Medications and traffic accidents involving older drivers: do Spanish primary healthcare physicians know enough?

BACKGROUND: Our aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics. METHODS: A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample. RESULTS: On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants. CONCLUSIONS: Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

How many collateral casualties are associated with road users responsible for road crashes?

OBJECTIVE: To estimate the number of collateral casualties associated with road users considered responsible for a road crash. METHOD: We analyzed the case series comprising all 790,435 road users involved in road crashes with victims in Spain from 2009 to 2013, recorded in a nationwide police-based registry. For each road user assumed to be responsible for a crash, we collected information relative to health outcomes in other people involved in it, and obtained the total number of collateral casualties per 100 road users considered responsible for the crash. We then estimated the strength of associations between sex, age and the number of collateral casualties generated by car drivers considered responsible for the crash, and calculated rate ratios and corresponding 95% confidence intervals. RESULTS: Pedestrians responsible for crashes were associated with the lowest number of collateral casualties (13.1/100), whereas the highest number (153/100) was observed for bus drivers responsible for crashes. Car drivers were associated with 104.4/100 collateral casualties. The youngest and the oldest car drivers responsible for crashes were associated with 33% and 41% more deaths, respectively, than the 25-34 year old group. Male drivers were associated with 22% more collateral casualties than female drivers. CONCLUSIONS: Regardless of the type of road user who was responsible for a road crash, their active contribution to the crash led to an additional number of collateral casualties in other, non-responsible users. The number and severity of collateral casualties were related to the type of vehicle and the number of people involved. These results are potentially useful to support the need to promote safer driver practices among subgroups of high-risk drivers.

[Association between type of vehicle and the risk of provoking a collision between vehicles]. / Asociación del tipo de vehículo con el riesgo de provocar una colisión entre vehículos.

OBJECTIVE: To quantify the magnitude of the association between the type of vehicle and the probability of being responsible for a collision between two or more vehicles. METHOD: From the registry of road crashes with victims maintained by the Spanish Traffic General Directorate (2014 and 2015), a matched case-control study was designed. Cases were offending drivers involved in the 27,630 collisions between two or more vehicles in which only one of the drivers had committed a driving mistake or offence. Each case was matched with the non-offending drivers of the vehicles involved in the same crash: in all, 31,219 controls were included. Apart from the commission of offences and the type of vehicle involved, we got information about other characteristics of the driver (age, sex, etc.) and about the vehicle (age). Odds ratios (OR) were calculated in order to quantify the association between each type of vehicle and the odds of being responsible for the collision, crude and adjusted (by conditioned logistic regression) by the rest of collected variables. RESULTS: In comparison with private cars, bicycles had a lower risk of causing a collision (adjusted OR: .30), and also mopeds (aOR: .52) and buses (aOR: .63). Vans (aOR: 1.19) and four-wheel vehicles (aOR: 1.33) increased the risk. CONCLUSION: Two-wheeled vehicles and buses had a lower risk of causing collisions than private cars. This association is independent of some of the characteristics of the driver, as well as the age of the vehicle.