Leave against medical advice (LAMA) from in-patient orthopaedic treatment (original) (raw)
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International Journal of Research in Orthopaedics
Background: Leave against medical advice (LAMA) of hospitalized patients is an adverse clinical event in which a patient chooses to leave the hospital before it is medically advisable to do so and it negatively affects the treatment outcome. Because of this, the study was designed to determine the incidence of and indications for LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan.Methods: This was a prospective hospital-based study determining the incidence of LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan between September 2019 and March 2020.Results: A total of 289 patients with orthopedic conditions presented within the study period and about 12.46% of these LAMA. The male to female ratio observed in this study is 2:1. The age range was between 8 and 93 years. Trauma from motorbike and motor vehicle accidents accounted for...
East and Central African Journal of Surgery, 2013
The aim of this study was to find out the reasons why trauma victims with Orthopaedic injuries take their discharge against medical advice. Methods: This was a prospective study conducted on Trauma victims presenting to the Wesley Guild Hospital Ilesha who took their discharge against medical advice (DAMA) over a 2 year period. A questionnaire was designed that was used to retrieve information on the patients biodata, their injuries and the reasons why they DAMA. Results: A total of 49 patients were interviewed over this period. The mean age of the patients was 36.7 years. Students (22.4%), traders (20.4%) and artisans (24.5%) were commonly involved in this practice. Eighteen (36.7%) of the respondents claimed to have taken DAMA due to hospital cost, 18 (36.7%) also DAMA because of their believe in Traditional Bone Setters. Eleven patients (22.4%) simply said they want treatment near home while one patient each gave the fear of amputation and hospital protocol as their reasons for DAMA. Conclusion: Cost of treatment and believe in traditional bone setters were the 2 main reasons why most patients with fracture DAMA. Measures to reduce the cost of treatment and patient's education about the dangers with unorthodox treatment of fractures and dislocations should help to reduce this behaviour.
2022
Background: Studies in the African Sub-region have highlighted injuries and its associated morbidity and mortality as an emerging public health problem, making it necessary to develop a holistic approach to handle injury outcomes in Ghana. The study purposed to assess the preference and reasons for people choosing a place of fracture care among the general population in the Assin North District of the Central region of Ghana. Method: A prospective cross-sectional study was employed in which 237 participants were randomly selected from six communities in the Assin-North District of the Central Region. Structured questionnaires after verbal informed-consent were used to collect data. The data collected was analyzed using descriptive statistics and chi-square test. Results: A total of 237 participants were interviewed, 14.8% of them had a history of fracture for which 60% sought treatment with Traditional Bone Setters (TBS). About 27.8% of respondents preferred TBS treatment over orthodox fracture care. Most of them (69.6%) were females with more than half (56.1%) being young adults. Only gender (p=0.029) and religion (p=0.043) were associated with the study group's preference of fracture care. Common reasons for choosing a particular place of fracture care included "perceived" healing methods (77.6%), past experience (20.7%), time to fracture healing (11.8%), and cost of treatment (9.3%). Generally, fear of complications such as mal-union (60.8%), stiff knee (62.1%), delayed union (69.6%), amputation (63.3%), and infection (76%) were some of the reasons why participants chose hospital care over TBS. Conclusion: People make decisions about where to seek fracture treatment (either at a hospital or with a traditional bonesetter) influenced by cost of treatment and knowledge of complications that may result from poorly handled fracture-care. The study showed the need to improve knowledge about the potential benefits of orthodox fracture-care using scientifically tested and reproducible methods which have been shown to consistently improve outcomes.
Abstract: Objective: To determine the rate of hospital discharges against medical advice (DAMA), identify reasons for such discharges and identify factors predicting such discharges compared with controls. Methods: This is a retrospective health records review of all patients who discharged against medical advice and matched cases of those discharged normally between 2009 and 2011. Patients with DAMA were identified and relevant socio-demographic as well as clinical data were extracted from their clinical charts. We compared characteristics of case control patients using χ2 and Wilcoxon Rank Sum test as appropriate. We used multivariate logistic regression to model the correlates of discharged against medical advice. We included in the analysis each characteristics that was significant (p=0.05) in bivariate comparison. We report odds ratio (ORs) and confidence intervals (CIs) from this model. Results: The prevalence of discharged against medical advice was 0.72% over the three year period. Patients who discharged against medical advice were younger, male gender and students. In addition they were predominantly Muslims and married with no form of formal education. Furthermore, residence in Bida where the hospital is situated and payment out of pocket is associated with DAMA. Most of these patients DAMA within the first five days of admission and signatories to the discharge were mostly parents, spouse, and other family members. Reasons for DAMA include financial constraints, improved health and desire to seek other treatments (faith/traditional based). The male gender, students and those without formal education all conferred increase odds of DAMA, while persons in age range 21-30 years, and married conferred protection against DAMA. Furthermore, individuals with normal delivery (SVD) (18), followed by RTA with minor injury such as bruises/laceration (14), and RTA with fracture (12) were much more likely to DAMA. Conclusion: Comparatively, DAMA rate at Federal Medical Centre, Bida is low. The factors associated with such DAMA include younger age, male sex and being a student. In addition, residing in Bida town and payments for healthcare out of pocket increase the likelihood of DAMA. We recommend formulation of explicit DAMA guidelines for the hospital and strengthening of the existing National Health Insurance Scheme as panacea for reduction in the rate of DAMA. Keywords: Discharge against Medical Advice, Health Records Review, Predictive Factors, Reasons, Tertiary Hospital, Rate
Clinical spectrum of discharges against medical advice in a developing country
Indian Journal of Surgery, 2008
Background Patients who leave the hospital before clinician certifi cation of fi tness are referred to as discharge against medical advice (DAMA). This phenomenon of discharges against medical advice is an undesirable but relatively common occurrence worldwide. Professional liability and harmful effect of this practice to individual health are of concern. Aims: The essence of this study is to determine the spectrum of patients who DAMA in a Nigerian teaching hospital. Design Descriptive study over a two-year period in an urban teaching hospital in Nigeria. Materials and methods All consecutive patients who discharge against medical advice at the surgical emergency room of University Teaching Hospital, Ilorin from January 2004 to December 2005 were studied prospectively. The patients' demographic details, diagnosis, reason for discharge, signatory to discharge and length of hospital stay were studied. Statistical analysis Analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 11. Results Prevalence rate of DAMA was 4.2%, comprising 110 of a total of 2,617 patients admitted during the study period. Male to female ratio was 3.8:1, the mean age was 30.0 years (range, 4-70 years). Trauma accounted for the highest number of patients 102(97.2%) out of whom 52 (51%) had long bones fracture. Patients who wish to seek alternate medical care accounted for 43.6%, while fi nancial constraint contributed to 29.1% DAMA. Forty-fi ve out of forty-eight (93.7%) of patients who DAMA to seek alternate medical care had fracture. Conclusion Trauma was the most common clinical condition for patients who DAMA. Most common reason for DAMA was to seek alternate treatment followed by fi nancial constraint. Health education on potential benefi t of orthodox treatment of fracture, treatment subsidy and full implementation of national health insurance scheme will reduce incidence of DAMA.
Causes of Bone Injuries and Patronage of Traditional Bone Setters in Maiduguri, Nigeria
Sierra Leone Journal of Biomedical Research, 2010
The study as an opinion survey identified Road Traffic Accidents (RTA), falling from height and gunshots/matchets as the causes of bone injuries in Maiduguri, Nigeria. Injuries sustained include fracture and dislocation. Structured Interview Schedule (SIS) and Focused Group Discussion (FGD) were the instruments used to obtain data. Population of study comprised of those involved in bone injuries between January and December, 2008. The sample size of 700 respondents was selected using stratified random sampling technique. Frequency distribution and percentages were employed to analyze data. Findings of the study revealed parents/families, relatives and friends as some of the sources of decision to patronize Traditional Bone Setting (TBS) while culture, phobia for hospitalization, no amputation and less expensive were some of the reasons adduced for patronage. Based on the findings, enactment of stringent laws/byelaws or re-enforcement of existing ones (if any), counselling and enlightenment were suggested/recommended.
Patient Intelligence, 2010
Methods: The UNTH's admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P , 0.05 (one degree of freedom) was considered statistically significant. Results: Of the 64,856 admissions (45.2% male, 54.8% female), 113 (0.002%; males: 54%, females: 46%) were discharged against medical advice. DAMA rate was highest in Surgery (0.4%), and lowest in Obstetrics and Gynecology (0.1%) and Pediatrics (0.1%). Infections (32.7%), trauma (29.2%), and cancer (16.8%) were the leading diagnoses in patients DAMA. Financial constraints (37.2%), unsatisfactory response to treatment (17.7%), and dissatisfaction with hospital environment (15.0%) were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P , 0.05), patients having high levels of formal education (P , 0.05), and those who had not been previously hospitalized (P , 0.05); but not with age (P = 0.398), gender (P = 0.489), or employment (P = 0.091). Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate.
Malaysian Orthopaedic Journal, 2020
Introduction: A small proportion of patients presenting to the Emergency department (ED) of any hospital tend to take discharge against medical advice (DAMA) due to several patient related or hospital/service related reasons. Amongst these, orthopaedic patients are a special group due to their inability to mobilise independently due to injuries and have treatment needs which involve higher costs. The aim of the current study was to ascertain and analyse the reasons for orthopaedic walkouts at a tertiary care new private hospital. Materials and Methods: This retrospective telephonic structured interview-based study was carried out on all orthopaedic patients taking DAMA during a one-year period from July 2016 to June 2017. They were telephonically interviewed with a structured questionnaire. Hospital and ED records were analysed for demographic as well as temporal characteristics. Results: A total of 68 orthopaedic patients walked out of casualty against medical advice out of a total 775 (8.77%) orthopaedic patients presenting during the period as against 6.4% overall rate of DAMA for all specialties. The main reasons for DAMA were financial unaffordability of treatment (36.7%), preference for another orthopaedic surgeon (22%) and on advice of the patient's General Practitioner (16.1%). Conclusion: Unaffordability of treatment is a significant cause for walkouts amongst orthopaedic patients. Private hospitals need to recognise and implement processes by which these patients can be treated at affordable costs and with coverage either by medical insurance or robust charity programs. Patient education and awareness are important to encourage them to have insurance coverage.
Traditional Bone-Setters and Fracture Care in Ekiti State, Nigeria
Alternative & Integrative Medicine, 2015
In Nigeria, the practice of traditional bone setting (TBS) is extensive as in other developing nations. Traditional bonesetters play an imperative role in fracture care. Though, the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient in the future. This study seeks to examine the activities of traditional bone setters on fracture care in Ekiti State, Nigeria. Survey method was applied in the study. 250 questionnaires were administered to owners of traditional bone centres and their clients respectively. Ten (10) of such centres were selected for the study in Ekiti. The findings indicated that majority of the bone setters had little or no formal education. Many of them acquired the schema used through ancestral/supernatural power. The TBS lack basic knowledge of investigations and wound care while most of their clients patronized them because of poverty, ignorance and superstitious beliefs. Provision of adequate basic equipment in health institutions may reduce the rate at which people utilize Traditional bone centres against medical advice.
Yoruba Studies Review, 2021
This study covers three purposively chosen states; Ogun, Ondo, and Oyo, in southwestern Nigeria. Primary data were collected using three sets of questionnaires. The respondent-driven sampling (RDS) technique was employed in selecting the respondents for the study. A total of 69 traditional bonesetters (TBS), 130 TBS patients, and 15 orthopedic surgeons were interviewed. The study reveals that majority (91.2%) of the TBS in the study area claimed that they had received an average of 11 patients from orthodox hospitals in the year preceding the survey while about 9.0% of the respondents reported that 78 Soladoye S. Asa, Matthew O. Ilori, and Lawrence A. Akinyoola they had on the average advised 6 patients per year to relocate to orthodox hospitals. The study also reveals the views of TBS areas of need from government to include recognition (93.7%) and integration into the country’s health system (63.5%). A majority (93.3%) of the orthopedic surgeons reported having received patients f...