Leaving against medical advice of addicted to drugs in a Department of Infectious Diseases: Economical analysis

• Main Authors: Julia González, Gloria Díaz, Mª Angeles Torre, Mercedes Galbaldón, Teresa Mora, Nuria Mira, Margarita Ramírez, Pascual Balsalobre
• Format: Article
• Language: Spanish
• Published: Fundación para el Desarrollo de la Enfermería 2003-11-01
• Series: NURE Investigación
• Subjects: Living AMA; discharges AMA; infectious patients; drug abuser; hospital financial management
• Online Access: http://www.fuden.es/originales_detalle.cfm?ID_ORIGINAL=51&FilaInicio=7
• ISSN: 1697-218X

Giving up health recommendations and care against medical advice is a setback that may happen in daily health work. In a pilot study made at the Department of Infectious Diseases in Hospital Gregorio Marañón (Madrid, Spain), during the first five months in 1998, the incidence of leaving against medical advice was 12,3 times higher than the mean in that hospital (7,03% vs 0,57%). Patients involved in this kind of event were drug abusers with acute infectious problems in a HIV primary infection or a multiple drug dependency. 42% of this patients returned to the hospital in the next 15 days. The research group thought out to study this problem under this hypothesis: Leaving against medical advice, besides having harmful consequences for the patient and the public health, produces an increase in the cost and the stay of the patient in hospital.The main objective of the research was to set up the economic the deviation in the cost/stay of a group of patients that had left against medical advice or in a regular process. It is a prospective and observational study. We studied 284 drug abusers staying in the Department of Infectious Diseases between Oct, 1st, 1999 and Sept, 30th, 2000. The research variables were: 1. Sociodemographic: Initials, , age, sex, and history number. 2. Clinical: Leaving medical diagnosis, returning medical diagnosis. 3. Administrative: Group of Related Diagnosis (GRD), admission date, leaving date, returning date and estimated cost of the episode. All episodes were grouped by kind of leaving and GRD. The cost/stay was calculated adjusted to GRD, and the deviations inside GRD were analyzed in the regular leaving group and the leaving against medical advice group.Results: Around 90% admission episodes were grouped in 6 GRD: 714 (47.92%), 541 (8.85%), 709 (8.85%), 710 (7,81%), 101 (7,29%) y 715 (7,29%). The Pneumonia in HIV (GRD 714) caused the majority of the admissions. Global deviation adjusted to cost/stay was 29,44% (more expensive in the leaving against medical advice group).