Reducing rates of discharge against medical advice in the neonatal intensive care unit in a tertiary care hospital in South India: a mixed-methods study
| Autor: | Carl Britto, P. N. Suman Rao, Chris A. Rees, A Shashidhar, Ashish Bosco, Andrew D. Wheeler |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Counseling Male medicine.medical_specialty Neonatal intensive care unit Birth weight 030231 tropical medicine India Logistic regression Odds Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Intensive Care Units Neonatal medicine Humans Obstetrics business.industry Public Health Environmental and Occupational Health Infant Newborn Against medical advice Prenatal Care Odds ratio Tertiary care hospital Confidence interval Patient Discharge Infectious Diseases Patient Compliance Parasitology Female business |
| Zdroj: | Tropical medicineinternational health : TMIHReferences. 26(7) |
| ISSN: | 1365-3156 |
| Popis: | OBJECTIVE To elucidate characteristics among neonates and their mothers who were discharged against medical advice (DAMA), providers' perspectives on DAMA and the effect of an intervention to reduce DAMA in a tertiary care hospital in South India. METHODS We conducted a mixed-methods study to identify neonates at risk of DAMA. We reviewed charts of neonates and their mothers who were DAMA and conducted logit regression analysis to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to determine associations with DAMA. We conducted focus group discussions with nurses and doctors. We developed an intervention that included family counselling, supplemental funds for hospital bills and involving family members to reduce DAMA. RESULTS Of 10 834 neonates, 179 (1.7%) were DAMA over the study period. Maternal characteristics associated with DAMA included higher previous parity (aOR 1.9, 95% CI 1.1-2.3, P = 0.001). Mothers who received antenatal care had lower odds of DAMA (aOR 0.2, 95% CI 0.1-0.7, P = 0.039). Neonates with lower birth weight (aOR 2.1, 95% CI 1.7-9.4, P = 0.002) and congenital malformations (aOR 3.3, 95% CI 1.1-5.3, P = 0.005) also had higher odds of DAMA. The most commonly cited reasons for DAMA were financial constraints, inadequate counselling and perceived poor prognosis. The average monthly number of neonates who were DAMA decreased from 3.6 (1.6%) to 1.5 (0.6%) after our multi-pronged intervention. CONCLUSIONS Neonates with severe illness and poor prognosis had higher odds of DAMA. A multi-pronged intervention demonstrated reductions in the rates of DAMA. This intervention may be trialled in similar settings to reduce DAMA. |
| Databáze: | OpenAIRE |
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