Psychiatric diagnosis–medication concordance and hospital stay outcomes in acute medical in-patients: evidence from a tertiary care centre in Pakistan
Abdullah Umer, Nimarta Heman, Amir Aibani, Muneeba Amin, Ainan Arshad, Sher Muhammad SethiBackground
Concurrent psychiatric care in medical in-patients is associated with adverse hospital stay outcomes, but data from low- and middle-income countries is limited.
Aims
We aimed to investigate the association between psychiatric diagnosis–medication concordance and discharge disposition outcomes in acute medical in-patients.
Method
This was a retrospective cross-sectional analysis of 16 868 adults presenting to the Department of Internal Medicine at Aga Khan University Hospital, Karachi, Pakistan (2018–2022) with specified acute care conditions. Patients were classified into four groups based on presence of a psychiatric diagnosis and/or psychiatric medication use: neither, medication without diagnosis, diagnosis without medication and both. Primary adverse outcomes were in-hospital mortality and leaving against medical advice. Multinomial logistic regression was used, adjusting for age, gender, Charlson Comorbidity Index score, medication burden and individual acute medical conditions.
Results
A total of 2527 (15.0%) patients had a documented psychiatric diagnosis; however, 6279 (37.2%) received at least one psychiatric medication. Referencing patients with neither exposure, those receiving psychiatric medications without a documented diagnosis had the highest adjusted odds of mortality (adjusted odds ratio (aOR) 1.95, 95% CI 1.74–2.19, p < 0.001) and higher odds of leaving against medical advice (aOR 1.21, 95% CI 1.06–1.39, p = 0.006). Patients with a documented diagnosis but no psychiatric medications had higher odds of leaving against medical advice (aOR 1.28, 95% CI 1.04–1.57, p = 0.022) without a significant increase in mortality (aOR 1.21, 95% CI 0.98–1.49, p = 0.076). Patients with both a diagnosis and psychiatric medication usage showed no significant change in either outcome.
Conclusions
Diagnosis–treatment concordance may be associated with in-patient prognosis in acute care conditions.