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KMID : 0897520100150010015
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Journal of Korean Association of Social Psychiatry
2010 Volume.15 No. 1 p.15 ~ p.22
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Factors Associated with Outpatients Department Treatment of the Psychiatric Patients Discharged Against Medical Advice
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Han Young-Hoon
Lee Do-Yun
Son Yong-Pyo
Park Chang-Jeung
Lee Kwang-Hun
Sakong Jung-Kyu
Kwak Kyung-Phil
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Abstract
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Objectives：The purpose of this study is to research factors which affect Outpatient department(OPD) follow up and consistency in psychiatric inpatients discharged against medical advice from psychiatric hospitalization.
Methods：The subjects in this study were 163 patients who were discharged against medical advice from Department of Neuropsychiatry at Dongguk University Hospital between January 1, 2006 and December 31, 2009. Patients were divided into two groups：patients who came for OPD follow up treatment and patients who did not. The group of patients who came for OPD follow up treatment was then subdivided into two groups：a group with patients who continuously came for OPD follow up treatment for more than 6 months and a group with patients who were lost before 6 months. After classifying the patients, we compared and analyzed the factors which could influence each group.
Results：After being discharged against medical advice, 43 patients did not show up for OPD follow up treatment at all and 120 patients came for OPD follow up treatment more than once. 49 patients were lost before 6 months and 71 patients continued to come for OPD follow up treatment for more than 6 months. Factors that affected OPD follow up treatment were the reasons for the patient’s discharge against medical advice, result of treatment and the duration of psychiatric hospitalization. When the reason for discharge against medical advice was complete denial of illness or dissatisfaction with staffs, patients were not well followed up at the OPD. On the other hand, when result of treatment was good at the time of discharge or when the duration of psychiatric hospitalization was long enough, patients were well followed up at the OPD. Among these factors, duration of psychiatric hospitalization was the only one that could affect the continuance of OPD follow up treatment for more than 6 months. Apart from these reasons, diagnosis, sociodemographic characteristics, mode of admission, day of admission, day of discharge and gender or grade of doctor did not influenced the OPD follow up treatment.
Conclusion： Insight of their own psychiatric illness and the duration of psychiatric hospitalization affected OPD follow up treatment in patients who were discharged against medical advice. In clinical application, even if patients are discharged against medical advice, psychiatrist should make efforts to get those patients to receive OPD treatment.
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KEYWORD
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Discharged against medical advice, Outpatient department treatment, psychiatric hospitalization, Insight
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