Abstract
Patients who self-discharge against medical advice (DAMA) are susceptible to life-threatening consequences. By understanding the factors associated with DAMA, healthcare centres can build strategies to assist patients to receive optimal medical care and prevent unfavourable outcome. The objective of this study was to determine the factors associated with DAMA from the Emergency Department (ED) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a prospective unmatched case control study conducted over a 4-month period. For every DAMA episode, two patients who were admitted on the same day were randomly selected as control. Following patient consent, data was collected using a standardized questionnaire. Patients were contacted by the investigator for information regarding hospitalization within two weeks of DAMA. Ninety three patients were recruited; 31 DAMA patients and 62 admitted patients. Payment method was significantly associated with DAMA (OR 3.17 95% CI 1.29-7.98; p=0.01). The likelihood of self-paying patients to take DAMA was three times higher than those who had a guarantor letter from their employer or insurance provider. Other factors which influence DAMA were family obligations (OR 4.08 95% CI 1.09-15.26; p = 0.03) and work problems (OR 3.83 95% CI 1.13-12.94; p=0.03). A total of 19.4% of DAMA patients left following symptomatic pain relief. A total of 80.6% DAMA patients were admitted to hospital within two weeks of the DAMA episode. Payment method significantly influences DAMA. Payment planning, social welfare services, non-governmental organization funds and the introduction of a national health policy scheme may aid hospital payment, alleviate financial limitation of patients and reduce DAMA episodes.
Keywords :
DAMA,
discharge,
emergency,
hospital,
treatment,
Abstrak
Pesakit yang pulang tanpa nasihat perubatan (DAMA) terdedah kepada akibat yang boleh mengancam nyawa. Dengan memahami faktor-faktor yang berkaitan dengan DAMA, pusat-pusat penjagaan kesihatan boleh membina strategi untuk membantu pesakit menerima rawatan perubatan yang optimum dan mengelakkan komplikasi yang lebih buruk. Objektif kajian ini adalah untuk menentukan faktor-faktor yang berkaitan dengan DAMA dari Jabatan Perubatan Kecemasan, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Kajian ini telah dijalankan dalam tempoh 4 bulan. Bagi setiap DAMA, dua pesakit lain yang dimasukkan ke wad pada hari sama telah dipilih secara rawak sebagai kumpulan kawalan. Data telah dikumpulkan melalui borang soal selidik setelah mendapatkan persetujuan pesakit. Pesakit telah dihubungi dalam masa dua minggu selepas DAMA. Dari 93 pesakit, kumpulan DAMA mempunyai 31 pesakit dan kumpulan kawalan mempunyai 62 pesakit. Kaedah pembayaran adalah faktor ketara bagi pesakit menambil DAMA (OR 3.17 95% CI 1.29-7.98; p = 0.01). Kebarangkalian DAMA bagi pesakit yang membayar kos perawatan sendiri adalah tiga kali lebih tinggi daripada mereka yang mempunyai surat penjamin daripada majikan atau syarikat insurans. Faktor-faktor lain yang mempengaruhi DAMA adalah keluarga (OR 4.08 95% CI 1.09-15.26; p = 0.03) dan kerja (OR 3.83 95% CI 1.13-12.94; p = 0.03). Sebanyak 19.4% pesakit mengambil DAMA berikutan gejala kesakitan berkurangan. Sebanyak 80.6% pesakit telah dimasukkan semula ke hospital dalam tempoh dua minggu setelah DAMA. Kaedah pembayaran mempengaruhi keputusan untuk DAMA. Kemudahan pembayaran yuran secara berkala, perkhidmatan kebajikan sosial, bantuan dana dari organisasi bukan kerajaan dan skim dasar kesihatan kebangsaan boleh mengurangkan DAMA.
Kata Kunci :
DAMA,
discaj,
hospital,
kecemasan,
rawatan,
Correspondance Address
Ahmad Khaldun Ismail, Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455493 Fax: +603-91456577 Email: khaldun_ismail@yahoo.com
