PREDICTORS OF LEAVING AGAINST MEDICAL ADVICE IN NEUROSURGERY: A PROSPECTIVE STUDY
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Keywords
Leaving against medical advice, neurosurgery, traumatic brain injury,, social determinants of health, rehabilitation services, predictors of LAMA
Abstract
Objectives: This study aims to identify key predictors of leaving against medical advice (LAMA) among neurosurgery patients by analyzing various demographic, social, and clinical factors to inform healthcare policies and improve patient management.
Materials and Methods: In the present investigation, a prospective study was carried out at a single neurosurgical centre Department of Neurosurgery, MTI, Lady Reading Hospital, Peshawar in the duration from 1st January, 2023 to 31st Decembr, 2023. The study duration was There were 350 patients admitted for neurosurgery, and focused variables included age, gender, socioeconomic status, and rehabilitation facility access. LAMA was operationally measured as those patients who were discharged early from the hospital without the appropriate treatment.
Results: Out of 350 patients, 38 (10.9%) discharged themselves early against medical advice. The most represented cause reported by the patient was TBI with 42%, followed by spinal cord injury with 29% and Brain Tumor with 16%. The data also showed that a majority of the LAMA patients were males (68%), and the majority were from the low-income group (76%). Hypothesis test results showed that two social determinants that had effects on LAMA decisions were lack of support (Mean = 2.71) and inadequate access to rehabilitation services (Mean= 2.62).
Conclusion: The present research examines the source of injury, socioeconomic status, and availability of rehabilitation as the main variables associated with LAMA. Removing these factors through specific actions could decrease LAMA rates and enhance neurosurgical results.
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Dr Zahid Khan
Associate Professor, Department of Neurosurgery, MTI, Lady Reading Hospital Peshawar, Pakistan
Dr Seema Sharafat
Associate Professor, Department of Neurosurgery, MTI, Lady Reading Hospital Peshawar, Pakistan
Dr Haidar Ali
Specialist Registrar, Department of Neurosurgery, MTI, Lady Reading Hospital Peshawar, Pakistan
Dr Adnan Khan
Medical Officer, Department of Emergency and Trauma Unit, MTI, Lady Reading Hospital, Peshawar, Pakistan
Dr Ahmad Noushad
Medical Officer, Department of Pediatric Unit, Ali Medical Center, Pakistan
Dr Javaria Farman
Medical Officer, Kalsoom Maternity Home, Pakistan