Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns

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Abstract

Objective

To provide an overview of the evidence regarding outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns, and to explore if outcomes differ for specific concerns and professions.

Methods

A search in four databases (Medline, Embase, PsycINFO and CINAHL) was conducted from 1 January 1990 to 7 May 2017. Studies reporting on outcomes of nationwide and state-wide programmes aimed at remediation and rehabilitating healthcare professionals with performance concerns (ie, dentists, midwives, nurses, pharmacists, physicians, physiotherapists, psychologists and psychotherapists) were included.

Results

We included a total of 38 studies. More than half of the studies included programmes in the USA (57.9%), and a majority of studies focused on outcomes for physicians (78.9%) and on outcomes for substance use disorders (SUDs, 63.2%). Programme completion rates for SUDs were positive and approximately 80%–90% of participants were employed after treatment. Studies that reported on remediation outcomes for dyscompetence, almost all from Canada (7/8), showed varying results. One study compared outcomes for performance concerns in the same programme (ie, SUD and other mental and behavioural problems) and showed comparably successful results. No study specifically compared outcomes between professions.

Conclusion

The literature is dominated by outcomes for physicians in North American programmes, with positive outcomes for SUD and varying outcomes for dyscompetence. Based on our findings we cannot make valid comparisons in outcomes between professions and specific performance concerns, and we call for other programmes to report on outcomes for different professions and concerns. Because of the positive outcomes of physician health programmes, other countries should consider introducing similar programmes to support healthcare professionals getting back on track.

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