Mon, Feb 13, 2017, noon:
Daniel Almirall, "Getting SMART about adaptive interventions"
Leinberger, Rebecca, Nancy K. Janz, David C. Musch, Leslie M. Niziol, and Brenda W. Gillespie. 2013. "Discussing Driving Concerns With Older Patients I. Vision Care Providers' Attitudes and Behaviors." JAMA Ophthalmolgy, 131(2): 205-212.
Objective: To investigate the perspectives of vision care providers (VCPs) on inquiring about driving among their older adult patients.
Methods: We surveyed a stratified random sample of 500 VCPs, 404 of whom completed the survey (response rate, 80.8%), who had been identified using membership lists of the Michigan Optometric Association and the Michigan Society of Eye Physicians and Surgeons. The survey assessed VCPs' attitudes and behaviors in addressing driving concerns with older patients. Ordinal logistic regression analyses were performed to identify associations between provider or practice characteristics and survey responses.
Results: More than 80% of VCPs are confident in their ability to determine whether their patients' vision is adequate for safe driving. The VCPs cite liability risk (for reporting [24.2%] and for not reporting [43.6%]) as a barrier to reporting unsafe drivers. Almost two-thirds report routinely inquiring about their older patients' driving, and 86.3% consider that counseling patients about driving is their responsibility. Almost 60% (57.2%) worry that reporting patients negatively influences the physician-patient relationship, and 43.1% consider that reporting is a breach of physician-patient confidentiality. Attitudes and behaviors in discussing driving varied by VCP characteristics, particularly provider type. More than one-third of VCPs (35.6%) report sometimes, often, or always communicating concerns about patients' driving to their primary care physician. Resources endorsed by VCPs as helpful or very helpful include driving assessment guidelines (80.5%), clinical screening instruments (70.1%), and patient self-assessment tools (59.9%).
Conclusion: While VCPs view that advising patients about driving is an important responsibility, further attention should be given to addressing barriers, providing resources, and devising communication strategies between VCPs and other members of the health care team.