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APHA Scientific Session and Event Listing

Recorded presentation

Sandra L. Putnam, PhD, WVU Injury Control Research Center, Pacific Institute for Research and Evaluation, 1541 Stewartstown Rd., Morgantown, WV 26505, 3042925148, sputnam@pire.org

Screening, brief intervention and referral to treatment (SBIRT) projects in emergency departments (EDs) offer much promise for early identification of high risk/harmful/hazardous alcohol and other drug use. However, their penetration is limited among hard-to-reach patients, including patients who leave the ED against medical advice (AMA). Leaving AMA is one of the most critical and potentially compromising issues facing EDs today due to problems of patient safety, legal liability, and recidivism; yet its determinants remain inconclusive. This paper examines the prevalence and correlates of leaving AMA in US EDs, using data from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS), conducted by the National Center for Health Statistics (NCHS). In this four-stage probability sample of 30,523 ED visits by adults in the US, 36% were for injury; 3.7% were reported as alcohol-related; 18-22% were estimated as alcohol--related based on CDC's alcohol attributable fractions (ARDI); and 6-8% were estimated as drug-related. In 1.2% of visits (n=352), patients left AMA, and in another 2%, they left without being seen. Logistic regression analysis, conducted to predict leaving AMA from a combination of patient, visit and hospital characteristics, shows that alcohol-and-drug-related illness and injury (OR=4.7) are major determinants, along with lack of insurance (OR=1.5), low SES (OR=1.8), being male (OR=1.7), and some setting characteristics. This study has important implications for improving SBIRTs in EDs.

Learning Objectives:

• 1.Understand predictors of leaving emergency departments (EDs) against medical advice (AMA) in the US
• 2.Identify correlates of leaving AMA including alcohol-and-drug-related illness and injury
• 3.Assess implications for screening and brief intervention projects in EDs.

Keywords: Emergency Department/Room, Drug Abuse

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: NA

Any relevant financial relationships? No

Recorded presentation