Introduction:Discharge Against Medical Advice (DAMA) serves as a critical indicator of healthcare quality, often resulting in adverse clinical outcomes and substantial economic strain. This study was undertaken to map DAMA prevalence, identify underlying risk factors, and evaluate effective interventions within both global and Iranian contexts.
Methods: Adopting a scoping review approach based on the Arksey and O’Malley framework, a systematic search was conducted across major databases, identifying 36 eligible articles. Data synthesis involved descriptive analysis to determine prevalence and inductive thematic analysis to extract core conceptual themes.
Results: The analysis yielded three primary themes (risk factors, causes, and effective interventions) and 11 sub-themes. The overall mean prevalence of DAMA was estimated at 5.28%, though rates in psychiatric departments were notably higher at 15.45%. Demographic variables, financial barriers, and breakdowns in professional communication emerged as the most significant predictors. Key mitigation strategies included early screening for high-risk patients and the prioritization of patient-centered care models.
Conclusion: Elevated DAMA rates underscore systemic management failures and fundamental gaps in healthcare quality and equity. Addressing this phenomenon requires a strategic policy shift toward mandatory professional standards, enhanced clinical communication skills, and reformed social support structures to prevent resource wastage and safeguard health system effectiveness.