In an attempt to gain a better understanding of why patients do this, Dr. Aslam Anis and colleagues reviewed all "index" (first admission) records for HIV/AIDS patients admitted to St. Paul's Hospital in Vancouver between Apr. 1, 1997, and Mar. 1, 1999. Of the 981 patients, 125 (13%) left hospital AMA. The authors found that departure on the day that welfare cheques were issued and a history of injection drug use were significant predictors of this action. Most troubling, however, is the finding that patients leaving AMA were more likely to be readmitted with the same diagnosis.
The authors suggest that a "redesign" of welfare policies to allow full payment to hospitalized recipients would help reduce the number of patients who leave hospital against medical advice.
In a related commentary, Dr. Richard Saitz suggests that brief interventions addressing underlying conditions such as alcohol or drug dependence and direct communication of the reasons for continuing a hospital stay may prevent some AMA discharges.
Leaving hospital against medical advice among HIV-positive patients -- A.H. Anis
Discharges against medical advice: time to address the causes -- R. Saitz
Canadian Medical Association Journal