Skipper Gregory E, Campbell Michael D, Dupont Robert L
Department of Medicine, University of Alabama School of Medicine, Montgomery, Alabama, USA.
Anesth Analg. 2009 Sep;109(3):891-6. doi: 10.1213/ane.0b013e3181adc39d.
Anesthesiologists have a higher rate of substance use disorders than other physicians, and their prognoses and advisability to return to anesthesiology practice after treatment remain controversial. Over the past 25 yr, physician health programs (PHPs), created under authority of state medical regulatory boards, have become primary resources for management and monitoring of physicians with substance abuse and other mental health disorders.
We conducted a 5-yr, longitudinal, cohort study involving 904 physicians consecutively admitted to 1 of 16 state PHPs between 1995 and 2001. This report analyzed a subset of the data involving the 102 anesthesiologists among the subjects and compared them with other physicians. The main outcome measures included relapse (defined as any unauthorized addictive substance use, including alcohol), return to anesthesiology practice, disciplinary actions, physician death, and patient harm.
Anesthesiologists were significantly less likely to enroll in a PHP because of alcohol abuse (odds ratio [OR] 0.4 [confidence interval {CI}: 0.2-0.6], P < 0.001) and much more likely to enroll because of opioid abuse (OR 2.8 [CI: 1.7-4.4], P < 0.001). Anesthesiologists had a higher rate of IV drug use, 41% vs 10% (OR 6.3 [CI: 3.8-10.7], P < 0.001). During similar periods of monitoring, anesthesiologists received more drug tests, 101 vs 82 (mean difference = 19 [CI: 3-35], P = 0.02); however, anesthesiologists were less likely to fail at least one drug test during monitoring, 11% vs 23% (OR 0.4 [CI: 0.2-0.9], P = 0.02). There was no statistical difference among rates of program completion, disciplinary actions, return to practice, or deaths, and there was no report of significant patient harm from relapse in any record.
Anesthesiologists in our sample treated and monitored for substance disorders under supervision of PHPs had excellent outcomes similar to other physicians, with no higher mortality, relapse rate, or disciplinary rate and no evidence in their records of patient harm. It is postulated that differences of study design account for contradictory conclusions from other reports.
麻醉医生物质使用障碍的发生率高于其他医生，其预后以及治疗后能否重返麻醉医生岗位仍存在争议。在过去25年中，依据州医学监管委员会授权设立的医生健康项目（PHP）已成为管理和监测存在药物滥用及其他心理健康障碍医生的主要资源。
我们进行了一项为期5年的纵向队列研究，研究对象为1995年至2001年间连续入住16个州PHP中1个项目的904名医生。本报告分析了其中涉及102名麻醉医生的数据子集，并将他们与其他医生进行比较。主要观察指标包括复发（定义为任何未经授权使用成瘾性物质，包括酒精）、重返麻醉医生岗位、纪律处分、医生死亡以及患者伤害。
麻醉医生因酒精滥用而参加PHP的可能性显著更低（优势比[OR]0.4[置信区间{CI}：0.2 - 0.6]，P < 0.001），而因阿片类药物滥用参加的可能性则高得多（OR 2.8[CI：1.7 - 4.4]，P < 0.001）。麻醉医生静脉注射吸毒的比例更高，分别为41%和10%（OR 6.3[CI：3.8 - 10.7]，P < 0.001）。在相似的监测期内，麻醉医生接受的药物检测更多，分别为101次和82次（平均差值 = 19[CI：3 - 35]，P = 0.02）；然而，麻醉医生在监测期间至少有一次药物检测不合格的可能性更低，分别为11%和23%（OR 0.4[CI：0.2 - 0.9]，P = 0.02）。项目完成率、纪律处分率、重返岗位率或死亡率之间无统计学差异，且在任何记录中均未报告因复发导致患者受到重大伤害。
在PHP监督下接受物质障碍治疗和监测的我们样本中的麻醉医生，其结果与其他医生类似，死亡率、复发率或纪律处分率并未更高，且记录中没有患者受到伤害的证据。据推测，研究设计的差异导致了与其他报告相互矛盾的结论。
