Physicians' Warnings to Unfit Drivers May Reduce Emergency Department Visits for Accidents

DynaMed Weekly Update - Volume 7, Issue 42

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A number of medical conditions may limit a patient’s ability to safely drive an automobile and may increase the risk of accidents. However, placing limits on the driving may affect the patient’s quality of life and many patients are reluctant to give up driving voluntarily. One approach to reduce injurious accidents caused by these drivers is for primary care physicians to issue warnings to patients judged unfit to drive. Previous research has been inconclusive on the benefits and costs of such warnings, and concern has been expressed for the effect of warnings on the patient-doctor relationship. A program for providing driving warnings has been in use in Ontario, Canada since 1968. A recent cohort study analyzed data from 100,075 consecutive patients who received such warnings since 2006.

Patients ≥ 18 years old (57% male) who received a medical warning from a physician judging them to be potentially unfit to drive due to a medical condition were assessed for emergency department visits over 2 time periods: a baseline period consisting of the 3 years prior to the warning, and a 1-year follow-up period after the warning was issued. Medical conditions for which patients received warnings included alcoholism, epilepsy, dementia, sleep disorder, fainting or dizziness, stroke, diabetes, and depression without psychosis. Most of the warnings (98%) were preemptive coming before the driver experienced a road crash resulting in an emergency room visit. A total of 6,098 physicians participated in the program.

Rates of emergency department visits were compared for the baseline and follow-up periods. Visits due to road crashes in which the patient was a driver were significantly reduced following the warning (4.76 per 1,000 person-years during baseline vs. 2.73 per 1,000 person-years during follow-up, p < 0.001) (level 2 [mid-level] evidence). However, the rate of accident-related visits during follow-up remained higher than the general population rate of 1.98 per 1,000 person-years during the same period (no p value reported). Furthermore, the rate of emergency visits for depression increased significantly during follow-up (19.15 vs. 23.91 per 1,000 person-years, p < 0.05). In addition, the warnings may have weakened the patient-doctor relationship. During the follow-up period, the number of return visits to the primary care physician who issued the warning dropped by about 0.66 visits per patient compared to the previous year (no p value reported) (N Engl J Med 2012 Sep 27;367(13):1228).

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