A high percentage of patients with sickle cell disease self-discharge from hospital care
Research Activities, July 2011, No. 371
Sickle-cell disease (SCD) is a painful genetic condition that in the United States affects mostly blacks. SCD changes normal, round red blood cells into cells shaped like a crescent moon or sickle, which get stuck and block blood vessels and blood flow. The condition can cause pain lasting from hours to days, as well as infections, anemia, and stroke. Painful episodes often land patients with SCD in the hospital for pain management. Many of these patients feel their clinicians do not take their pain seriously and even suspect them of having a substance abuse problem. The result? A new study reveals that nearly half (46.5 percent) of patients hospitalized for SCD have self-discharged from a hospital against medical advice, which can jeopardize their health.
Researchers examined the lifetime prevalence of hospital self-discharge in this population and found that, of the 86 SCD patients studied, 40 (46.5 percent) had a history of self-discharge. These patients were more likely to report experiencing three or more hospitalizations each year for treatment of SCD pain. Patients who were more distrustful of clinicians, and those who reported difficulty in persuading medical staff about sickle-cell pain were more likely to report having ever self-discharged from a hospital. The researchers also found that hospital self-discharge tended to be associated with having a history of substance abuse as determined by a positive toxicology screen for cocaine or marijuana use during any admission in the previous 5 years.
When seeing a positive toxicology result, clinicians may doubt the legitimacy of the patient's pain reports, when, in fact, a substantial proportion of these results may reflect SCD patients' attempts to manage their pain outside of a hospital setting, note the researchers. They point out that the discrepancy between the clinical interpretation and the actual significance of positive toxicology screen results could contribute to interpersonal conflicts between clinicians and patients and, ultimately, diminished patient trust in clinicians and eventual self-discharge. They call for design of interventions to reduce the occurrence of this potentially dangerous phenomenon. This study was supported by the Agency for Healthcare Research and Quality (HS13903).
See "Hospital self-discharge among adults with sickle-cell disease (SCD): Associations with trust and interpersonal experiences," by Carlton Haywood, Jr., Ph.D., Sophie Lanzkron, M.D., Neda Ratanawongsa, M.D., and others in the Journal of Hospital Medicine 5, pp. 289-294, 2010.