Betz Marian E, Jones Jacqueline, Carr David B
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Inj Prev. 2015 Aug;21(4):231-7. doi: 10.1136/injuryprev-2014-041450. Epub 2015 Jan 23.
Primary care physicians play a leading role in counselling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations.
To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a programme supporting routine conversations.
This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers.
From 15 interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterised their experiences in terms of current and ideal states.
Physicians have been tasked with assessing older driver safety and guiding older patients through the process of 'driving retirement.' Attention to system-level factors such as provider roles, resources, and training can support them in this process.
基层医疗医生在为老年驾驶员提供咨询方面发挥着主导作用，但往往直到出现安全问题时才会进行相关讨论。先前的研究表明，对驾驶情况进行例行询问可能有助于开展这些艰难的对话。
探讨影响基层医疗环境中驾驶相关讨论的系统层面因素，以便为支持例行对话的项目设计与实施提供参考。
这项定性描述性研究对在一家三级医疗教学医院的两家诊所（一家老年病诊所，一家普通内科诊所）工作的提供者（医生、护士、医疗助理、社会工作者和行政人员）进行了迭代访谈。在转录分析中采用一般归纳技术，以确定利益相关者所感知到的与老年驾驶员进行例行对话的系统层面障碍和促进因素。
通过15次访谈，出现了四个主题：（1）基层医疗环境中既定提供者角色的复杂性（这既可以支持团队协作，也可能阻碍效率）；（2）支持提供者的资源不足（包括临床提示、当地指南以及获得社会工作者和驾驶专家的帮助）；（3）提供者和患者在讨论驾驶方面的教育差距；（4）提高提供者与老年驾驶员对话的建议模式（包括借鉴成功案例并使用集成到电子病历中的既定路径）。第五个主题是，参与者根据当前状态和理想状态来描述他们的经历。
医生的任务是评估老年驾驶员的安全性，并指导老年患者完成“停止驾驶”的过程。关注诸如提供者角色、资源和培训等系统层面因素可以在此过程中为他们提供支持。
