Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Leaving a hospital against medical advice (AMA) is a growing public health challenge in North America, particularly among people who inject drugs (IDU). Of concern is the fact that discharge AMA has been linked to significant healthcare costs and individual-level harms, including readmission with a more serious form of an initial illness and mortality. Given that little is known about the circumstances that influence discharge AMA among IDU, the proposed research will seek to investigate individual and contextual factors that are associated with elevated risk of discharge AMA among IDU in Vancouver, Canada. Furthermore, this research will explore potential novel, low-threshold approaches to delivering care to IDU and thereby minimizing discharge AMA among this population. Specifically, the proposed research will evaluate an existing low-threshold community-based program that provides medical care and support for IDU who require long-term intravenous (IV) antibiotic treatment, the Community Transitional Care Team, and its impact on IV antibiotic treatment completion and hospital readmission rates. Additionally, a needs assessment of a supervised drug consumption facility operating within a hospital setting will be conducted as a potential intervention for reducing discharge AMA among this population. Data for this research will be collected from IDU residing in the Greater Vancouver area, and will be augmented by external hospital and public health databases. Given the lack of available evidence on discharge AMA among IDU, findings from this research will aim to provide critical knowledge needed for developing and implementing relevant policies and programs that aim to improve the health of this population.