1977 年至 2013 年期间，美国麻醉学培训后医生的物质使用障碍。

Substance Use Disorder in Physicians after Completion of Training in Anesthesiology in the United States from 1977 to 2013.

机构信息

From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota (D.O.W., K.B.) the American Board of Anesthesiology, Raleigh, North Carolina (D.O.W., H.S., A.H., T.W.).

出版信息

Anesthesiology. 2020 Aug;133(2):342-349. doi: 10.1097/ALN.0000000000003310.

DOI:10.1097/ALN.0000000000003310

PMID:32282430

Abstract

BACKGROUND

Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence and outcomes of substance use disorder that resulted in either a report to a certifying body or death in physicians after the completion of anesthesiology training.

METHODS

Physicians who completed training in U.S. anesthesiology residency programs from 1977 to 2013 and maintained at least one active medical license were included in this retrospective cohort study (n = 44,736). Substance use disorder cases were ascertained through records of the American Board of Anesthesiology and the National Death Index.

RESULTS

Six hundred and one physicians had evidence of substance use disorder after completion of training, with an overall incidence of 0.75 per 1,000 physician-years (95% CI, 0.71 to 0.80; 0.84 [0.78 to 0.90] in men, 0.43 [0.35 to 0.52] in women). The highest incidence rate occurred in 1992 (1.79 per 1,000 physician-years [95% CI, 1.12 to 2.59]). The cumulative percentage expected to develop substance use disorder within 30 yr estimated by Kaplan-Meier analysis equaled 1.6% (95% CI, 1.4 to 1.7%). The most common substances used by 353 individuals for whom information was available were opioids (193 [55%]), alcohol (141 [40%]), and anesthetics/hypnotics (69 [20%]). Based on a median of 11.1 (interquartile range, 4.4 to 19.8) yr of follow-up, the cumulative proportion of survivors estimated to experience at least one relapse within 30 yr was 38% (95% CI, 31 to 43%). Of the 601 physicians with substance use disorder, 114 (19%) were dead from a substance use disorder-related cause at last follow-up.

CONCLUSIONS

A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive.

摘要

背景

医生的药物使用障碍会使医生及其患者面临重大风险。关于医生药物使用障碍的流行病学和结果的数据很少，但可以指导政策制定和个人治疗决策。本文描述了在完成麻醉学培训后，导致向认证机构报告或导致医生死亡的药物使用障碍的发生率和结果。

方法

本回顾性队列研究纳入了 1977 年至 2013 年期间在美国完成麻醉学住院医师培训且至少持有一个有效行医执照的医生（n=44736）。通过美国麻醉学委员会和国家死亡指数的记录来确定药物使用障碍病例。

结果

601 名医生在培训完成后有药物使用障碍的证据，总体发生率为每 1000 名医生年 0.75 例（95%CI，0.71 至 0.80；男性为 0.84 [0.78 至 0.90]，女性为 0.43 [0.35 至 0.52]）。发病率最高的年份是 1992 年（每 1000 名医生年 1.79 例[95%CI，1.12 至 2.59]）。通过 Kaplan-Meier 分析估计，在 30 年内预计会发生药物使用障碍的累积百分比为 1.6%（95%CI，1.4 至 1.7%）。在 353 名提供信息的个人中，最常见的药物是阿片类药物（193 名[55%]）、酒精（141 名[40%]）和麻醉剂/催眠药（69 名[20%]）。基于中位数为 11.1 年（四分位距，4.4 至 19.8 年）的随访，估计在 30 年内至少有一次复发的幸存者累积比例为 38%（95%CI，31 至 43%）。在 601 名有药物使用障碍的医生中，有 114 名（19%）在最后一次随访时因药物使用障碍相关原因死亡。