Bayview Internal Medicine Residency Program, Johns Hopkins University School of Medicine, Baltimore, MD (JDP); Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, Baltimore, MD (DAR).
J Addict Med. 2018 Nov/Dec;12(6):447-452. doi: 10.1097/ADM.0000000000000430.
To determine if certain patient, clinical, and disease factors are associated with against medical advice (AMA) discharge among patients admitted for treatment of alcohol withdrawal.
Data from admissions to a dedicated unit for treatment of substance withdrawal were collected over a 6-month period. Patients with AMA and planned discharge were compared with regard to demographics, clinical data, and substance use disorder disease characteristics. A stepwise logistic regression was used to find the best model.
The study population included 655 patient encounters. A total of 93 (14%) discharges were AMA. Bivariate analysis showed patients with AMA discharge were younger (mean age 43 vs 46 years; P < 0.05), more likely to leave on a Tuesday to Thursday, and to have an initial withdrawal score at or above the median (AMA 69% vs planned 56%; P = 0.02). Emergency department (ED) admissions had an AMA discharge rate of 21% compared with 10% of community admissions (P < 0.05). Regression analysis found AMA discharge was significantly associated with admission from the ED (odds ratio [OR] 2.03, confidence interval [CI] 1.27-3.25) and younger age (OR 0.97, CI 0.95-0.99). There was no significant difference in discharge disposition among patients with concurrent opioid use disorder who were on opioid agonist therapy.
AMA discharges occurred in 1 of every 7 admissions. Being admitted from the ED and younger age was associated with AMA discharge. No other patient or clinical factors were found to be associated with AMA discharge.
确定某些患者、临床和疾病因素是否与接受酒精戒断治疗的患者的拒绝医疗建议（AMA）出院相关。
在 6 个月的时间内收集了专门用于治疗物质戒断的住院患者的数据。将 AMA 出院和计划出院的患者进行比较，比较内容包括人口统计学、临床数据和物质使用障碍疾病特征。使用逐步逻辑回归来找到最佳模型。
本研究共纳入 655 例患者就诊。共有 93 例（14%）出院是 AMA。单变量分析显示，AMA 出院的患者年龄较小（平均年龄 43 岁 vs 46 岁；P<0.05），更有可能在周二至周四出院，并且初始戒断评分在中位数或以上（AMA 为 69%，计划为 56%；P=0.02）。急诊科（ED）入院的 AMA 出院率为 21%，而社区入院的 AMA 出院率为 10%（P<0.05）。回归分析发现，ED 入院（优势比 [OR] 2.03，置信区间 [CI] 1.27-3.25）和年龄较小（OR 0.97，CI 0.95-0.99）与 AMA 出院显著相关。同时患有阿片类药物使用障碍且正在接受阿片类激动剂治疗的患者中，出院处置方式没有差异。
每 7 例住院患者中就有 1 例发生 AMA 出院。从 ED 入院和年龄较小与 AMA 出院相关。没有发现其他患者或临床因素与 AMA 出院相关。
