Joanne G. Schwartzberg

The American Medical Association older driver curriculum for health professionals: changes in trainee confidence, attitudes, and practice behavior

Few gerontology and geriatrics professionals receive training in driver fitness evaluation, state reporting of unfit drivers, or transportation mobility planning yet are often asked to address these concerns in the provision of care to older adults. The American Medical Association (AMA) developed an evidence-based, multi-media Curriculum to promote basic competences. This study evaluated reported changes in practice behaviors 3 months posttraining in 693 professionals trained via the AMA approach. Eight Teaching Teams, designated and trained by AMA staff, offered 22 training sessions across the United States in 2006 to 2007. Trainees (67% female; mean age 46) completed a pretest questionnaire and a posttest administered by mail. Physicians were the largest professional group (32%). Although many trainees acknowledged having conversations with patients about driving at pretest, few endorsed utilizing specific techniques recommended by the AMA prior to this training. The posttest response rate was 34% (n = 235). Significant improvements in reported attitudes, confidence, and practices were found across measured items. In particular, posttest data indicated new adoption of in-office screening techniques, chart documentation of driver safety concerns, and transportation alternative planning strategies. Findings suggest that a well-designed, one-time continuing education intervention can enhance health professional confidence and clinical practice concerning driver fitness evaluation and mobility planning. Targeted dissemination of this Curriculum (in-person and online) will allow more to benefit in the future.

Home Care and Physician Assistants-Reply

In Reply.— Physician assistants contribute to all health care fields. Their role as physician extenders in home care has not received the same recognition (financially or otherwise) as their similar roles in hospitals, offices, and nursing homes. We hope that home care will be a growing field for physician assistants, and their omission in the list of possible home care services was unintentional.