Predictors of Patient-Initiated Discharge From an Inpatient Withdrawal Management Service: A Sex-Based Study.

Sara Ling, Beth Sproule, Martine Puts, Kristin Cleverley
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Abstract

Objectives: The purpose of this study was to examine sex-stratified independent predictors of patient-initiated discharge from an inpatient withdrawal management service and to determine whether those predictors differed by sex.

Methods: This study compared people who had self-initiated versus planned discharges and used sex-stratified generalized estimating equations models to identify independent predictors of patient-initiated discharge. Predictors examined included age, ethnicity, substance of concern, tobacco use, mental health comorbidities, day of discharge, referral source, children, and social assistance funds.

Results: Among females, there were 722 discharges, 116 of which were patient initiated. Among females, increasing age was associated with lower odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Racialized females were nearly 2 times more likely to experience patient-initiated discharge compared with White females (OR = 1.8, 95% CI [1.09, 3.00]). Compared with weekdays, weekends were associated with over 4 times the odds of patient-initiated discharge (OR = 4.77, 95% CI [2.66, 8.56]). Having one or more mental health comorbidities was associated with lower odds of patient-initiated discharge compared with having no mental health comorbidities (OR = 0.51, 95% CI [0.32, 0.82]). Among males, there were 1,244 discharges, 185 of which were patient initiated. Among males, increasing age was associated with decreased odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Compared with weekdays, weekends were associated with nearly 15 times the odds of patient-initiated discharge (OR = 14.9, 95% CI [9.11, 24.3]).

Conclusions: Males and females have shared and unique predictors of patient-initiated discharge. Future studies should continue to examine the influence of sex and gender on engagement with addictions care.

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住院病人戒毒管理服务中病人主动出院的预测因素:基于性别的研究
研究目的本研究的目的是检测住院病人戒断管理服务中病人主动出院的性别分层独立预测因素,并确定这些预测因素是否因性别而异:本研究比较了患者主动出院与计划出院的情况,并使用性别分层广义估计方程模型来确定患者主动出院的独立预测因素。研究的预测因素包括年龄、种族、关注物质、烟草使用、精神健康合并症、出院日期、转诊来源、子女和社会援助基金:女性共有 722 例出院,其中 116 例由患者主动提出。在女性中,年龄越大,患者主动出院的几率越低(OR = 0.97,95% CI [0.95,0.98])。与白人女性相比,种族化女性由患者主动要求出院的几率要高出近 2 倍(OR = 1.8,95% CI [1.09,3.00])。与平日相比,周末患者主动出院的几率是平日的 4 倍多(OR = 4.77,95% CI [2.66,8.56])。与没有精神疾病的患者相比,患有一种或多种精神疾病的患者主动出院的几率较低(OR = 0.51,95% CI [0.32,0.82])。男性共有 1,244 例出院,其中 185 例由患者主动提出。在男性中,年龄的增加与患者主动出院几率的降低有关(OR = 0.97,95% CI [0.95,0.98])。与平日相比,周末患者主动出院的几率几乎是平日的 15 倍(OR = 14.9,95% CI [9.11,24.3]):男性和女性在预测患者主动出院方面既有共同点,也有独特之处。今后的研究应继续探讨性别对参与成瘾治疗的影响。
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