Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving.

Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals' ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts.Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting.Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania's mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p < 0.001).Conclusions: These findings highlight a need to enhance standard of care practices related to driver screening, counseling, and reporting. Overall, providers recognized the importance of their role in advising patients about safe driving and desired standardized protocols for guiding conversations about driving with patients, PennDOT reporting, and referring patients to driver rehabilitation services.

Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale.

This study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory-Child Version (OCI-CV) for youth with obsessive-compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and posttreatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the posttreatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20%-25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55%-65% reduction in the OCI-CV total score and a posttreatment total score ≤6-8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pretreatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.