Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital Obada Hasan 1* ID , Muhammad Adeel Samad 2 , Hamza Khan 3 , Maryam Sarfraz 4 , Shahryar Noordin 1 , Tashfeen Ahmad 1,5 ID , Gul Nowshad 6 Abstract Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital. Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression. Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital. Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences. Keywords: LAMA, DAMA, Morbidity, Developing Country Copyright: © 2019 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Hasan O, Samad MA, Khan H, et al. Leaving against medical advice from in-patients departments rate, reasons and predicting risk factors for re-visiting hospital retrospective cohort from a tertiary care hospital. Int J Health Policy Manag. 2019;8(8):474–479. doi:10.15171/ijhpm.2019.26 *Correspondence to: Obada Hasan Email: obada.husseinali@gmail.com Article History: Received: 23 August 2018 Accepted: 5 May 2019 ePublished: 18 May 2019 Original Article Full list of authors’ affiliations is available at the end of the article. htp://ijhpm.com Int J Health Policy Manag 2019, 8(8), 474–479 doi 10.15171/ijhpm.2019.26 Implications for policy makers • Policy-makers and decision-makers should know the rate and reasons for patients to opt for leave against medical advice (LAMA). • This knowledge will help in planning better measurements to reduce this phenomenon and its consequences. • Better hospital resources utilization and patients’ satisfaction. Implications for the public Leave against medical advice (LAMA) is not without a price. There are many catastrophic consequences on morbidity and severity of the pre-existing disease. Patients who LAMA are at a higher risk of clinical worsening and ‘bouncing back.’ Discussing your concerns and factors with your physician and even the hospital administration can lead to a better result. Key Messages