Rate and causes of discharge against medical advice in Iranian hospitals: A systematic review and meta-analysis

Background: discharge against medical advice (dama) is a problem for hospitals which may result in increasing readmissions,morbidities,inabilities,deaths and health care costs. this study,aimed to investigate the rate and causes of dama in iranian hospitals. methods: a systematic review and meta-analysis study was conducted in 2014. required data were collected through searching for key words included: “discharge against medical advice”,“leaving against medical advice”,“causes*”,“hospital” and their persian equivalents,over databases including pubmed,ovid,google scholar,embase,scopus,magiran,scientific information database (sid). the reference lists of the articles,certain relevant journals and web sites in this field were also searched. results: out of 913 articles initially retrieved,finally 17 articles were incorporated into the study. there were 244858 individuals studied in the articles. using a random effects model,the rate of dama in iranian hospitals was estimated at 7.9% (6.3%-9.8%). while the highest rate of dama was associated with patients in departments of psychiatry (12%),the lowest rate was related to patients in departments of pediatrics (3.7). dama was in men more than women (p<0.05) patient's perception of feeling of wellbeing,financial problems,family problems,the lack of attention from physicians and nurses,inappropriate behavior with patients by hospital team and the lack of timely care were men-tioned as main causes for dama. conclusion: the rate of dama in iranian hospitals is relatively high. thus effective initiatives in this area are re-quired. © 2015 iranian journal of public health. all rights reserved.