Rural background and low parental literacy associated with discharge against medical advice from a tertiary care government hospital in India

Abstract

Aims: To determine the proportion availing discharge against medical advice (DAMA) as well as reasons and socioeconomic factors associated it, stratified by gender. Method: Prospective, semi-qualitative, descriptive study, conducted in a tertiary care teaching hospital in Northern India, after obtaining institutional ethical clearance. Included were patients aged 1 month to 12 years, who were DAMA and whose caregivers consented for interview. Preformed pilot tested questionnaire was administered by trained resident doctor on duty. Clinical and socioeconomic characteristics of the patient and reasons for DAMA were recorded using structured and semi-structured questions. Reasons were classified into subcategories – financial, perceived or informed low-probability of survival, dissatisfaction with hospital care and family commitments. Some of the caregivers reported more than one reason for DAMA. Results: From August 2011 to November 2012 of 4394 admissions {66.6% males (n = 2942)}, 5.6% cases (n = 245) were DAMA of which 79 patients (64.5% males, 91.1% from rural area) were recruited. Decision for DAMA was taken within 48 h in 62.03% (n = 49) cases and by father in 73.4% cases (n = 58). Reasons for DAMA were financial in 28.18%, low-probability of survival in 41.82%, dissatisfaction with hospital care in 11.82% and family commitments in 18.18%. Risk factors for taking female patient DAMA were parental illiteracy or education below fifth standard (Maternal: OR = 5.83; 95% CI: 1.57–21.86; p = 0.01 Paternal: OR = 2.78; 95% CI: 0.97–8.02, p = 0.05), and joint family structure (OR = 4.78; 95% CI, 1.57–14.54, p– 0.01). Decision for availing DAMA was statistically significantly associated with the interest of male as compared to female patients (OR = 4.088; 95% CI, 1.344–12.438). Conclusion: Since 1 in 20 patients avail DAMA and since those of rural background and of parents with low educational status are at risk for it, hence counseling of care providers and parents for completion of treatment should begin early in hospitalization.