CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Hospital discharge against medical advice, especially among substance-abusing populations, is a frustrating problem for health care providers. Because of the high prevalence of injection drug use among HIV-positive patients admitted to hospital in Vancouver, we explored the factors associated with leaving hospital against medical advice in this population. ⋯ Discharge against medical advice among HIV-positive patients was associated with frequent readmissions with the same diagnosis. Preventing such discharges is likely to benefit patients (by improving their health status) and the health care system (by reducing unnecessary readmissions).
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Clinical trials have demonstrated the superiority of coordinated interdisciplinary stroke unit care over conventional treatment of stroke patients on general medical wards. The evidence is so strong that several national bodies have recommended that stroke unit care be widely implemented. ⋯ By replicating and adapting the core characteristics identified in the randomized trials, we have been able to demonstrate the effectiveness of stroke unit care in a routine clinical setting. Our experience may help facilitate the development of organized stroke care in Canada.