Retrospective Evaluation of Patients Leaving against Medical Advice in a Tertiary Care Teaching Hospital

Context: Leaving against medical advice (LAMA) is a worldwide healthcare problem, occurring due to various contributing factors, seen more commonly in developing countries like ours. Aims: To retrospectively study the prevalence of LAMA along with its affecting factors. Settings and Design: We screened the hospital record for one year, of a tertiary care teaching hospital, after obtaining approval from the institutional ethical committee. Patient demography, disease characteristics and status at the time of LAMA were noted and statistically analysed. Results: During the study period, 4.95% patients took LAMA.The mean age was 47.2 +/- 21 years (range newborn to 103 years) with 2:1 Male: Female ratio. Forty nine percent of patients resided in rural areas and around 1/3rd were dependent on others for their living. The mean length of stay in hospital was 6.1 +/- 9.3 days. Around 60% patients required mechanical ventilation and 51% patients had been explained guarded prognosis. About 53% of patients taking LAMA were admitted in medical wards, trauma being the most common diagnosis (17.2%). History of alcohol abuse and poisoning with suicidal intent was seen in 11.47% and 3.9% respectively. Conclusions:The number of patients taking LAMA from our country Is quite high.This necessitates formulation and implementation of strategies to reduce the prevalence of AMA discharges like further investigations to look into the causes contributing to patients taking LAMA, attending to substance abuse issues, recognizing psychological factors & strengthening the social systems, encouraging insurance cover, helping patients' treatment expenses through charity care and optimizing healthcare delivery and patient centred policies. Key Messages: LAMA is a global health issue precipitated by unemployment and alcohol abuse, commonly taken due to financial reasons.This necessitates a strong social system and national health insurance schemes to reduce the cost of treatment.