Spittal Matthew J, Studdert David M, Paterson Ron, Bismark Marie M
Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
Stanford University School of Medicine and Stanford Law School, 117 Encina Commons, Stanford, CA, 94305, USA.
BMC Med. 2016 Dec 2;14(1):198. doi: 10.1186/s12916-016-0748-6.
Medical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions.
We conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30-54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration.
There were 8307 notifications. The notification rate was highest among doctors (IR = 29.0 per 1000 practitioner years) and dentists (IR = 41.4) and lowest among nurses and midwives (IR = 4.1). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors.
Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.
医学委员会及其他从业者委员会旨在保护公众免受不安全执业行为的侵害。以往的研究考察了针对医生的纪律处分，但其他职业（如护士和助产士、牙医、心理学家、药剂师）仍未得到充分研究。我们试图描述澳大利亚十个职业的健康从业者在健康、执业表现和行为方面受到关注的通报结果，并确定与采取限制行动相关的因素。
我们对在24个月内向澳大利亚健康从业者监管局提交的所有通报进行了一项回顾性队列研究。对通报进行了30至54个月的跟踪。我们的主要结果是限制行动，定义为施加承诺、条件或暂停或取消注册的决定。
共有8307份通报。通报率在医生中最高（发病率=每1000名从业者年29.0例）和牙医中（发病率=41.4），在护士和助产士中最低（发病率=4.1）。十分之一的通报导致了限制行动；不到300份通报中有一份导致注册被暂停或取消。与关于临床护理的通报相比，与健康损害（药物滥用，比值比=7.0；酒精滥用，比值比=4.6；精神疾病，比值比=4.1，身体或认知疾病，比值比=3.7）、非法开药或用药（比值比=2.1）以及违反性界限（比值比=1.7）相关的通报采取限制行动的几率更高。由另一名健康从业者（比值比=2.9）或雇主（比值比=6.9）而非患者或亲属提出报告时，采取限制行动的几率更高。护士和助产士（比值比=1.8）、心理学家（比值比=4.5）、牙医（比值比=4.7）以及其他健康从业者（比值比=5.3）受到限制行动的几率均高于医生。
限制行动是健康从业者委员会为保护公众免受伤害所能采取的最有力措施，这些行动可能会对从业者的生计、声誉和福祉产生深远影响。在澳大利亚，很少实施限制行动，其使用情况因通报来源、所涉问题类型以及从业者职业而异。
