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European Psychiatry
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 25 juin 2011
Doi : 10.1016/j.eurpsy.2011.04.009
Received : 25 February 2011 ;  accepted : 29 April 2011
Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice
 

A. Valevski a, ⁎, b , G. Zalsman a, b, S. Tsafrir a, R. Lipschitz-Elhawi a, c, A. Weizman a, b, d, T. Shohat e
a Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100 Petach Tikva, Israel 
b The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 
c School of Social Work, Bar-Ilan University, Ramat Gan, Israel 
d Felzenstein Medical Research Center, Petach Tikva, Israel 
e Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel 

Corresponding author. Tel.: +972 3 9258283; fax: +972 3 9259287.
Abstract
Purpose

To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation.

Methods

The records (1984–2005) of all consecutive admissions (n =12,937) of schizophrenia patients (n =8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n =1345).

Results

AMA patients were younger at admission (P <0.001), comprised more males (P <0.01), more were single (P <0.0001), and had a shorter duration of illness than the controls (P <0.05). A total of 49.9% of AMA events occurred within the first 2weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P <0.001). The mortality rate as a result of suicide (P <0.0001) and accidents (P <0.05) was higher for AMA patients compared to controls.

Conclusion

The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.


Keywords : Schizophrenia, Against medical advice, Mortality, Suicide rate


OutlineMasquer le plan
Introduction
Subjects and methods
Results
Discussion
Conclusion
Disclosure of interest


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