影響病人違背醫囑自動出院之因素探討

Objectives: This study investigates the against medical advice (AMA) discharges concludes that the majority of the AMA patients leave hospitals for personal and medical reasons. There are medical perception and experience gaps between patients and physicians.
Methods: A retrospective chart review and a matching survey based on PZB model was performed. A total of 350 AMA patients discharged from a regional teaching hospital were compared retrospectively with another 350 general physician-approved discharged patients during the same period. The questionnaire compares the medical perception and experience from patients discharged AMA and their attending physicians.
Results: Patients who leave hospital against medical advice differ from the general patient population. They include a higher proportion of male gender, living in other city, admission through the emergency department and readmission with l4days after discharge. Regarding medical perception and experience appear to be significant on reliability, assurance, responsiveness, and empathy aspects. The largest gaps in five constructed differentials is empathy.
Conclusions: The study establishes a profile of AMA patients leave hospital. Early identification of targeted patients may facilitate this process. Such as, early discharges planning for appropriate outpatient treatment are recommended, thereby decreasing readmission and improving health outcomes. One challenge that patients who leave hospital AMA authority may not best interest and the doctrine of informed consent, so comprehensive documentation should be planned and reinforced. It has been suggested in postgraduate medical education. Healthcare quality professionals should also receive formal training on patient relations as part of the management program, programs to improve continuity of care and to provide easier access to the health care system.