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Accident Analysis and Prevention 61 (2013) 222– 232

Contents lists available at ScienceDirect

Accident Analysis and Prevention

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valuation of curriculum to improve health professionals’ ability to managege-related driving impairments

inda L. Hill ∗, Jill Rybar, Tara Styerraining, Research, and Education for Driving Safety, Center for Injury Epidemiology Prevention Research Center, School of Medicine, University of California, San Diego, United States

r t i c l e i n f o

rticle history:eceived 20 April 2012eceived in revised form 1 September 2012ccepted 10 September 2012

eywords:lder adult driverrofessional trainingandated reporting

a b s t r a c t

As our elderly population increases in proportion with respect to the rest of society, age-related drivingimpairments are increasing in importance as a public health concern. In this context, health profession-als play an important role in identifying impaired drivers. This situation is complicated for two reasons:discussion of driving cessation is a sensitive topic for both health professionals and the elderly, and physi-cians have limited familiarity with the current American Medical Association (AMA) screening guidelinesor mandated reporting laws.

To assess curriculum that trains health professionals to increase their awareness, screening, manage-ment, and reporting of age-related driving impairments.

Between 2009 and September 2011, 47 trainings were delivered to 1202 health professionals. Themajority of trainings were seminars or lectures lasting 1 h; all were conducted in southern California.

The training curriculum was divided into four sections: introduction and background; screening andinterpretation; managing outcomes and reporting; and referrals and resources. Videos addressed broach-ing the topic with patients and counseling on driving cessation.

The curriculum was delivered by physicians with the support of public health-trained program staff.Pre- and post-testing was done with 641 of the participants; the majority were physicians. Post-training,participants’ confidence in ability to screen increased to 72% and intent to screen increased to 55%. Fully92% stated they had developed a better understanding of California’s mandated reporting laws. Similarly,92% said they had developed a better understanding of the medical conditions and medications that

may impair older adults’ ability to drive safely. Furthermore, 91% said mandated-reporting laws helpedprotect the safety of patients and others, and 59% said it was easier to discuss and justify driving cessationwith patients.

In-person training of health professionals on age-related driving impairments was well received andresulted in increased self-reported knowledge, confidence to screen, and intent to screen. Physicianswere supportive of mandatory reporting laws.

. Introduction

As our aging population grows in proportion to the rest ofociety, age-related driving impairments are increasing in impor-ance as a public health concern. The population of individualsver 65 years is the fasting growing population in the countryUnited States Census Bureau, 2011). Between 1997 and 2007,he total number of licensed drivers increased by 13%, with older

rivers comprising 15% in 2007 (National Highway and Trafficafety Association, 2008). Not only are people living longer, buthey are maintaining their driver’s licenses longer. In 2009, 84% of

∗ Corresponding author at: 9500 Gilman Dr., MS 0811 La Jolla, CA 92093-0811,nited States. Tel.: +1 619 840 6258; fax: +1 858 534 9404.

E-mail address: llhill@ucsd.edu (L.L. Hill).

001-4575/$ – see front matter © 2012 Elsevier Ltd. All rights reserved.ttp://dx.doi.org/10.1016/j.aap.2012.09.026

© 2012 Elsevier Ltd. All rights reserved.

those 70 and older had driver’s licenses, compared to 66% in 1990(Federal Highway Administration, 2011).

Seniors suffer from declining vision, physical limitations, and,depending on the individual, possibly cognitive impairment. Thosewith chronic medical conditions typically take associated medica-tions, which can also affect their responses behind the wheel. In thiscontext, those over 65 accounted for 8% of injury crashes, makingup 15% of all traffic fatalities in 2008 (National Highway and TrafficSafety Association, 2008). Death rates for VMT (vehicle miles trav-eled) begin to rise by age 65–69 and rise sharply after 74 (Li et al.,2003). Motor vehicles were among the leading causes of uninten-tional injury deaths among individuals 5–64 years and were the

second leading cause (after falls) of injury among people over age74 (Lin et al., 2011).

It is estimated that men, on average, outlive their ability to drivesafely by 6 years and women by 10 years. Thus, at some point,

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lder adults must address, with their physicians, the driving dan-er they present (Foley et al., 2002). However, the AMA pointsut that the topic is avoided by drivers and health professionalslike, and, furthermore, physicians are not aware of the AMA’screening guidelines (Slomski, 2010). In addition, driving is widelyegarded as a sign of independence and the ability to engage inociety (which characteristics some studies indicate contribute toongevity). When the decision to stop driving is made, an older adults likely to experience an increase in social isolation, a decrease inctivities outside the home (Marottoli et al., 2000), and an increasen symptoms of depression (Ragland et al., 2005). As a result, theMA requires individual assessment before recommending drivingessation.

Health professionals play an important role in identifyingmpaired drivers. Since 2003, the AMA has published clear guide-ines for physicians on how to screen and manage age-relatedriving impairments (American Medical Association, 2011). Theuidelines were revised in 2011. They outline screening for theommon conditions that lead to age-related driving impairments:educed vision, declining cognitive function, and frailty. The AMAecommends baseline screening beginning at age 65–70, with peri-dic screening after age 70. Their recommendations include takingaseline histories to identify, up front, issues of concern that cane monitored, including loss of consciousness, seizures, dementia,nd use of medications that could interfere with the ability to driveafely.

While state motor vehicle licensing agencies (in California, thisgency is called the Department of Motor Vehicles [DMV]) are alsorucial to managing impaired drivers, their ability to revoke driver’sicenses is hampered by physicians’ varying awareness of reportingolicies and procedures and their broad interpretation of them. Inhe U.S., for example, nine states mandate physician reporting forertain conditions. The California physician-reporting law stateshat physicians must report every patient diagnosed with a dis-rder characterized by lapses of consciousness. The law defineshis disorder further to include conditions that involve a reduc-ion of alertness or responsiveness to external stimuli; an inabilityo perform one or more activities of daily living; or an impairedensory motor function used to operate a motor vehicle (Californiaepartment of Motor Vehicles, 2011). This disorder can be causedy dementia and other diseases.

Against this background, we report here on the results of ourrogram to train health professionals to increase their awarenessf age-related driving impairments and their ability to screen andanage patients, and, when necessary, report on their conditions

o authorized agencies.

. Methods

.1. Development and piloting

This training program originated from a 2-year study titledRoad Safe Seniors (RSS)” conducted in 2007–2009. A convenienceample of 755 older adults completed age-related driving impair-ent screening at inpatient and outpatient health centers at theniversity of California, San Diego (Hill et al., 2011). Based on AMA

ecommendations, the screening included three strength/frailtyests, two vision tests (acuity and fields), and two cognitive tests.ssessment outcomes were scored as pass, fail, and incomplete.

The scoring criteria were adapted from the AMA score sheet andncluded medical history questions to capture individuals who may

equire reporting to the DMV. A pass score was given to those whouccessfully completed all portions of the AMA screening and didot have any medical conditions that would require DMV repor-ing. A fail score consisted of two parts: fail in the vision or frailty

Prevention 61 (2013) 222– 232 223

screens, or fail in the cognitive screen or medical history. Those whofailed the cognitive screen or indicated they had experienced a con-dition characterized by a lapse in consciousness required reportingto the DMV. An incomplete score was given to individuals who wereunable to complete one or more of the screens (e.g., if they weretethered to the bed or did not have reading glasses). The averageage of participants was 72.5; 55.5% were male and 94% English-speaking; 17.8% of this group failed at least one aspect of screening(Hill et al., 2011).

Physician involvement was critical throughout this study. Theparticipating physicians often expressed that they were not awareof the AMA screening guidelines and lacked confidence in theirabilities to assess older patients for driving fitness. Additionally,many were not aware that California law requires that all patientsdiagnosed with dementia be reported to the DMV.

Physician feedback caused us to develop and present severalpilot training lectures to physician audiences in 2008 and 2009.We then revised the curriculum based on physician questions andtheir requests that we include specific additional information (e.g.,reporting criteria). Based on interest in the pilot, we submitted agrant proposal in 2009 to the California Office of Traffic Safety totrain health professionals to assess older patients for impairmentsthat might impact driving. Project goals were to improve healthprofessionals’ intent to screen, and confidence in screening, olderpatients.

2.2. Implementation

Between October 2009 and September 2011, we conducted 47trainings of 1202 health professionals. Most trainings were semi-nars or lectures lasting 1 h except for two longer trainings thatprovided participants with practical, hands-on training. The authordelivered the seminars with support from the training team, whichincluded two staff members with a public health research back-ground. The target audience was primary care physicians who serveat least some proportion of older adults in their practices, occu-pational therapists, physical therapists, nurse practitioners, andphysician assistants.

To encourage participation, project staff accommodated thetime and geographic constraints of the practitioners and modifiedthe format at physician request. They also provided refreshments.The training was voluntary and, where allowed, Continuing Medi-cal Education (CME) credit was provided. To identify training sites,project staff reached out to various health care settings acrosssouthern California.

2.3. Course objectives and structure

The objectives of the training included that, at the conclusion oftraining, the recipients be able to do the following:

• Understand the safety risks of older drivers.• Identify conditions that may put patients at risk for unsafe driv-

ing.• Select the appropriate clinical screens to evaluate patients’ level

of function for driving fitness.• Describe referral and treatment options for patients determined

to be no longer fit to drive.• Demonstrate familiarity with California DMV reporting methods

and requirements.

The training curriculum (see Table 1) was divided into four sec-tions:

• Section 1: Introduction and background;

224 L.L. Hill et al. / Accident Analysis and Prevention 61 (2013) 222– 232

Table 1Training outline.

Section Topics Educational aids

Introduction and background Epidemiology; vision, frailty and cognitive decline; medications; older driverstatistics

Screening and interpretation 7 AMA screening tools: how to implement and interpret? Pocket guideManaging outcomes and reporting Algorithm for outcomes of screening; reporting to the DMV; DUI and Videos of physician–patient encounters

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distracted drivingReferrals and resources Occupational therapists; driving rehab sp

cessation; DMV ombudsman; other refer

Section 2: Screening and interpretation;Section 3: Managing outcomes and reporting;Section 4: Referrals and resources.

Section 1 covered the epidemiology of aging, including demo-raphic trends. It addressed medical conditions that can impairriving at all ages, with an emphasis on those likely to affectlder drivers: declining vision and cognitive function, and overallrailty (Fig. 1). It also reviewed medications that can impair drivingerformance. Data on older-driver, on-the-road performance andutcomes was also covered.

Section 2 elaborated on the seven tools recommended by the

MA (Fig. 2). The depth of explanation for how to perform eachf the tests varied with the audience. For example, it turned outhat the two vision tests (Snellen-type testing for visual acuitynd confrontational testing for visual fields) were more familiar to

Fig. 1. Pocket guide front.

sts; counseling for driverrces

Videos of physician patient encountersPocket guide

physicians than occupational and physical therapists. Both physi-cians and therapists, however, were familiar with frailty testing(timed gait, range of motion, and strength testing). The cognitivetests (clock drawing and trail-making B) were described in detailto both groups.

Section 2 included interpretation of the testing from a driv-ing safety perspective, with guidance on how to approach thosepatients who, based on initial results, required additional testing.A video was also presented to explain how to broach the need forscreening with older patients.

Section 3 included health recommendations to share withpatients who passed the screening, including promoting generalguidelines for healthy eating, daily physical activity, strong socialinteractions, and regular screening for disease. Participants wereencouraged, where appropriate, to recommend a driver educationrefresher course. Physicians (e.g., participants who could prescribemedication) were also encouraged to minimize the potential effectsof medication on driving by following evidence-based guidelines toprescribe the lowest effective dose of drugs necessary.

Section 3 also provided an algorithm to manage patients whodid not pass the screen. Based on the results of the screen, the algo-rithm advised the physician on appropriate steps to take with theindividual. Referral to a specialist was recommended to confirm thediagnosis, and detailed direction was provided on how to report tothe Department of Health Services and the state licensing agency(Fig. 1). A second video provided an example of how to counsel apatient about driving cessation.

Section 4 covered appropriate use of occupational therapists,driving rehabilitation specialists, and the Senior Driver Ombuds-man Program, which is unique to California’s DMV. (This latterresource consists of four specialists who provide support to olderdrivers in relation to re-testing and information to professionalsand the public regarding methods for reporting drivers and there-examination process.) Participants received a pocket guide (seeFig. 2) that itemized the seven AMA recommended tests (includinginterpretation) and listed resources and referral agencies (Fig. 3).

Pre- and post-testing (8 and 15 questions, respectively) wasanonymous and voluntary. The pre-test asked about the physician’spatient population, current screening and reporting practices, andconfidence in ability to screen older patients for age-related drivingimpairments. The post-test asked about their intent and confidenceto incorporate the training in their practices. Additionally, it askedparticipants if their understanding of the available resources, thereporting mandate, and counseling techniques had improved. Italso included questions about their attitudes towards mandatedDMV reporting of impaired drivers. Finally, it included questions togauge satisfaction with the training and collect feedback to improvethe curriculum (Appendices A and B).

The pre- and post-testing scores were not paired due to (1)concerns about confidentiality and (2) to avoid physicians com-pleting the post-test before the end of training because the pre- and

post-testing questions appeared in the same document. Frequently,the trainings were held during lunch hour, and often participantsjoined the training late or were unable to stay for the entirelecture.

L.L. Hill et al. / Accident Analysis and Prevention 61 (2013) 222– 232 225

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screening and screening rates were low, despite published AMAguidelines and DMV guidelines (both available on the web). In-person seminars and lectures lasting 1 h, delivered by a physician,increased both confidence in ability to screen and intent to screen.

Table 2Feedback.

Categories Identify new informationlearned

Professional changes thatyou intend to make

Responses • Options for on-roaddriving assessments andsimulators• California lawsconcerning reporting andphysician responsibility• The validity of the ARDDs

• Check patient’s meds anddisorders that can affectdriving• Identify DRS in thecommunity• Make hospital produce apolicy for reporting to the

Fig. 2. Poc

. Results

Pre- and post-testing was done with 641 of the participants. Ofhis group, 60% were clinicians (including MDs, Dos, nurse prac-itioners, and physician’s assistants), 20% occupational or physicalherapists, 5% nurses, 2% medical assistants, and 10% others. Mostf the clinicians (96% [45 of 47]) were in large group practices.

At baseline, participant confidence in screening was low, with8% reporting an absence of confidence in their skills. Screeningates at baseline were also low: 62% responded that they “rarely” ornever” screened their elderly patients, and 30% responded “some-imes”; only 8% screened “very often” or “always.”

Following training, participants “agreed” or “strongly agreed”hat their confidence in ability to screen older patients for age-elated driving impairments increased to 72% and their intent tossess their older patients for age-related driving impairmentsvery often” or “always” increased to 55%. Fully 92% of partici-ants “agreed” or “strongly agreed” that, as a result of the training,hey had a better understanding of California’s mandated repor-ing laws. Similarly, 92% “agreed” or “strongly agreed” that theyad developed a better understanding of the medical conditionsnd medications that might impair older adults’ ability to driveafely. Comments regarding the training were generally positivend reflected an intent to change behavior to include this kind ofcreening with their elderly patients (Table 2).

The majority of practitioners in this group of Californians sup-ort mandated reporting. Some 91% said the law helped protect

he safety of patients and others, 59% said it made them more will-ng to discuss driving cessation with patients, and 45% said the lawrotected them from liability. Those practitioners not in favor ofandated reporting cited several reasons: alienation of patients,

ide inside.

the compromise of confidentiality, and the lack of choice. Duringthe period 2009–2011, 303 of 314 practitioners indicated they werein favor of mandated reporting while 33 of 314 were not in favor.Significantly, 22 of the 314 clinicians selected both in favor and notin favor of the mandated reporting, presumably indicating mixedfeelings on the issue.

4. Discussion

In this study of California practitioners who received training onscreening for age-related driving disorders, baseline confidence in

assessment tests• Those with dementianeed to be reported to theDMV by their physician

DMV• Increasing testing fordiagnosing dementia

226 L.L. Hill et al. / Accident Analysis and

Tototmt

teeepu

Fig. 3. Pocket guide back.

he training was promoted by a team member (office partner andccasional champion) from the target medical centers or hospitalshat hosted the training. The team member offered insight on meth-ds to increase physician attendance. Tailoring the training to meethe needs of the practitioners’ schedules and providing refresh-

ents led to better attendance compared with locations wherehese amenities were not offered.

Physicians have to address many competing priorities, and oftenhe urgency they face to respond to acute and chronic illness pre-mpts a greater focus on prevention (Coffield et al., 2001; Maciosek

t al., 2006). In this context, we found we had better participantngagement when we presented the topic as an injury or traumarevention service, rather than a preventive one. By comparingnintentional injury deaths resulting from motor vehicle crashes

Prevention 61 (2013) 222– 232

to other causes of injury mortality, we were able to raise the levelof interest, and the high levels of “intent to screen” attest to thissuccess (Lin et al., 2011). Nevertheless, intent often fails to convertto actual practice, so further research needs to be done to identifymechanisms to maintain interest and commitment.

Physicians expressed concerns about alienating patients, bothin raising the topic and subsequently reporting their findings toauthorized agencies. We tried to address these concerns with thevideos that modeled counseling and addressed the issues aroundmandated reporting, and by reminding the health professionals(and urging them to tell their patients) that only the DMV canrevoke a license. They found the multiple opportunities for test-ing and retaining a license to be reassuring. However, the sensitivenature of the topic remains a concern, and ways to address it moreeffectively need to be identified.

This study supports other studies that have found limited physi-cian familiarity and/or compliance with mandated reporting laws.In this study, the majority of participating physicians were in favorof and felt legally protected by the mandated reporting require-ments in California.

Like states in the U.S., Canadian provinces also vary in reportingrequirements. Studies have found that 45% of Canadian physiciansdid not feel confident in reporting, and 88% wanted more training(Jang et al., 2007). However, physicians in provinces with mandatedreporting laws were three times more likely to report. Based on thisdata, other states might consider implementing mandated repor-ting as a way of legally protecting their physicians and increasingreferrals.

We and others, including the AMA, have posted age-relateddriving impairments training online. However, the feedback fromparticipating health professionals reinforced the value of in-personlectures to maintain interest throughout the training. Our variousaudiences had differing needs, backgrounds, and time constraints,which we tried to address. Our in-person format permitted us to beflexible with respect to scheduling and settings, without compro-mising our main messages.

Importantly, the trainings were delivered by two practicingphysicians (both members of the Preventive Medicine Board) whowere able to discuss their own experiences. We believe that,where possible, physician engagement is superior with face-to-facedelivery, as this promotes dialog among physicians and facilitatesquestions with immediate and credible responses. With minormodifications to accommodate state legislative reporting require-ments, trainings similar to this could be accomplished across thecountry.

This study was limited by the temporal relationship betweenthe training and immediate post-testing prior to implementationattempts, and the lack of pairing of pre- and post-testing. Ourresearch team is exploring follow-up studies to determine whetherthe training has a long-term impact on health professional prac-tices. However, we are encouraged by early results: the increaseamong participating health professionals in confidence and intentto screen and manage elderly patients subject to age-related drivingimpairments.

s and Prevention 61 (2013) 222– 232 227

A

irments 2011-2012

PT MA

d of older a dults (>65

% 70% 80%

D) Ve ry O�en E)

iving impairme nts:

D) A gree E)

drivi ng and a ny diffi cul�es?

L.L. Hill et al. / Accident Analysi

ppendix A.

APPENDI CES

Appendi x A: Pre -Ass ess ment

Pre AssessmentScreening and Management of Age-Related Driving Impa

Please select your �t le:

MD DO PA NP RN LVN OT

Other _______________

1. Current Status:A) In prac�ceB) Ac�ve licen se bu t not in prac�ceC) Re�red

2. Ap proxi mate ly what pe rcen tage of your p a�en t p opu la�on is compr ise

years )?

0% 10% 20% 30% 40% 50% 60

90% 100 %

3. I as sess my olde r p a�en ts for age -relate d d riving impairme nts:

A) Never B) Rarely C) Some�mes

Alwa ys

4. I fe el confiden t in my a bility to screen olde r p a�en ts for age -relate d d r

A) Strongly Disagree B) Disa gree C) Undeci ded

Strongly Agree

5. How f requen tly d o you a sk your olde r p a�en ts (>65 years ) a bout the ir A) At ever y vis itB) At their an nual examC) Every two years

D) As neededE) Never

6. How f requen tly d o you f ormal ly test your olde r p a�en ts (>65 years) f or d eme n�a?

2 s and Prevention 61 (2013) 222– 232

ing syncope or a

ble e pilep sy)?

a loss of consciousne ss to n is the last �me you recall

or Pu blic He alth

ng rep orte d?)

28 L.L. Hill et al. / Accident Analysi

A) At their an nual examB) Every two yearsC) As neededD) Never

7. How o�e n d o you di agnose a pa �en t with d eme n�a?A) At leas t once per weekB) Several �mes per mo nthC) Up to several �mes per yearD) Less than once a yearE) Never

8. How o�e n d o you di agnose a pa �en t with loss of consciousness (includ concussion)?

A) At leas t once per weekB) Several �mes per mo nthC) Up to s everal �mes per yearD) Less than once a yearE) Never

Over, please!9. How o�e n d o you di agnose a pa �en t with seiz ures (not referr ing to sta

A) At leas t once per weekB) Several �mes per mo nthC) Up to s everal �mes per yearD) Less than once a yearE) Never

10. When is the last �me you rep orte d a pa �en t with a seiz ure disorde r or the DM V or Pu blic Hea lth De partmen t? (If you are not a p hysician, whe a p a�en t be ing rep orte d?)

A) <1 yearB) 1-3 yearsC) 4-5 yearsD) >5 yearsE) NeverF) Did n ot know I shoul d r eport

11. When is the last �me you rep orte d a pa �en t with deme n�a to the DM VDepartmen t? (If you are not a phy sician, when is the last �me you recall a pa �en t be i

A) <1 year

B) 1-3 yearsC) 4-5 yearsD) >5 yearsE) Never

s and Prevention 61 (2013) 222– 232 229

to the Publi c Hea lth

L.L. Hill et al. / Accident Analysi

F) Did n ot know I shoul d r eport

12. In your prac�ce, who is responsible f or rep or�ng di seases or cond i�onsDepartmen t or DM V?

A) No one, we do n ot re portB) PhysiciansC) NursesD) Office MangerE) Other _________________________________

Thank you!

2 s and Prevention 61 (2013) 222– 232

A

g Impairments

PT MA

ed of older adults (>65

0% 70% 80%

ts:

D) Ve ry O�en E)

riving impairme nts:

D) A gree E)

Disagree Neutral/ Undecided Agree Strongl y

Agree

30 L.L. Hill et al. / Accident Analysi

ppendix B.

Appendi x B: Post -Ass ess ment

Post AssessmentScreening and Ma nagemen t of Age-Re lated D rivin

Please select your �tle:

MD DO PA NP RN LVN OTOther _______________

2. Curren t Status:D) In prac�ceE) Ac�ve license but not in prac�ceF) Re �red

13. Approximately what percentage of your pa�ent popula�on is comprisyears )?

0% 10% 20% 30% 40% 50% 690% 100%

14. I inte nd t o a ssess my olde r p a�en ts f or age -relate d d rivi ng imp airme n

A) Never B) Rarely C) Some�mes

Alwa ys

15. I fe el confiden t in my a bility to screen olde r p a�en ts for age -relate d d

B) Strongly Disagree B) Disa gree C) Undeci ded

Strongly Agree

Please com ment on the following stateme nts: Strongl y Disagree

16. This tr aining is usef ul.

17. I h ave a be�er unders tand ing of th e me dical cond i�ons and med ica�ons that may imp air olde r a dults’ ability to

driv e safely.

18. I h ave a be�er u nders tand ing of d riv er reh abili ta�on op�ons ava ilable to olde r adu lts.

s and Prevention 61 (2013) 222– 232 231

Fair Average Good Excellent

ns. (Plea se c ircle all that

�ents and the safety of others.

ecommenda�ons to pa�ents.

sla�on.

aving a choice.

ality .

to terminate our

_____________ _______

an a ffect drivi ng a bility h as

% 70% 80%

uire rep or�ng u nde r

L.L. Hill et al. / Accident Analysi

19. I h ave a be�er u nders tand ing of strate gies to use when coun seli ng p a�en ts a bout driving.

20. I h ave a be�er u nders tand ing of Cali fornia’s mand ate d repor�ng laws.

21. I am comf ortab le coun seli ng pa�en ts who may b e a t risk for unsafe driving.

Please rate the speaker on the following: Poor

22. Content

23. Presen ta�on

24. Cali fornia h as mand ate d me dical rep or�ng laws f or spe cific cond i�o

apply.)

A) I am in favor of this: it is important to protect the safety of my pa

B) I am in favor of this: it makes it easier to jus�fy driver cessa�on r

C) I am in f avor of this: I feel protected f rom lia bility d ue to th is legi

D) I a m not in favor of this: I feel forced to r eport pa�en ts wit hout h

E) I am not in favor of this : I feel i t break s d octor/pa�en t confiden�

F) I a m not in favor of this: it may alie nate pa�e nts and ca use th em

doctor/pa�ent rela�onsh ip.

G) Other, please specify,

______________________ ______________________ _________

25. As a result of th is tr aining, my k nowled ge a bout imp airme nts that cincreased by:

0% 10% 20 % 30% 40% 50% 6090% 100%

26. As a result of th is tr aining, my k nowled ge a bout condi�ons that req

Cali fornia’s ma ndate d rep or�ng laws h as increased by:

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2 s and

sult o

R

A

C

C

F

F

H

J

32 L.L. Hill et al. / Accident Analysi

Please iden�f y n ew informa �on you lea rned today :

Please list two profess ional changes that you int end to ma ke as a re

1.

2.

How ca n this training b e improv ed:

Comme nts or Sugg es�ons:

Thank you!

eferences

merican Medical Association, 2011. AMA physician’s guide to assessingand counseling older drivers. Retrieved from: http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety/assessing-counseling-older-drivers page (accessed24.08.12).

alifornia Department of Motor Vehicles, 2011. Reporting disorders characterized bylapses of consciousness. Health and Safety Code Section 103900. Retrieved from:http://www.dmv.ca.gov/pubs/vctop/appndxa/hlthsaf/hs103900.htm (accessed24.08.12).

offield, A.B., Maciosek, M.V., McGinnis, M., Harris, J.R., Caldwell, B., Teutsch, S.M.,Haddix, A., 2001. Priorities among recommended clinical preventive services.American Journal of Preventive Medicine 21 (1), 1–9.

ederal Highway Administration, 2012. Our Nation’s Highways: 2011. U.S. Depart-ment of Transportation – Highway Finance Data Collection, Retrieved from:http://www.fhwa.dot.gov/policyinformation/pubs/hf/pl11028/chapter4.cfm(accessed 24.08.12).

oley, D.J., Heimovitz, H.K., Guralnik, J.M., Brock, D.B., 2002. Driving life expectancyof persons aged 70 years and older in the United States. American Journal ofPublic Health 92 (8), 1284–1289.

ill, L., Rybar, J., Baird, S., Concha-Garcia, S., Coimbra, R., Patrick, K., 2011. Road safeseniors: screening for age-related driving disorders in inpatient and outpatientsettings. Journal Safety Research 42, 165–169.

ang, R.W., Man-Son-Hing, M., Molnar, F.J., Hogan, D.B., Marshell, S.C., Auger,J., Naglie, G., 2007. Family physicians’ attitudes and practices regarding

Prevention 61 (2013) 222– 232

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