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Substance misuse ‘common issue’ at PHMP

By Dermot - 04th Apr 2017

Substance misuse was the most common stand-alone presenting problem for patients attending a specialist health service for doctors, dentists and pharmacists, its first report reveals.

The Practitioner Health Matters Programme (PHMP) is a confidential service which provides support and medical care for practitioners suffering stress and mental health difficulties, or who may have an alcohol or drug misuse problem. It was established in recognition of the particular barriers to seeking support that may be experienced by healthcare professionals suffering from sensitive health issues. The programme’s first report covers the period September 2015, when it officially launched, up to December 2016.

There are 47 practitioner patients registered with the PHMP from across the professions of medicine, dentistry, pharmacy and nursing. The majority are doctors and particularly NCHDs (21 practitioners) and GPs (14 practitioners). In percentage terms, 49 per cent of patients are NCHDs, 30 per cent GPs, 7 per cent consultants, 6 per cent dentists and 4 per cent pharmacists. Nurses and medical students each represent 2 per cent of practitioner patients.

Thirty practitioners had a single presenting problem at registration, while 17 had more than one problem on presentation, according to the PHMP report. “Substance misuse was the most common stand-alone presenting problem for practitioner patients (n=15), followed by anxiety (n=6) and depression (n=4). Where practitioners presented with a combination of issues, depression was the most common presentation (n=13) followed by anxiety (n=10) and substance misuse in combination with other symptoms being found in a further seven cases.”

Contact with the PHMP can be made via a confidential email address or designated telephone number, both of which are available on the programme’s website Practitioners may self-refer or can be referred by others, such as a family member, colleague or GP. Referrals can also be made by a training body or by the practitioner’s employer. “At all times, confidentiality is of paramount importance. PHMP has developed strong links with some external providers and accepts referrals following inpatient admissions,” stated the report.

Almost half of all referrals were self-referrals (22). There were eight referrals made by a consultant psychiatrist and six practitioner patients were referred by a colleague. The remainder of referrals were made by the practitioners’ GP (3), employer (2), regulator (2), training body (2), ICGP Health in Practice programme (1) and hospital occupational health services (1).

The largest number of registrations were represented in the age groups 30-39 (n=13) and 50-59 (n=13), with fewest practitioner patients in the 60-to-69 age group (n=3).

Female practitioners represented just under half of the total registered practitioner patients (n=23). The numbers of females were greater than their male counterparts in the both the youngest and oldest age groups; in the age 24-to-29 and age 60-to-69 groups, they represented 70 per cent and 67 per cent, respectively, of practitioners. The 24-to-29 age group also represented the greatest individual numbers of female practitioners in one group (n=8).

Male practitioner patients represented just over half of the total practitioner population (n=24). Males were registered in greatest numbers in the 30-to-39 and 50-to-59 age groups (n=8, both) and least in the 24-to-29 age group (n=3, 30 per cent).

According to the report, over half of all practitioner patients registered on the programme have continued working in their professions and, with the support provided by PHMP, did not require taking time off work. “Six practitioner patients were required to stop working for a period of time but have now either returned or are returning to work in the near future. Seven patients are not currently working; of these six patients, one has retired and the others are deemed unfit for practice and are under ongoing review.”

The PHMP anticipates that, with further awareness of the programme, it will serve as an increasingly important service for practitioners. “Demands to expand the programme will require additional funding and resources and we look to all the relevant bodies to support us in our endeavours to develop the service further in 2017.”  It noted that practitioner health programmes are being developed across Europe, Australia and the US.

Based on international statistics, there remains “a significant cohort of practitioners” who may be experiencing difficulties but who have yet to seek advice and support, stated the report.

“Estimates would indicate that between 12 per cent and 15 per cent of practitioners may experience problems with mental health or substance use issues. Current prevalence rates are not available in Ireland but based on the estimates from other jurisdictions, we would anticipate that in excess of 2.000 practitioners may require help on an annual basis.”

The programme’s aims for 2017 include exploring options for a more secure funding basis; engaging in an awareness-raising campaign; evaluating its initial assessment procedures and review processes to ensure they are fit-for-purpose; and seeking feedback from specialist services with which it partners.

The PHMP underlines that it operates separately from the regulatory and professional bodies. The principles of the programme, however, are endorsed by the three regulatory bodies and it has a Memorandum of Understanding (MoU) with the Medical Council, Dental Council and Pharmaceutical Society of Ireland. “The programme has also been recognised by representative organisations for the three professions… and the professional training bodies, as well as by the HSE. A range of funding has been provided by these professional bodies, as well as contributions from individual participants.”

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