Past Issues

Reducing the Rate of Discharge against Medical Advice by Pre-hospitalization Psycho-education

Chien-Cheng Kuo, M.D., Hsiao-Tan Chiou, R.N., Ta-Jen Chang, M.D., M.H.S., Jaw-Haw Chiou, R.N., Yan-Fen Chang, R.N., Su-Hwa Shen, R.N., Wen-Chen Ouyang, M.D., M.P.H., Ph.D.

Objectives: It is assumed that patients on first admission are new members of a group. It is proposed that the use of a “pre-group preparation” rationale will help to decrease the rate of discharge against medical advice (DAMA) from acute wards. The outcome of such an approach was assessed. Methods: The study was a prospective study. The control group was made up of 85 patients on their first admission to hospital from an outpatient department (OPD) and these personswere recruited fromMarch 1 to August 31, 2004. The intervention group consisted of 71 first admission OPD patients recruited from March 1 to August 31, 2005. An inpatient psycho-education manual was created based on a review of the causes of DAMA obtained from the literature and this formed the “pre-group preparation” rationale. The psycho-education, which was aimed at decreasing DAMA, was conducted by the nursing staff on the wards where patients were staying. Results: The rate of DAMA among patients on first hospitalization from the OPD decreased from 14.1% to 1.4% (p=0.004) when the control and intervention groups were compared. The risk ofDAMA among patients from the group who did not receive psychoeducation was 12.8 times higher than among those that received psycho-education. Conclusions: The psycho-education was designed in accordance with the “pre-group preparation” rationale and its application resulted in a significant decline in DAMA among patients on the first admission from the OPD. (Full text in Chinese)
Key Word discharge against medical advice, group psychotherapy, psycho-education, pre-group preparation
Editorial Committe, Taiwanese Journal of Psychiatry
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