Chronic Pancreatitis Patients Who Leave Against Medical Advice: Prevalence, Trend, and Predictors.

Tytuł:: Chronic Pancreatitis Patients Who Leave Against Medical Advice: Prevalence, Trend, and Predictors.
Autorzy:: Akanbi O; Department of Medicine, Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA. .
Adejumo AC; Department of Medicine, North Shore Medical Center, Salem, MA, USA.; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Soliman M; Department of Medicine, Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA.
Kudaravalli P; Department of Medicine, Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA.
Źródło:: Digestive diseases and sciences [Dig Dis Sci] 2021 Feb; Vol. 66 (2), pp. 424-433. Date of Electronic Publication: 2020 May 02.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2005- : New York, NY : Springer Science + Business Media
Original Publication: New York, Plenum Pub. Corp.
MeSH Terms:: Patient Acceptance of Health Care*
Pancreatitis, Chronic/*epidemiology
Pancreatitis, Chronic/*therapy
Patient Discharge/*trends
Treatment Refusal/*trends
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis, Chronic/psychology ; Predictive Value of Tests ; Prevalence ; Retrospective Studies ; Treatment Refusal/psychology ; Young Adult
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Contributed Indexing:: Keywords: Chronic pancreatitis; Leaving against medical advice; Predictors; Prevalence; Trend
Entry Date(s):: Date Created: 20200504 Date Completed: 20210428 Latest Revision: 20210428
Update Code:: 20240105
DOI:: 10.1007/s10620-020-06279-2
PMID:: 32361924
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Background and Aims: Leaving against medical advice (LAMA) is an unfortunate occurrence in 1-2% of all hospitalized patients and is associated with worse outcomes. While this has been investigated across multiple clinical conditions, studies on patients with chronic pancreatitis (CP) are lacking. We aimed to determine the prevalence and determinants of this event among patients with CP.
Methods: The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS), 2007-2014, was used in the study. Patients with LAMA were identified, and the temporal trend of LAMA was estimated and compared among patients with and without CP. We then extracted patients with a discharge diagnosis of CP from the recent years of HCUP-NIS (2012-2014) and described the characteristics of LAMA in these patients. Multivariate logistic regression models were used to evaluate predictors of LAMA.
Results: 3.39% of patients with CP discharged against medical advice. LAMA rate in CP patients was higher and increased more steeply at quadruple the rate of those without. More likely to self-discharge were patients who were young, males, non-privately insured, or engaged in alcohol and substance abuse, likewise were those with psychosis and those admitted on a weekend or non-electively. The northeast and for-profit hospitals also had higher odds of LAMA. However, patients transferred from other healthcare facilities have reduced LAMA odds. Among all patients with CP, those with LAMA had shorter length of stay (2.74 [2.62-2.85] days vs. 5.78 [5.71-5.83] days) and lower hospitalization cost $23,271 [$22,171-$24,370] versus $45,472 [$44,381-$46,562] compared to the no-LAMA group.
Conclusion: LAMA occurs in approximately 1 in 29 patients with CP and is increasing at almost quadruple the rate of those without. Clinicians need to pay closer attention to the identified at-risk groups for ameliorative targeted interventions.

Comment in: Dig Dis Sci. 2021 Feb;66(2):334-335. (PMID: 32562037)

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