Discharge against medical advice (AMA) from an acute care private psychiatric hospital
✍ Scribed by Harold H. Smith Jr.
- Publisher
- John Wiley and Sons
- Year
- 1982
- Tongue
- English
- Weight
- 445 KB
- Volume
- 38
- Category
- Article
- ISSN
- 0021-9762
No coin nor oath required. For personal study only.
✦ Synopsis
compliance with a physician's treatment regimen. Forty-one patients (26 male, 15 female) discharged AMA from a 32-bed proprietary acute care psychiatric hospital were matched by sex to 41 regularly discharged atients. Data that pertained to account status, marital status, race, montg of admission, day of week of admission, time of admission, day of week of d ~charge, time of discharge, length of stay, religion, diagnosis, employment status, presence of prior psychiatric treatment, attending physician, hospital census, and adolescent census a t time of admission were analyzed by Student's ttest, Chi-square, and Pearson correlation coefficients. Significant differences were found for length of stay ( p <.01), time of discharge ( p <.002), presence of prior psychiatric treatment ( p < .0005), and attending physician ( p <.02). Age and length of sta for the regularly discharged group were correlated (r = .47; p <.OOl). 'fh e failure of this study to support much prior research may be related to differences in hospital setting, client popuation, and therapist variables.
Self-discharge from a hospital may be viewed as one point on a continuum of a patient's failure to follow a physician's treatment regimen. This noncompliance has raised numerous questions that have resulted in studies of the self-discharged patient from general medical hospitals, psychiatric hospitals, or psychiatric wards in general hospitals, tuberculosis hospitals, alcoholic treatment programs, and coronary care units. Numerous terms have been used to describe this patient's behavior, including irregular discharge, escape, abscond, AWOL, AMA, elope, and walk out. The term AMA discharge will refer to this collective group of patients in this report.
One of the earlier articles t o appear on this subject described the observed characteristics of AMA patients in a tuberculosis section of a VA Hospital. Demographic factors and psychiatric diagnoses did not distinguish regularly vs. irregularly discharged groups, but those who discharged themselves had difficulty forming relationships with persons met in the hospital. Various intervention procedures, such as group therapy and a "buddy system" were noted, but success of such approaches to reduce patient discharge was only descriptively noted (Lewis, Lorenz, & Calden, 1955). Baile, Brinker, Wachspress, and Engel (1979) found that AMA discharge patients differed significantly from regularly discharged patients on the basis of age, number of previous AMA sign-outs, severity of medical problems and selfreports of alcoholism and emotional difficulties. Schofield (1978) noted the higher rate of AMA discharge from alcoholic treatment programs and focused his research upon psychometric differences between the two groups. He found that AMA discharge patients had higher internal/external locus of control scores (i.e., more external) than regularly discharged patients, which suggests that the AMA discharge patient feels he/she is unable to control his or her destiny.
Results of other studies conducted within general hospital settings appear to reflect characteristics of the particular hospital. Jankowski and Drum (1977), Withersty (1977), andSchlauch, Reich, andKelly (1979) each reported a significantly greater frequency of alcoholism and drug addiction among AMA discharge patients. Albert and Kornfeld (1973) noted overwhelming fear, anger, depression, and psychotic reactions to account for the patient's AMA discharge. Michelson (1979) reported that hospital size was not a significant variable, but that significantly more patients discharged themselves AMA on weekends and tended to be responsible for payment of their hospital bills, as opposed to thirdparty carriers.