Physicians and nurses in Sweden who reported problem drinking or illicit drug use may have been more likely to rate the quality of care they provided to patients as poor 1 year later, according to a longitudinal study.
The study analyzed panel data from the Longitudinal Occupational Health Survey in Healthcare Sweden, collected in 2022 and 2023. The final sample included 3,280 health care workers aged 69 years or younger, including 1,649 physicians and 1,631 nurses.
At baseline, 3.8% of the participants met criteria for problem drinking, defined using a modified version of the Cut, Annoyed, Guilty, and Eye opener questionnaire. Illicit drug use, defined as nonprescribed stimulant or cannabis use at least a few times in the prior year, was reported by 1.3%.
Physicians reported a higher prevalence of illicit drug use compared with nurses (1.8% vs 0.9%), while nurses reported a higher prevalence of problem drinking (4.4% vs 3.3%). Both exposures were more common among male participants. Illicit drug use was more prevalent among those with fewer than 15 years of work experience, whereas problem drinking was more common among those with 15 years or more of experience.
At follow-up, 15.9% of the full sample rated the quality of care they provided as poor. That proportion increased to 28.9% among those who reported illicit drug use at baseline and 25% among those with problem drinking at baseline.
In adjusted analyses accounting for profession, sex, and years of experience, both illicit drug use and problem drinking remained associated with poor self-rated quality of care at follow-up. There was no statistically significant difference in subsequent self-rated care quality between nondrinkers and non-problem drinkers.
The findings were generally consistent across sensitivity analyses using alternative cutoffs for exposure and outcome measures, although the association between illicit drug use and care quality was no longer statistically significant under a stricter definition of poor care.
“This novel longitudinal study shows that health care workers reporting substance use at baseline were about twice as likely to report providing poor quality of care 1 year later,” wrote lead study author Josefina Peláez Zuberbuhler, PhD, of the Unit of Occupational Medicine at the Institute of Environmental Medicine at the Karolinska Institutet as well as the Department of Leadership and Organization at the Kristiania University College in Oslo, and colleagues.
The investigators noted several limitations. Substance use and care quality were self-reported, which may have led to underreporting because of stigma or fear of professional consequences. Response rates were modest—32% at baseline and 35% at follow-up—raising the possibility of selection bias. In addition, quality of care was measured only at follow-up, preventing adjustment for baseline care quality. The illicit drug use measure relied on brief survey items and didn't capture self-prescribed narcotic-classified medications.
The study was conducted in the aftermath of the COVID-19 pandemic, a period associated with elevated stress and increased substance use in health care settings, which may have limited generalizability of prevalence estimates.
The investigators emphasized the importance of nonpunitive approaches to substance use in health care, including clinician health programs, peer assistance initiatives, and workplace-based early support systems.
“Confidential pathways for seeking help and preventive interventions are vital to protect both health care workers’ well-being and patient safety,” the study authors concluded.
The study was funded by Afa Insurance. The investigators reported no competing interests.