Effects of Iranian Healthcare Transformation Plan on Discharge against Medical Advice

Authors

  • Ayshe Hajiesmaeilpoor Instructor, School of Allied Medical Sciences, Kurdistan University of Medical Sciences, Sanan. Author
  • Esmaeil Mohammadnejad Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Author
  • Alireza Shameli Master of Science in Health Services Management, Mazandaran University of Medical Sciences, Sari, Iran. Author
  • Fatemeh Sadat Izadi- Avanji Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. Author

DOI:

https://doi.org/10.61841/4rq8sa19

Keywords:

Discharge against Medical Advice, Patient Satisfaction, Healthcare Transformation, Patient Recovery

Abstract

Background: The healthcare transformation plan (HCTP) is expected to improve the regulations and quality of the provided services in hospitals. The aim of this study was to evaluate the effects of the Iranian healthcare transformation plan on discharge against medical advice (DAMA) of Mazandaran University of Medical Sciences. Method: This descriptive-retrospective study was performed on 2630 patients discharged during the two half-yearly time intervals before (2013-2014) and after (2015-2016), respectively. Data collection was by the standard form of DAMA issued by the Ministry of Health and Medical Education. Data analyses were performed using descriptive statistics and inferential statistics. SPSS-16 software was used in this study, and P values less than 0.05 were considered significant. Results: The level of DAMA before and after the introduction of the Healthcare Reform was 4.5 and 4.11 percent, respectively, which did not differ significantly (p = 0.889). In addition, there was no significant difference in the discharge level by age groups, hospital departments (p = 1), gender (p = 0.57), or holidays (p = 0.73). Conclusion: Our study did not find any evidence for the impact of the HCTP on the frequency of the DAMA and the factors associated with it. However, the overall results implied the necessity of more comprehensive and integrated planning regarding the supply of the required facilities, equipment, and human resources, as well as the enlargement of the physical space of treatment centers within the framework of this large-scale, nationwide program. 

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References

[1] Hajitabar Z, Nasiripour A, Jahani M. The Effect of Supplemental Health Insurance on Family Quality of

Life. JBUMS. 2016; 18 (8): 67-72.

[2] Rezapoor A, Ebadifard Azar F, Abbasi Broujeni P. Situation of resource allocation in Iranian health

system. J Hosp. 2013; 11 (4): 53-64.

[3] Esmaili A, Abbasi M. Moral enterprise-wide health system. Journal of Bioethics. 2012; 2(4): 11-37.

[4] Bahrami M, Vatankhah S, Tayebi J, Toorani S. Design an evaluation of the health system for Iran. Sid's health

Information management. 2011; 8(3):285-305.

[5] Datobar H, Alijanpour S, Khafri S, Jahani M, Naderi R. Patient Satisfaction in Emergency Department

Affiliated Hospital of Babol University of Medical Sciences in 2013-14. JBUMS. 2016; 18 (4):56-62.

[6] Niazi S, Jahani M, mahmoodi G. Evaluation of Human Resources in the Hospitals Affiliated to Babol

University of Medical Sciences and Social Security of Qaemshahr City based on the Standards of the

Iranian Ministry of Health. JBUMS. 2016; 18 (56-63

[7] Mohammad Nejad E, Jafari S, Mahmoodi M, Begjani J, Roghayyeh Ehsani S, Rabirad N. Hepatitis B virus

antibody levels in high-risk health care workers. Hepat Mon. 2011;11(8):662-3.

[8] Rabirad N, Mohammad Nejad E, Hadizadeh MR, Begjan J, Ehsani SR. The Prevalence of Tb in HIV

Patients and Risk Factor With Frequent Referral (Iran, 2009-10). Iran Red Crescent Med J. 2013

Jan; 15(1):58-61.

[9] Mohammadnejad E, Jalaimanesh S, Mahmoodi M. Clinical syndrome in HIV/AIDS resulting in

hospitalization based on the CD4 count. J Mazandaran Univ Med Sci. 2010; 19 (74): :70-7

[10] William N. Southern, Shadi Nahvi, Julia H. Arnsten, Increased Risk of Mortality and Readmission among Patients Discharged Against Medical Advice, The American Journal of Medicine, 2012; 125(6): 594–602.

[11] Rangraz Jeddi F, Rangraz Jeddi M, Rezaeiimofrad M. M.Patients’ Reasons for Discharge against Medical Advice in University Hospitals of Kashan University of Medical Sciences in 2008. Hakim. 2010; 13 (1):33-39. [In Persian]

[12] Asgari M, Arab M, Rahimi-e Foroushani A, Ebadi Fard-Azar F, Mousavi M. Surveying the Factors Affecting Patient Discharge against Medicine Advice from the Emergency Ward of Amir AmirAlam TreatmentTeaching Hospital in Tehran: 2012. jhosp. 2013; 12 (2): 19-28. [In Persian]

[13] Mokhtari L, Korami Marekani A, Madadi M. Studying the rate and cause of being discharged against

medical advice in inpatient and outpatient wards of Shahid Madani Hospital in Khoy City, 2014. J Urmia

Nurs Midwifery Fac. 2016; 14 (2): 100-107. [In Persian]

[14] Ravanipour M, Tavasolnia S, Jahanpour F, Hoseini S. Appointment of important causes of discharge

against medical advice in patients in Gachsaran Rajaii hospital in the primary six months of 2013. J Educ Ethics

Nurs. 2014; 3 (1) :1-7 [In Persian].

[15] Asadi P, Zohrevandi B, Monsef Kasmaei V, Heidari Baten B. Discharge against Medical Advice in

Emergency Department. Iranian Journal of Emergency Medicine (2015); 2(3): 110-115

[16] Soleimani M, Kazemi M, Vazirinejad R, Ostadebrahimi H, Auobipour N. Assessment of the incidence and

reasons of discharge against medical advice in the hospitals of Rafsanjan University of Medical sciences in

2012-2013. chj. 2014; 8 (3) :64-72.

[17] Dirkovandmoghadam, Hashemian Sayehmiri SoheyliF. Factors affecting the level of satisfaction with

medical care Using factor analysis in patients admitted to the emergency department Public hospitals in

Ilam. Journal of Medical Council of Islamic Republic of Iran. 2013; 31(1):34-39.

[18] Plewnia, A, Bengel, J, Körner, M, Patient-centeredness and its impact on patient satisfaction and treatment

outcomes in medical rehabilitation, Patient Education and Counseling, 2016; PP:1-25.

[19] Vahdat SH, Hesam S, Mehrabian F. Effective factors on patient discharge with own agreement. Holistic Nursing

Midwifery. 2010; 20 (2): 47-52.

[20] Awasthi, S , Pandey, Nitin. Rural background and low parental literacy associated with discharge against

Medical advice from a tertiary care government hospital in India, Health Policy, 2015; 95: 82–89.

[21] Youssef, A, Factors associated with discharge against medical advice in a Saudi teaching hospital , Journal

of Taibah University Medical Sciences, 2012; 7(1):1–13.

[22] Small, M. R., W, Evan, W Kerr, and Thomas, Hospitals as a ‘risk environment’: An ethno-epidemiological

study of voluntary and involuntary discharge from hospital against medical advice among people who

inject drugs, Social Science & Medicine, 105: Pages 59–66.

[23] Baiden, P1, den Dunnen, W, Stewart, SL, Discharge of adolescents with mental health problems against

Medical Advice: Findings from Adult Mental Health Inpatient Facilities Across Ontario, Canada, 2013, NCB.

[24] Vahdat, SH; Hesam, S; Mehrabian, F. Effective factors on patient discharge with own agreement. Holistic Nursing

Midwifery. 2010; 20 (2): 47-52.

[25] Asgari M, Arab M, Rahimi-e Foroushani A, Ebadi Fard-Azar F, Mousavi M. Surveying the Factors

Affecting Patient's Discharge against Medicine Advice from Emergency Ward of AmirAlam Treatment Teaching Hospital in Tehran: 2012. jhosp. 2013; 12 (2): :19-28

[26] Rangraz Jeddi F, Rangraz jeddi M, Rezaeiimofrad Patients’ Reasons for Discharge against Medical

Advice in University Hospitals of Kashan University of Medical Sciences in 2008. Hakim. 2010; 13 (1)

:33-39

[27] Soleimani M, Kazemi M, Vazirinejad R, Ostadebrahimi H, Auobipour N. Assessment of the incidence and

reasons of discharge against medical advice in the hospitals of Rafsanjan University of Medical sciences in

2012-2013. chj. 2014; 8 (3) :64-72.

[28] Lekas H M, Alfandre D, Gordon P. Harwood K. Yin M. T. The role of patient-provider interactions:

Using an accounts framework to explain hospital discharges against medical advice, Social Science &

Medicine, 2016; 156: 106–113.

[29] Olufajo O. A., Brian K. Yorkgitis, M.Sc, Adil H. Haider, Whatever happens to trauma patients who leave

against medical advice? , The American Journal of Surgery, 2016; 211 (4): 677–683.

[30] Awasthi, S , Pandey, Nitin. Rural background and low parental literacy associated with discharge against

Medical advice from a tertiary care government hospital in India, Health Policy, 2015; 95: 82–89.

[31] Rubio, M. L., Holleck Kahle, C., Santos, R. A., Discharges Against Medical Advice: Considerations for the Hospitalist and the Patient, Hospital Medicine Clinics, 2015; 4(3): 421–429 .

[32] Small, M. R., W. Evan, W. Kerr, and Thomas, Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs, Social Science & Medicine, 105: Pages 59–66.

[33] William N. Southern, Shadi Nahvi, Julia H. Arnsten, Increased Risk of Mortality and Readmission among Patients Discharged Against Medical Advice, The American Journal of Medicine, 2012; 125(6): 594–602.

[34] Ibrahim SA , Kwoh CK , Krishnan E. Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice. American Journal of Public Health 2007; 97 (12): 2204-8.

[35] Yong T, Fok J, Hakendorf P, Ben‐Tovim D, Thompson C, Li J. Characteristics and outcomes of discharges against medical advice among hospitalized patients. Internal Medicine Journal 2013;43(7):798-802.

[36] Kavosi Z, Hatam N, Hayati AH, Nemati J, Bayati M. Factors Affecting Discharge against Medical Advice in a Teaching Hospital in Shiraz, Iran. Journal of Health Information Management 2012;9(4):448-56. [persian]

[37] Glasgow JM, Vaughn-Sarrazin M, Kaboli PJ. Leaving against medical advice (AMA): risk of 30-day mortality and hospital readmission. Journal of general internal medicine 2010;25(9):926-9.

[38] Kim H, Colantonio A, Bayley M, Dawson D. Discharge against medical advice after traumatic brain injury: Is intentional injury a predictor? Journal of Trauma and Acute Care Surgery 2011;71(5):1219-25.

[39] Shirani F, Jalili M, Asl-e-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. European Journal of Emergency Medicine 2010;17(6):318-21. [persian]

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Published

31.07.2020

How to Cite

Hajiesmaeilpoor, A., Mohammadnejad, E., Shameli, A., & Sadat Izadi- Avanji, F. (2020). Effects of Iranian Healthcare Transformation Plan on Discharge against Medical Advice. International Journal of Psychosocial Rehabilitation, 24(5), 779-786. https://doi.org/10.61841/4rq8sa19