Tara Beaulieu1,2, Ashok Krishnamoorthy3, Viviane Lima4,5, Tian Li5,6, Anthony Wu5,7, Julio Montaner4,5, Rolando Barrios3,5, Lianping Ti8,9. 1. Faculty of Medicine, Graduate Programs in Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada. 2. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. 3. Vancouver Coastal Health, 520 West 6th Ave, Vancouver, BC, V5Z 4H5, Canada. 4. Faculty of Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada. 5. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada. 6. Department of Statistics & Actuarial Science, Faculty of Science, Simon Fraser University, Room SC K10545 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. 7. Assessment and Grants Division, Assessment Services Branch, Government of Alberta Municipal Affairs, 15th Floor, Commerce Place 10155 - 102 Street, Edmonton, AB, T5J 4L4, Canada. 8. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. lianping.ti@bccsu.ubc.ca. 9. Faculty of Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada. lianping.ti@bccsu.ubc.ca.
Abstract
PURPOSE: Leaving hospital against medical advice (AMA) is a significant source of morbidity, mortality, and a major burden to the healthcare system. Studies have indicated that marginalized populations, including people living with HIV (PLHIV) and those living with a personality disorder (PD), experience high hospitalization rates. We sought to identify whether being diagnosed with a PD was associated with leaving hospital AMA among PLHIV in British Columbia (BC), Canada. METHODS: Data were derived from the STOP HIV/AIDS in BC cohort, a provincial-level linkage of a series of surveillance, laboratory, and health administrative databases of all identified PLHIV in BC. Using multivariable generalized estimating equations (GEE), we examined the relationship between diagnoses of PD and premature hospital discharge among PLHIV. RESULTS: Among 8763 PLHIV included in the study sample, 1321 (15%) were diagnosed with a PD. The prevalence of leaving hospital AMA at least once during the study period was 9%. In multivariable GEE analyses, after adjusting for a range of demographic and clinical confounders, there remained a positive association between being diagnosed with a PD and leaving hospital prematurely. Results showed a significant and independent association between a PD diagnosis and leaving AMA among PLHIV. CONCLUSIONS: These findings underscore the importance of identifying and addressing specific PD-related behaviour which negatively impact inpatient treatment completion among this subpopulation of PLHIV. Furthermore, these findings suggest a need to develop novel health system interventions to minimize AMA discharge among this population.
PURPOSE: Leaving hospital against medical advice (AMA) is a significant source of morbidity, mortality, and a major burden to the healthcare system. Studies have indicated that marginalized populations, including people living with HIV (PLHIV) and those living with a personality disorder (PD), experience high hospitalization rates. We sought to identify whether being diagnosed with a PD was associated with leaving hospital AMA among PLHIV in British Columbia (BC), Canada. METHODS: Data were derived from the STOP HIV/AIDS in BC cohort, a provincial-level linkage of a series of surveillance, laboratory, and health administrative databases of all identified PLHIV in BC. Using multivariable generalized estimating equations (GEE), we examined the relationship between diagnoses of PD and premature hospital discharge among PLHIV. RESULTS: Among 8763 PLHIV included in the study sample, 1321 (15%) were diagnosed with a PD. The prevalence of leaving hospital AMA at least once during the study period was 9%. In multivariable GEE analyses, after adjusting for a range of demographic and clinical confounders, there remained a positive association between being diagnosed with a PD and leaving hospital prematurely. Results showed a significant and independent association between a PD diagnosis and leaving AMA among PLHIV. CONCLUSIONS: These findings underscore the importance of identifying and addressing specific PD-related behaviour which negatively impact inpatient treatment completion among this subpopulation of PLHIV. Furthermore, these findings suggest a need to develop novel health system interventions to minimize AMA discharge among this population.
Entities:
Keywords:
Against medical advice; Canada; Discharge; HIV; Personality disorder
Authors: C Blaney; J Sommer; R El-Gabalawy; C Bernstein; R Walld; C Hitchon; J Bolton; J Sareen; S Patten; A Singer; L Lix; A Katz; J Fisk; R A Marrie Journal: Epidemiol Psychiatr Sci Date: 2020-01-09 Impact factor: 6.892