AI Article Synopsis
- Discharge "against medical advice" (AMA) is a significant issue in obstetrics, particularly affecting marginalized groups, and it is linked to negative perinatal outcomes.
- The study analyzed electronic health records of obstetric patients from 2008-2018 to uncover reasons for AMA discharges, categorizing obstacles into extrinsic (e.g., childcare, responsibilities) and intrinsic (e.g., disagreements with healthcare, emotional distress).
- The findings suggest that the term "AMA" unfairly places blame on patients, neglecting systemic barriers; addressing these issues through better partnership and support could improve maternal and infant health outcomes.
Article Abstract
Introduction: Discharge "against medical advice" (AMA) in the obstetric population is overall under-studied but disproportionally affects marginalized populations and is associated with worse perinatal outcomes. Reasons for discharges AMA are not well understood. The objective of this study is to identify the obstacles that prevent obstetric patients from accepting recommended care and highlight the structural reasons behind AMA discharges.
Methods: Electronic health records of patients admitted to antepartum, peripartum, or postpartum services between 2008 and 2018 who left "AMA" were reviewed. Progress notes from clinicians and social workers were extracted and analyzed. Reasons behind discharge were categorized using qualitative thematic analysis.
Results: Fifty-seven (0.12%) obstetric patients were discharged AMA. Reasons for discharge were organized into two overarching themes: extrinsic (50.9%) and intrinsic (40.4%) obstacles to accepting care. Eleven participants (19.3%) had no reason documented for their discharge. Extrinsic obstacles included childcare, familial responsibilities, and other obligations. Intrinsic obstacles included disagreement with provider regarding medical condition or plan, emotional distress, mistrust or discontent with care team, and substance use.
Discussion: The term "AMA" casts blame on individual patients and fails to represent the systemic barriers to staying in care. Obstetric patients were found to encounter both extrinsic and intrinsic obstacles that led them to leave AMA. Healthcare providers and institutions can implement strategies that ameliorate structural barriers. Partnering with patients to prevent discharges AMA would improve maternal and infant health and progress towards reproductive justice.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s10995-024-03959-7 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!