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Tahereh Shafaghat, Mohammad Kazem Rahimi Zarchi, Zahra Kavosi, Ali Ayoubian,
Volume 11, Issue 1 (5-2017)
Abstract

Background and Aim: The number of patients who leave hospital against medical advice could reflect patient dissatisfaction and it is a notable important problem. The present study aimed to identify the causes of discharge against medical advice at a hospital of Shiraz University of medical sciences.
Materials and Methods: This was a qualitative study using grounded theory. Data were collected through telephone interviews with patients or their concomitants. All interviews were recorded by researcher and thematic method used to analyze the data. Based on it, causes of discharge against medical advice were determined and solutions were provided.
Results: Causes of discharge against medical advice were categorized into 3 general themes: "causes related to the status of the hospital", "causes related to hospital staff", and "causes related to patients" that each of them include some sub-themes. Between the sub-themes, the issues relating to the hospital staff and economic status of patient had the most and the least frequency respectively.
Conclusion: The research findings make it possible for the hospital managers to find solutions to prevent creation of DAMAs and side effects for early discharged patients, patients' readmission and imposing additional costs on them. These solutions can be mentioned as attention and understanding of authorities, preparing some amenities for patients, holding justification meetings for medical personnel and students and reengineering some hospital processes.


- Zeinab Hashemzadeh, Farhad Habibi, Hossein Dargahi, Mohammad Arab,
Volume 17, Issue 1 (3-2023)
Abstract

Background and Aim: Home care is an alternative method of hospitalization, especially for chronic patients and is an innovative approach to improve care and reduce the costs of hospital readmissions. The present study was conducted with the aim of investigating the benefits and challenges of implementing the home care plan after being discharged from the hospital considering the perspective of health service recipients and providers at Tehran University of Medical Sciences in 2021.
Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification.
Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges.
Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.


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