Predictors of Leaving an Inpatient Medical Withdrawal Service Against Medical Advice: A Retrospective Analysis

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Abstract

Objectives:

The purpose of this study was to determine the frequency and predictors of patients leaving an inpatient medical withdrawal unit against medical advice (AMA).

Methods:

This study used a case-control design to compare patients who were discharged AMA (n = 164) with those who completed treatment (n = 678). Logistic regression analysis was used to determine which variables were independent predictors of patients leaving AMA.

Results:

We found that being admitted through the emergency department (odds ratio [OR] 3.17, confidence interval [CI] 1.66–6.08), having gamma-hydroxybutyrate (OR 7.61, CI 1.81–32.09) as a primary substance of concern compared to alcohol, and having multiple axis I psychiatric diagnoses (OR 2.20, CI 1.16–4.18) or depression (OR 2.86, CI 1.32–6.17) compared with no psychiatric diagnosis increased the odds of leaving inpatient medical withdrawal AMA. By contrast, not being dependent on nicotine (OR 0.45, CI 0.23–0.88) and increasing time since admission (OR 0.42, CI 0.36–0.48) reduced the odds of leaving AMA.

Conclusions:

The findings of this study reveal novel information about patients who leave inpatient medical withdrawal AMA and can inform targeted interventions to prevent vulnerable patients from terminating treatment early and improve healthcare service utilization.

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