDD (OR, 4.22).
• Unstable housing (OR, 4.39) and living alone (OR, 4.45) correlated with IVDU; PDD patients had higher ED revisits and readmission rates.

Conclusions:

• Socioeconomic factors, especially IVDU, critically influence PDD in hand infection patients.
• Integrated healthcare strategies addressing medical and social determinants are needed.
• Reducing PDD can improve patient outcomes and reduce healthcare utilization.