Discharge Against Medical Advice From the Tamale Teaching Hospital: Who Is Involved, the Prevalence and Departmental Differences

Discharge Against Medical Advice (DAMA) is a phenomenon where patients seek to terminate treatment against the advice of healthcare giver. Globally, DAMA represents a complex issue within healthcare systems, posing challenges to patients and healthcare providers. Generally, DAMA patients are at a higher risk for complications, re-admissions, increased healthcare costs, disability, longer rehabilitation and higher mortality. They are potentially a source of disease spread in communities and public. This study aimed to characterise the DAMA patients from a major referral facility, its prevalence at the hospital and departmental level. A retrospective descriptive cross-sectional design using quantitative method. Secondary data of 941 DAMA patients between December 1, 2020, to June 31, 2023, were extracted. DAMA patients (n = 941) showed an overall hospital prevalence rate of 1.75%. Accident and Emergency had a prevalence of 3.26%, followed by a prevalence rate of 2.25% at the Medicine and Therapeutics department. The polyclinic department recorded a prevalence rate of 1.72%, then the Department of Surgery followed closely with a prevalence rate of 1.54%. A low prevalence rate of 0.86% was obtained at the Department of Obstetrics and Gynecology while the paediatric department closely followed with a lower prevalence rate of 0.80. The dental department recorded no case. The majority of cases were male, 667 (70.88%). The majority of the patients; 650 (69.08%) were in the economically productive age group (between the ages of 20 to 61 years). Furthermore, 278 (29.54%) of patients had no form of formal education while 397 (42.19%) patients had some level of formal education. The majority 573 (60.89%) of patients who took DAMA had no form of health insurance. In addition, 144 (15.30%) of the patients were single while 241 (25.61%) were identified as married. Also, 506 (53.77%) of the patients belonged to the Islamic religion, 203 (21.57%) Christian and 16 (1.70%) of the patients practised African traditional religion. As many as 289 (30.71%) had no record of their employment status. Employed and unemployed had a total of 232 (24.65%) and 215 (22.84%) respectively. The hospital will utilize this knowledge to empower and encourage the records department of TTH to encourage its staff to endeavour to ensure complete data of the patient to be taken to further enable full analysis in future studies.