Physician Warnings in Psychiatry and the Risk of Road Trauma: An Exposure Crossover Study
Physician Warnings in Psychiatry and the Risk of Road Trauma: An Exposure Crossover Study
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DOI：
10.4088/jcp.15m10224
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发表时间：
2016-10-01
影响因子：
5.3
通讯作者：
Redelmeier, Donald A.
中科院分区：
文献类型：
--
作者：
Lustig, Andrew J.;Kurdyak, Paul A.;Redelmeier, Donald A.
目的：确定医生对精神病患者的警告是否会改变随后的机动车碰撞频率。次要目标是确定医生警告是否会改变随后精神科住院的频率。方法：23，145例ICD-9精神分裂症患者的暴露交叉设计（代码295），情绪障碍（296），人格障碍（301），或物质使用障碍（303，304）并在2006年4月1日至2011年3月31日期间被医生警告驾驶安全。每例患者在警告前和警告后分别随访4年和1年。居住在该地区以外或缺乏有效健康卡号码的患者被排除在外。结果：在医生警告后，患者的机动车碰撞频率从每1,000名患者每年11.78起下降到8.17起，相对危险度为0.69（95%CI，0.59-0.81; P <0.001）。精神病住院频率从147例/1,000例患者每年增加到289例/1,000例患者每年，相应的相对危险度为1.97（95%CI，1.91-2.03; P <0.001）。结论：医生警告与随后的机动车碰撞频率降低和精神病住院频率增加相关。这一结果表明，医生警告是一种有效的干预措施，以减少道路创伤，但需要权衡对潜在的不利精神健康。(C)版权所有2016 Physicians Postgraduate Press，Inc.
Objective: To determine if physician warnings to psychiatric patients alter the subsequent frequency of a motor vehicle crash. A secondary objective was to determine if physician warnings change the subsequent frequency of psychiatric hospitalization.Methods: Exposure crossover design of 23,145 psychiatric patients diagnosed with ICD-9 schizophrenia (code 295), mood disorder (296), personality disorder (301), or substance use disorder (303, 304) and warned by their physician about driving safety between April 1, 2006, and March 31, 2011. Each patient was followed for 4 years before the warning and 1 year after the warning. Patients living outside the region or lacking a valid health card number were excluded.Results: Patients' motor vehicle crash frequency decreased from 11.78 to 8.17 events per 1,000 patients per year after a physician warning, which corresponded to a relative risk of 0.69 (95% CI, 0.59-0.81; P < .001). Psychiatric hospitalization frequency increased from 147 to 289 events per 1,000 patients per year corresponding to a relative risk of 1.97 (95% CI, 1.91-2.03; P < .001).Conclusions: Physician warnings are associated with a subsequent decreased frequency of motor vehicle crashes and increased frequency of psychiatric hospitalization. This result suggests that physician warnings are an effective intervention for reducing road trauma but need to be weighed against potential adverse psychiatric health. (C) Copyright 2016 Physicians Postgraduate Press, Inc.