| 1.
AUTHOR | Butler
C; Rollnick S; Stott N |
| INSTITUTION | Department
of General Practice, College of Medicine, University of Wales, Llanedeyrn Health
Centre, Cardiff, Wales. |
| TITLE | The
practitioner, the patient and resistance to change: recent ideas on compliance. |
| SOURCE | CMAJ
1996 May 1;154(9):1357-62 |
| ISSN | 0820-3946 |
| ABSTRACT | Despite
the explosion of research into the effect of medical advice on patient behaviour,
only about 50% of patients comply with long-term drug regimens. And when it comes
to changes in lifestyle, the percentage of patients who comply with medical advice
often falls to single figures. Review articles on compliance have traditionally
concentrated on factors that make it easier for patients to adhere to medical
advice. However, recent articles urge clinicians to be more understanding of the
wider implications of compliance in their patients' lives. This article focuses
on how clinicians' consulting methods can affect patients' behaviour. Specifically,
the authors consider the patient-centred clinical method as well as insights from
and consulting techniques pioneered in the addictions field that can help to bring
ambivalent patients closer to decisions about change. Instead of seeing resistance
to change as rooted entirely in the patient, the authors view it as stemming partly
from the way clinicians talk to patients. An advice-giving approach is usually
inadequate to motivate people to embark on major lifestyle changes. Instead, the
authors propose a negotiation-based framework that harnesses patients' intrinsic
motivation to make their own decisions. This approach also promotes clinicians'
acceptance of patients' decisions, even if these decisions run counter to current
medical wisdom. |
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| 2.
AUTHOR | Dubow
D; Propp D; Narasimhan K |
| INSTITUTION | University
of Illinois Affiliated Hospitals Emergency Medicine Residency. |
| TITLE | Emergency
department discharges against medical advice [see comments] |
| SOURCE | J
Emerg Med 1992 Jul-Aug;10(4):513-6 |
| ISSN | 0736-4679 |
| ABSTRACT | A
retrospective chart review was performed on 52 consecutive discharges against
medical advice (AMA) from an emergency department. The study's objective was to
assess documentation of the medical record as well as the patients' perceptions
of their experience. Sixty-seven percent of the charts reflected the competence
of the patient. The physicians documented that the patients understood their diagnosis
(36%), proposed treatment (44%), alternative therapy (2%), and the clinical consequences
of refusal (57%). The discharge instructions included a referral to a physician
62% of the time. A post-visit survey contacting 46% of the group revealed that
82% of these respondents left because they didn't agree with the physician's management
plan, although 70% of the patients were either "very satisfied" or "satisfied"
with their interaction with the physician. These results suggest that more attention
and better documentation needs to be directed to the patient who is leaving the
emergency department against medical advice. |
| |
| 3.
AUTHOR | Phillips
MS; Ali H |
| TITLE | Psychiatric
patients who discharge themselves against medical advice. |
| SOURCE | Can
J Psychiatry 1983 Apr;28(3):202-5 |
| ISSN | 0706-7437 |
| ABSTRACT | Hospital
treatment staff are constantly faced with the problem of psychiatric patients
who discharge themselves against medical advice before their treatment is completed.
A total of 50 patients who signed themselves out of the 9th floor service of the
Clarke Institute of Psychiatry, over a two year period, were analyzed. When compared
with a random sample of patients who remained for the duration of their treatment,
the authors found the AMA patients to have the following characteristics: The
patient is likely to be a young male, admitted as an emergency, remain in hospital
for three days or less and have a diagnosis of personality disorder or schizophrenia.
The authors conclude with a number of recommendations to assist in dealing with
the problem. |
| |
| 4.
AUTHOR | Pennycook
AG; McNaughton G; Hogg F |
| INSTITUTION | Department
of Accident and Emergency Medicine, Royal Infirmary, Glasgow. |
| TITLE | Irregular
discharge against medical advice from the accident and emergency department--a
cause for concern. |
| SOURCE | Arch
Emerg Med 1992 Jun;9(2):230-8 |
| ISSN | 0264-4924 |
| ABSTRACT | An
irregular discharge (ID) from the A&E department is an undesirable, but relatively
common occurrence. A prospective study was undertaken to quantify the size of
the problem and by arranging a subsequent review of the patient, to determine
the clinical outcome. Over a 3-month period, 139 patients (0.73%) of attendances)
took their own discharge against medical advice. A further 566 patients (3.03%
of attendances) left prematurely prior to any medical assessment (DNW). Attenders
irregularly discharged, often with serious untreated conditions. A high proportion
were intoxicated with alcohol (65.5%). Attempted follow up proved difficult and
incomplete. Patients with serious conditions appeared to return spontaneously
for further care. Methods of minimizing the numbers of patients who take an ID
or DNW are discussed. Taken together, the numbers of these attenders leaving prematurely,
can be used as a valid performance indicator of the delivery of health care in
the A/E department.
|
| |
| 5.
AUTHOR | Lee
TH; Short LW; Brand DA; Jean-Claude YD; Weisberg MC; Rouan GW; Goldman L |
| INSTITUTION | Brigham
and Women's Hospital, Boston, MA 02115. |
| TITLE | Patients
with acute chest pain who leave emergency departments against medical advice:
prevalence, clinical characteristics, and natural history. |
| SOURCE | J
Gen Intern Med 1988 Jan-Feb;3(1):21-4 |
| ISSN | 0884-8734 |
| ABSTRACT | The
study group identified 107 patients who left against advice from the emergency
departments of three university and four community hospitals after presenting
for evaluation of acute chest pain. In comparison with other emergency department
patients with acute chest pain, patients who left against advice had findings
that suggested they were at higher risk for myocardial infarction than patients
for whom admission was not recommended but at lower risk than patients who consented
to be admitted. Specific follow-up plans were made at the time of evaluation for
45 patients (42%). Survival data were obtained at 48-72 hours for 104 patients
(97%) and at one month for 101 patients (94%). Fourteen patients (12%) were hospitalized
within three days of their original emergency department visits, and three patients
had documented acute myocardial infarctions. The only death within one month was
that of a patient who died suddenly out-of-hospital later on the day of his emergency
department visit. The authors conclude that patients who left against medical
advice had presentations and prognoses that were in between those of patients
for whom admission was not recommended and those of patients who consented to
be admitted.
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