Mapping by the Numbers: Exploring the Phenomenon of Patients Leaving Against Medical Advice and Providers’ Perceptions and Attitudes.

Abstract

Background:

Patients leaving against medical advice (LAMA) is a common issue that presents significant challenges to healthcare providers, leading to worsened health outcomes and increased healthcare costs. This study aimed to investigate the distribution patterns of LAMA across various admission units in a tertiary healthcare facility in southwest Nigeria and to explore healthcare providers’ perceptions and attitudes toward LAMA.

Methods:

A retrospective and cross-sectional study was conducted at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, between July and December 2022. LAMA cases were identified from hospital records and case files, and relevant demographic and clinical data were extracted. Additionally, a questionnaire exploring healthcare providers' attitudes toward LAMA was administered to 113 staff members, with a 94.5% response rate.

Results:

Out of 4,547 admissions, 576 patients (12.7%) left against medical advice. The highest LAMA rates occurred in the Adult Emergency (21.8%) and Medical (15.9%) units, while the Postnatal unit had the lowest rate (0.38%). Healthcare providers identified communication barriers, dissatisfaction with care, financial concerns, and patient autonomy as key reasons for LAMA. Providers also reported frustration and emotional impact when dealing with LAMA cases, with 80% emphasizing the importance of improved communication as a preventive strategy.

Conclusions:

LAMA is a significant issue across various hospital units, particularly in the Adult Emergency unit. Addressing communication breakdowns, financial constraints, and patient engagement may reduce LAMA rates and improve outcomes. Understanding healthcare providers' perspectives is critical to developing targeted interventions to mitigate LAMA and enhance patient care.

Keywords: LAMA, healthcare, providers, perceptions, attitudes