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Simple Summary: Discharge against medical advice (DAMA) is a complex phenomenon with the potential to disrupt care in hospitalized patients, particularly in oncology, where continuous treatment is crucial for managing disease progression and improving outcomes. This study aimed to explore the prevalence of DAMA among cancer patients in Germany and identify factors associated with its occurrence. Analysis of data from over 51,000 patients hospitalized across 36 facilities revealed a DAMA rate of 0.9%. Younger age (especially under 60 years) and male sex were associated with higher DAMA rates. Patients with cancers of the lip, oral cavity, pharynx, larynx, and liver had the highest DAMA prevalence, while distant metastases showed no significant association. These findings highlight the multifaceted nature of DAMA and suggest that non-clinical factors, such as psychological, social, and economic pressures, may play a critical role in patients' decisions. This study provides a foundation for further research into strategies to better understand and address DAMA in vulnerable groups, improving care and outcomes for hospitalized cancer patients. Background: Discharge against medical advice (DAMA) disrupts continuity of care and is associated with increased readmission rates, morbidity, and mortality. While extensively studied in general hospital populations, its prevalence and associated factors in cancer patients, where treatment adherence is critical for outcomes, remain underexplored. Methods: This multicenter, cross-sectional study analyzed anonymized data from the IQVIA hospital database, including cancer patients hospitalized in 36 German hospitals between January 2019 and December 2023. Multivariate logistic regression assessed associations between DAMA and factors such as age, sex, cancer type, metastases, and comorbidities. Results: Among 51,505 cancer patients, DAMA occurred in 0.9% of hospitalizations. The highest rates were observed in cancers of the lip, oral cavity, and pharynx (2.1%), larynx (2.0%), and liver (1.8%). DAMA was more frequent in younger patients (≤50 years) (OR: 1.73; 95% CI: 1.30–2.14) and males (OR: 1.46; 95% CI: 1.23–1.72). Distant metastases showed no significant association (OR: 0.96; 95% CI: 0.81–1.13). Conclusions: The findings suggest that DAMA in cancer patients is more strongly associated with demographic and social factors than with disease severity. These results provide a basis for exploring strategies that address underlying psychosocial and economic challenges during hospitalization, particularly in younger and male patients. Further research is needed to better understand these associations and their implications for clinical practice. [ABSTRACT FROM AUTHOR]

Background: To identify the risk factors and reasons for discharge against medical advice (DAMA) for newborns with neonatal surgical diseases in a tertiary care hospital in China.Methods: A retrospective study was conducted on all newborn patients admitted to the neonatal surgery department of Beijing Children's Hospital between January 1, 2016 and January 1, 2020. Medical records were compared between DAMA and non-DAMA patients. Univariate and multivariate logistic regression analyses were conducted to identify potentially useful characteristics for predicting DAMA.Results: During the study period, 854 newborns were admitted to the neonatal surgery department. A total of 68 DAMA patients (68/854, 7.96%, 47 boys), with a median age at diagnosis of 1 day (range, from birth to 21 days), were included in this study. After multivariate analysis, we found that emergency admission, age at admission ≤5 days, rejection for surgery, and admission to the neonatal intensive care unit were significant independent risk factors for DAMA. According to the electronic medical records, the reasons for DAMA included belief in incurability and concerns about the prognosis of the disease (n = 31), multiple malformations with poor prognosis (n = 8), severe postoperative complications (n = 5), financial difficulties (n = 3), refusal of further examinations (n = 2), assumption of clinical improvement (n = 1), and unknown (n = 18).Conclusions: This preliminary study showed that neonatal surgical patients in critical conditions were high-risk groups for DAMA, and the main possible reasons for DAMA were the parents' belief in incurability and concerns about the prognosis of the disease.

Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44 - 2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by patients’ characteristics, medical conditions and hospital circumstances. It raises some ethical concerns, mainly due to a conflict between patients’ autonomy and beneficence. It is helpful for the medical staff to create an effective relationship with patients who are at higher risk of DAMA, in order to increase their compliance and prevent the consequences of leaving hospital against medical advice.

Discharge against medical advice (DAMA) is a common problem in the health-care system. It imposes risks to both patients and medical staff and could be the subject of ethical deliberation. This cross-sectional study was conducted in 2017 on 400 patients who were discharged against medical advice from the emergency ward of Shariati Hospital, Tehran, Iran. Patients’ information was collected using clinical records and telephone calls. The collected data were analyzed using STATA software. DAMA rate was 12% in the emergency department of Shariati Hospital. Male gender was found to be a risk factor for DAMA (OR: 1.90; CI (95%): 1.44 - 2.52; P < 0.0001). In addition, younger patients were more likely to leave hospital against medical advice (p-value: 0.04). The more common reasons for DAMA were feeling better, long delay in diagnostic and therapeutic procedures and the hectic ambience of the emergency ward. Patients’ self-discharge is a multi-dimensional phenomenon that is affected by patients’ characteristics, medical conditions and hospital circumstances. It raises some ethical concerns, mainly due to a conflict between patients’ autonomy and beneficence. It is helpful for the medical staff to create an effective relationship with patients who are at higher risk of DAMA, in order to increase their compliance and prevent the consequences of leaving hospital against medical advice. [ABSTRACT FROM AUTHOR]

Background & Objectives: Discharge Against Medical Advice (DAMA) is one of the important concerns of health systems. This could be potentially life-threatening and cause readmission. The purpose of this study was to determine causes of DAMA in patients of some selected hospitals. Methods: This cross-sectional, descriptive-analytic study was performed in winter 2016. The medical files of 261 patients discharged against medical advice were selected by simple random sampling and reviewed. Data were gathered through Hospital Information System and using a self-designed check list. Data were analyzed through SPSS software and using descriptive statistics and Chi-square test. Results: From all, 58.6% were male, 66.3% were married and 22.2% did not have any insurance coverage. The most common reason of DAMA was feeling better (43.3%). Discharge against medical advice showed significant relationship with marital status (P= 0.02), and insurance type (P= 0.05). Conclusion: Since the most common reason of DAMA was feeling better, more attention of authorities and also a stronger patient-physician relationship are recommended in order to aware patients of their clinical conditions and treatment process. Key­words: Teaching Hospital, Discharge, Discharge Against Medical Advice (DAMA) Citation: Ghorbani R, Moradi Magin M. Causes of Discharge against Medical Advice in patients of a Number of Selected Hospitals. Journal of Health Based Research 2017; 2(4): 319-327. Keywords: Teaching Hospital, Discharge, Discharge Against Medical Advice (DAMA)

Objective: The occurence of discharge against medical advice (DAMA) has impacted globally. Decisions of DAMA in pediatric patients are not made by the patients, but pose life-threatening consequences, especially for children treated in Pediatrics Intensive Care Unit (PICU). The present study aimed to identify the occurence of DAMA and subsequent events to the DAMA patients after treated in PICU of Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Methods: A retrospective study from medical records of DAMA patients from PICU of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between April 2011 and April 2012. Results: A total of 195 children aged 1–5 years were admitted. Of this number, 12 (6.2%) were DAMA. Financial problems were the most common reason for DAMA, followed by parents’ perception about their child’s terminal condition. The majority of parents were laborer. Last parents’ education level was mostly elementary school. Most patients who DAMA from PICU died in less than 24 hours. Conclusions: A considerable number of DAMA was found in our PICU. High mortality occured after patients asked for DAMA from PICU.

Introduction: Urinary tract infections (UTIs) are more common in geriatrics due to physiological alterations/pathological conditions. The main objective of this study was to analyze the incidence, causative organisms, types of antibiotics used, drug interactions, the antibiotic cost, and its outcome. Method: This is across-sectional study conducted in selected medicine units over a period of 18 months. The enrolled patient's therapy pattern spotted from the admission to discharge. The mandatory patients provided with pharmaceutical care services. Results: Among 475 observed cases, 106 patients had UTIs (22.31%). The mean number of drug were 7.42 ± 2.31per prescription. Out of 106 prescriptions, 63 prescriptions had drug interactions. The drug interactions degree varied from mild (12.63%), moderate (60.3%) and severe (26.58%) remained managed by spacing intervals, alternate drug use, and close monitoring techniques. Strangely, all comorbid UTI patient outcomes showed improvement. The antibiotic cost of the management ranged from $ 0.21-160.8 with a median of $ 26.30 and the common organisms were E. coli (48%), Enterococcus (16%). The average length of patient hospital stay was 11.65 ± 8.94 days. Conclusion: This study showed that about one-fourth patients have UTIs and half of them were affected by E. coli. Hence, this study proposes the paucity and its implication of pharmaceutical care service research studies, on healthhygiene, proper use of antibiotics & its cost minimization; untoward interactions cost prevention, for better outcome in India. [ABSTRACT FROM AUTHOR]

Background: Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such discharges. Methods: A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. Results: The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were DAMA; Odd ratio, OR=2.8; 95% Confidence Interval, CI= 1.26, 6.20). Majority (65.4%) of the signatories to the discharge documents were the child's fathers. In only 5.5% of cases were the child's mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. Conclusions: DAMA is a common social pediatric health problem, especially among infants and has multi-factorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence. [ABSTRACT FROM AUTHOR]

Background: Discharge from the hospital against the doctor's advice and refusal of receiving treatment is one of the significant issues at the time of hospitalization, which is especially crucial in relation to psychiatric patients. It can exacerbate the disorder and the subsequent complications and increase further hospital admissions. The present study was designed to evaluate the causes of discharge from the hospital and the refusal of receiving treatment against medical advice in hospitalized patients in Iran Psychiatric Hospital. Methods: The present study was a descriptive cross-sectional study. One hundred patients hospitalized in Iran Psychiatric Hospital discharged with personal consent against medical advice from July to December 2018 were studied. Two methods were used for assessment; the fulfillment of a routine ministry-approved checklist by the dischargers themselves and the face-to-face interview with both the patient and discharger based on a researcher-made checklist. Cohen's Kappa coefficient was used to assess the agreement of the answers of patients to both routine ministry-approved and researcher-made checklists by SPSS software version 16.0 with an overall accuracy of 95%. Results: Based on the results extracted from the researcher-made checklist, 43 (43%) of the discharges were generally based on patient-related factors. The personal insistence to discharge by the patient was cited as the main reason for discharge. Cohen's Kappa coefficient showed no significant agreement between the patient's answers to the interview and what they have previously filled in the routine ministry-approved checklist. More specifically, the measure of agreement for answers of patients to questions in the standard checklist and the questions asked by the interviewer was 0.078 (p=0.167). Conclusion: From the results of this study, it can be concluded that the face-to-face interview based on the researcher-made checklist can more effectively determine the reasons for discharge of patients due to the accuracy of the interview., (© 2021 Iran University of Medical Sciences.)