System facilitators and barriers to discussing older driver safety in primary care settings
System facilitators and barriers to discussing older driver safety in primary care settings
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DOI：
10.1136/injuryprev-2014-041450
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发表时间：
2015-08-01
影响因子：
3.7
通讯作者：
Carr, David B.
中科院分区：
文献类型：
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作者：
Betz, Marian E.;Jones, Jacqueline;Carr, David B.
初级保健医生在为老年驾驶员提供咨询方面发挥着主导作用，但讨论通常不会发生，直到出现安全问题。先前的研究表明，关于驾驶的常规提问可能会促进这些困难的对话。目的探讨影响初级保健环境中驾驶讨论的系统水平因素，以便为设计和实施支持常规对话的计划提供信息。方法本定性描述性研究使用与提供者的迭代访谈在一所三级护理教学医院的两个诊所（一个是老年诊所，一个是普通内科诊所）工作的1000名医务人员（医生、护士、医疗助理、社会工作者和行政人员）。结果在15次访谈中，发现了四个主题：（1）在初级保健环境中，定义的提供者角色的复杂性（既支持团队工作，又妨碍效率）;（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）;（3）提供者和患者在讨论驾驶方面的教育差距;以及（4）建议的模式，以加强提供者与老年驾驶员的对话（包括遵循成功的例子和使用集成到电子医疗记录中的定义的途径）。第五个主题是，参与者的特点是他们的经验，在当前和理想的states.Conclusions医生的任务是评估老年驾驶员的安全和指导老年患者通过过程中的“驾驶退休。关注系统层面的因素，如提供者的角色、资源和培训，可以在这一过程中为他们提供支持。
Background 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.Objective 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.Methods 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.Results 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.Conclusions 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.