TY - JOUR
T1 - What factors contributed to the misconduct of health practitioners?
T2 - An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016
AU - Hulme, Shann
AU - Hughes, Caitlin Elizabeth
AU - Nielsen, Suzanne
PY - 2019/5/9
Y1 - 2019/5/9
N2 - Introduction and Aims: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. Design and Methods: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. Results: Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63–640.11) and pharmacists (AOR 85.59, 95% CI 5.08–1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80–97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01–0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50–157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24–20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52–41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. Discussion and Conclusions: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.
AB - Introduction and Aims: Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. Design and Methods: Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. Results: Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63–640.11) and pharmacists (AOR 85.59, 95% CI 5.08–1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80–97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01–0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50–157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24–20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1.52–41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. Discussion and Conclusions: Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs.
KW - health practitioners’ misconduct
KW - overprescribing
KW - pharmaceutical diversion
KW - prescription drug misuse
KW - supply
UR - http://www.scopus.com/inward/record.url?scp=85065481075&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/nhmrc/1132433
U2 - 10.1111/dar.12918
DO - 10.1111/dar.12918
M3 - Article
C2 - 30887600
AN - SCOPUS:85065481075
SN - 0959-5236
VL - 38
SP - 366
EP - 376
JO - Drug and Alcohol Review
JF - Drug and Alcohol Review
IS - 4
ER -