Authors

1Pascual Balsalobre López, 2Julia González del Moral, 3Margarita Ramírez Schacke, 4Teresa Mora Cítores, 5Mercedes Gabaldón Fernández, 6Mª Gloria Díaz Faurie, 7Mª de los Ángeles Torre Rodríguez, 8Nuria Mira Carballo

Position

¹Enfermero, Data Manager, U. Trasplante de Médula Ósea, HGU "Gregorio Marañón". ²Enfermera, Dpto. Urgencias, HGU Gregorio Marañón.³Enfermera. Unidad de Enfermedades Infeccionsas. HGU Gregorio Marañón.⁴Enfermera. Unidad de Adolescentes. HGU Gregorio Marañón.⁵Enfermera. Maternidad. HGU Gregorio Marañón.⁶Enfermera. Departamento de Urgencias. HGU Gregorio Marañón.⁷Enfermera. Servicio de Admisión. HGU Gregorio Marañón.⁸Enfermera. Oncología. HGU Gregorio Marañón.

Contact address

Sta. Mª de la Alameda, 11, 4º C. 28002 Madrid.

Contact email: pascual.balsalobre@madrid.org

Abstract

Leaving Against Medical Advice has harmful consequences for public health, the patient and the medical economy, being this an unpublished topic in drug abusers hospitalized due to acute health problems. Our objective was to identify the incidence of leaving the hospital AMA and related re-admisssions, the characteristics of patients leaving AMA, and the opinion of the patients and the professionals about related risk factors. We designed an observational, prospective and analytic study of active drug abusers being admitted into an infectious diseases ward. Patients were interviewed about the hospital conditions that may induce leaving AMA. The clinical and social characteristics of the patient were also registered. When a patient left AMA, he was asked about the reasons that prompted him or her to leave. The nurse was also asked for his or her opinion. The incidence of leaving AMA was 15%. 54.5% of patients leaving AMA were readmitted into the hospital and 14% were diagnosed of tuberculosis. Statistical association was observed between leaving AMA and a deficiency in familiar and social support, taking more than two drugs, the consumption of alcohol, the use of heroin, the use of more than 2 types of drugs for the treatment of abstinence syndrome, neuroleptic treatment and previous episodes of leaving AMA. 64% of the patients were not satisfied with their abstinence syndrome treatment and this was reported as the main cause for leaving AMA in 40% of cases. Poverty and taking more than two drugs (mainly heroin) was strongly associated with drug abusers leaving AMA with acute health problems. The incidence of re-admissions showed that the patient was not cured when he or she left AMA, and this was related to a misuse of the medical resources.

Keywords:

Leaving AMA; discharges AMA; infectious patients; drug abuser; heroincocaine

Versión en Español

Título:

Epidemiología de las altas en contra de la opinión clínica (ACOC)