Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T04:21:30.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice

Published online by Cambridge University Press:  15 April 2020

A. Valevski ,
G. Zalsman ,
S. Tsafrir ,
R. Lipschitz-Elhawi ,
A. Weizman  and
T. Shohat
A. Valevski*
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
G. Zalsman
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
S. Tsafrir
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel
R. Lipschitz-Elhawi
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel School of Social Work, Bar-Ilan University, Ramat Gan, Israel
A. Weizman
Affiliation:
Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100Petach Tikva, Israel The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Felzenstein Medical Research Center, Petach Tikva, Israel
T. Shohat
Affiliation:
Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
*
*Corresponding author. Tel.: +972 3 9258283; fax: +972 3 9259287. E-mail address:[email protected]
Get access

Abstract

Purpose

To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation.

Methods

The records (1984–2005) of all consecutive admissions (n = 12,937) of schizophrenia patients (n = 8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n = 1345).

Results

AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls.

Conclusion

The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.

Keywords

SchizophreniaAgainst medical adviceMortalitySuicide rate
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 7 , October 2012 , pp. 496 - 499
Copyright
Copyright © European Psychiatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brook, M.Hilty, D.M.Liu, W.L.Hu, R.Frye, M.A.Discharge against medical advice from inpatient psychiatric treatment: a literature review. Psychiatr Serv. 2006; 57: 1192–1198.CrossRefGoogle ScholarPubMed
Chandrasena, R.Miller, W.C.Discharges AMA and AWOL: a new “revolving door syndrome”. Psychiatr J Univ Ott. 1988; 13: 154–157.Google ScholarPubMed
Corley, M.C.Link, K.Men patients who leave a general hospital against medical advice: mortality rate within six months. J Stud Alcohol. 1981; 42: 1058–1061.CrossRefGoogle ScholarPubMed
Crowe, D.B.Rosse, R.B.Sheridan, M.J.Deutsch, S.I.Substance use diagnoses and discharge patterns among psychiatric-inpatients. Hosp Community Psychiatry. 1991; 42: 403–405.Google ScholarPubMed
Dalrymple, A.J.Fata, M.Cross-validating factors associated with discharges against medical advice. Can J Psychiatry. 1993; 38: 285–289.CrossRefGoogle ScholarPubMed
Franks, P.Meldrum, S.Fiscella, K.Discharges against medical advice: are race/ethnicity predictors?. J Gen Intern Med. 2006; 21: 955–960.CrossRefGoogle Scholar
Gerbasi, J.B.Simon, R.I.Patients’ rights and psychiatrists’ duties: discharging patients against medical advice. Harv Rev Psychiatry. 2003; 11: 333–343.Google ScholarPubMed
Heinssen, R.K.McGlashan, T.H.Predicting hospital discharge status for patients with schizophrenia, schizoaffective disorder, borderline personality-disorder, and unipolar affective-disorder. Arch Gen Psychiatry. 1988; 45: 353–360.CrossRefGoogle ScholarPubMed
Jeffer, E.K.Against medical advice. 2. The Army Experience 1971–1988. Mil Med. 1993; 158: 73–76.CrossRefGoogle ScholarPubMed
Kuo, C.J.Tsai, S.Y.Liao, Y.T.Lee, W.C.Sung, X.W.Chen, C.C.Psychiatric discharge against medical advice is a risk factor for suicide but not for other causes of death. J Clin Psychiatry. 2010; 71: 808–809.CrossRefGoogle Scholar
Pages, K.P.Russo, J.E.Wingerson, D.K.Ries, R.K.Roy-Byrne, P.P.Cowley, D.S.Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatr Serv. 1998; 49: 1187–1192.CrossRefGoogle ScholarPubMed
Phillips, M.S.Ali, H.Psychiatric patients who discharge themselves against medical advice. Can J Psychiatry. 1983; 28: 202–205.CrossRefGoogle ScholarPubMed
Planansky, K.Johnston, R.Survey of patients leaving a mental-hospital against medical advice. Hosp Community Psychiatry. 1976; 27: 865–868.Google ScholarPubMed
Senior, N.Kibbee, P.Can we predict the patient who leaves against medical advice: the search for a method. Psychiatr Hosp. 1986; 17: 33–36.Google ScholarPubMed
Smith, D.B.Telles, J.L.Discharges against medical advice at regional acute care hospitals. Am J Public Health. 1991; 81: 210–213.CrossRefGoogle ScholarPubMed
Talbott, J.A.Lessons learned about the chronic mentally ill since 1955. Psychiatr Serv. 2004; 55: 1152–1159.CrossRefGoogle ScholarPubMed
Wung, Y.T.Chen, C.C.Chen, F.C.Lin, C.H.Schizophrenia patients discharged against medical advice at a mental hospital in Taiwan. Psychiatry Clin Neurosci. 2010; 64: 415–420.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.