Rose John S, Campbell Michael, Skipper Gregory
University of California Davis School of Medicine, Department of Emergency Medicine, Sacramento, California.
Institute for Behavior and Health, Inc., Rockville, Maryland.
West J Emerg Med. 2014 Feb;15(1):20-5. doi: 10.5811/westjem.2013.7.17871.
Emergency physicians (EPs) are reported to have a higher rate of substance use disorder (SUD) than most specialties, although little is known about their prognosis. We examined the outcomes of emergency physician compared to other physicians in the treatment of substance use disorders in Physician Health Programs (PHP).
This study used the dataset from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 56 EPs to 724 other physicians. Main outcome variables were rates of relapse, successful completion of monitoring, and return to clinical practice.
EPs had a higher than expected rate of SUD (odds ratio [OR] 2.7 confidence interval [CI]: 2.1-3.5, p<0.001). Half of each group (49% of EPs and 50% of the others) enrolled in a PHP due to alcohol-related problems. Over a third of each group (38% of EPs and 34% of the others) enrolled due to opioid use. During monitoring by the PHPs, 13% of EPs had at least one positive drug test compared to 22% of the other physicians; however, this difference was not significant (p=0.13). At the end of the 5-year follow-up period, 71% of EPs and 64% of other physicians had completed their contracts and were no longer required to be monitored (OR 1.4 [CI: 0.8-2.6], p = 0.31). The study found that the proportion of EPs (84%) continuing their medical practice was generally as high as that of other physicians (72%) (OR 2.0 [CI: 1.0-4.1], p = 0.06).
In the study EPs did very well in the PHPs with an 84% success rate in completion and return to clinical practice at 5 years. Of the 3 outcome variables measured, rates of relapse, successful completion of monitoring, and return to clinical practice, EPs had a high rate of success on all variables compared to the other physician cohort. These data support the conclusion that EM physicians do well following treatment of SUD with monitoring in PHPs and generally return to the practice of emergency medicine.
据报道，急诊医生（EP）的物质使用障碍（SUD）发生率高于大多数专科，但对其预后了解甚少。我们在医生健康项目（PHP）中研究了急诊医生与其他医生在物质使用障碍治疗方面的结果。
本研究使用了一项为期5年的纵向队列研究数据集，该研究涉及1995年至2001年期间连续被16个州的PHP收治的904名被诊断为SUD的医生。我们将56名急诊医生与724名其他医生进行了比较。主要结局变量为复发率、监测成功完成率和重返临床实践率。
急诊医生的SUD发生率高于预期（优势比[OR]2.7，置信区间[CI]：2.1 - 3.5，p < 0.001）。每组中有一半（49%的急诊医生和50%的其他医生）因酒精相关问题参加了PHP。每组中超过三分之一（38%的急诊医生和34%的其他医生）因使用阿片类药物而参加。在PHP的监测期间，13%的急诊医生至少有一次药物检测呈阳性，而其他医生为22%；然而，这种差异不显著（p = 0.13）。在5年随访期结束时，71%的急诊医生和64%的其他医生完成了他们的合同，不再需要监测（OR 1.4[CI：0.8 - 2.6]，p = 0.31）。研究发现，继续从事医疗工作的急诊医生比例（84%）总体上与其他医生（72%）一样高（OR 2.0[CI：1.0 - 4.1]，p = 0.06）。
在该研究中，急诊医生在PHP中表现良好，5年时完成治疗并重返临床实践的成功率为84%。在所测量的3个结局变量中，即复发率、监测成功完成率和重返临床实践率，与其他医生队列相比，急诊医生在所有变量上的成功率都很高。这些数据支持这样的结论，即急诊医生在PHP中接受SUD监测治疗后表现良好，并且通常会重返急诊医学实践。
