| Leaving hospital against medical advice among HIV-positive patients. | |
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MedLine Citation:
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PMID: 12358196 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hospital discharge against medical advice, especially among substance-abusing populations, is a frustrating problem for health care providers. Because of the high prevalence of injection drug use among HIV-positive patients admitted to hospital in Vancouver, we explored the factors associated with leaving hospital against medical advice in this population. METHODS: We reviewed records for all HIV/AIDS patients admitted to St. Paul's Hospital, Vancouver, between Apr. 1, 1997, and Mar. 1, 1999. After identifying the first ("index") admission during this period, we followed the patients' records for 1 year. Multivariate models were applied to identify the determinants of discharge against medical advice and to estimate the impact of such discharge on readmission rate, readmission frequency and length of stay in hospital. RESULTS: Of 981 index admissions among HIV/AIDS patients, 125 (13%) of the patients left the hospital against medical advice. Departure on the day on which welfare cheques were issued and a history of injection drug use were significant predictors of leaving against medical advice. After adjusting for sex, age, severity of illness, injection drug use and homelessness, we found that patients leaving against medical advice were readmitted more frequently than those who were formally discharged (frequency ratio 1.25, 95% confidence interval [CI] 1.11-1.42), were more likely to be readmitted with a related diagnosis within 30 days (odds ratio 5.00, 95% Cl 3.04-8.24) and had significantly longer lengths of stay in the follow-up period. INTERPRETATION: Discharge against medical advice among HIV-positive patients was associated with frequent readmissions with the same diagnosis. Preventing such discharges is likely to benefit patients (by improving their health status) and the health care system (by reducing unnecessary readmissions). |
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Authors:
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Aslam H Anis; Huiying Sun; Daphne P Guh; Anita Palepu; Martin T Schechter; Michael V O'Shaughnessy |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Volume: 167 ISSN: 0820-3946 ISO Abbreviation: CMAJ Publication Date: 2002 Sep |
Date Detail:
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Created Date: 2002-10-02 Completed Date: 2002-10-16 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9711805 Medline TA: CMAJ Country: Canada |
Other Details:
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Languages: eng Pagination: 633-7 Citation Subset: AIM; IM |
Affiliation:
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British Columbia Centre for Excellence in HIV/AIDS, Canadian HIV Trials Network, Vancouver. anis@hivnet.ubc.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult British Columbia Female HIV Seropositivity / therapy* Humans Length of Stay Male Multivariate Analysis Patient Discharge / statistics & numerical data* Patient Dropouts / statistics & numerical data* Patient Readmission Public Assistance Regression Analysis Retrospective Studies Risk Substance Abuse, Intravenous / complications |
| Comments/Corrections | |
Comment In:
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CMAJ. 2002 Sep 17;167(6):647-8
[PMID:
12358198
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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