Ling Sara, Davies Julia, Sproule Beth, Puts Martine, Cleverley Kristin
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Centre for Addiction and Mental Health, Toronto, Canada.
Drug Alcohol Rev. 2022 Jan;41(1):62-77. doi: 10.1111/dar.13311. Epub 2021 May 27.
Early discharges, also known as 'against medical advice' discharges, frequently occur in inpatient withdrawal management settings and can result in negative outcomes for patients. The purpose of this scoping review is to identify what is known about predictors of and reasons for the early discharge among adults accessing inpatient withdrawal management settings.
MEDLINE, CINAHL, PsycINFO, ASSIA and EMBASE were searched, resulting in 2587 articles for screening. Title and abstract screening and full-text review were completed by two independent reviewers. Results were synthesised in quantitative and qualitative formats.
Sixty-two studies were included in this scoping review. All studies focused on predictors of early discharge, except one which only described reasons for the early discharge. Forty-eight percent of studies involved retrospective review of health records data. The most frequently examined variables were demographics. Variables related to the treatment setting, such as referral source and treatment received, were examined less frequently but were more consistently associated with early discharge compared to demographics. Only six studies described patient reasons for the early discharge, which were retrieved via clinical documentation. The most common reasons for early discharge were dissatisfaction with treatment and family issues.
Most demographic variables do not consistently predict early discharge, and reasons for early discharge are not well understood. Future studies should focus on the predictive value of non-patient-level variables, or conduct analyses to account for predictors of early discharge among different subgroups of people (e.g. by gender or ethnicity). Qualitative research exploring patient perspectives is needed.
早期出院，也称为“违反医疗建议”出院，在住院戒断管理环境中经常发生，可能会给患者带来负面后果。本范围综述的目的是确定在接受住院戒断管理的成年人中，关于早期出院的预测因素和原因的已知情况。
检索了MEDLINE、CINAHL、PsycINFO、ASSIA和EMBASE，共筛选出2587篇文章。由两名独立评审员完成标题和摘要筛选以及全文评审。结果以定量和定性形式进行综合。
本范围综述纳入了62项研究。除一项仅描述早期出院原因的研究外，所有研究都聚焦于早期出院的预测因素。48%的研究涉及对健康记录数据的回顾性分析。最常研究的变量是人口统计学变量。与治疗环境相关的变量，如转诊来源和接受的治疗，研究较少，但与早期出院的相关性比人口统计学变量更一致。只有六项研究通过临床记录获取了患者早期出院的原因，最常见的原因是对治疗不满意和家庭问题。
大多数人口统计学变量并不能一致地预测早期出院，而且早期出院的原因尚不清楚。未来的研究应关注非患者层面变量的预测价值，或进行分析以找出不同人群亚组（如按性别或种族）中早期出院的预测因素。需要开展探索患者观点的定性研究。
