TY - JOUR
T1 - Canadian epileptologists' counseling of drivers amidst guideline inconsistencies
AU - Jirsch, Jeffrey
AU - Gross, Donald W.
AU - Jette, Nathalie
AU - Federico, Paolo
AU - Dubeau, Francois
AU - Tellez-Zenteno, Jose F.
AU - Pohlmann-Eden, Bernd
AU - Burneo, Jorge G.
AU - McLachlan, Richard
AU - Ahmed, Syed N.
AU - Deacon, Charles
AU - Javidan, Manouchehr
AU - Nguyen, Dang K.
AU - Sadler, R. Mark
AU - Spiller, Allison
AU - Townsend, Tiffany
AU - Veilleux, Martin
AU - Wennberg, Richard A.
AU - Wiebe, Samuel
AU - Yankovsky, Alexei
PY - 2014/7/1
Y1 - 2014/7/1
N2 - Background: epilepsy is a common medical condition for which physicians perform driver fitness assessments. the Canadian Medical association (CMa) and the Canadian Council of Motor transportation administrators (CCMta) publish documents to guide Canadian physicians' driver fitness assessments. Objectives: We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions. Methods: We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians' philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. of the nine scenarios, CCMta and CMa recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test. Results: overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). for the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). a majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. the lack of consistency in respondents' agreement attained statistical significance (p<0.001). Conclusions: Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. this study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada. COPYRIGHT
AB - Background: epilepsy is a common medical condition for which physicians perform driver fitness assessments. the Canadian Medical association (CMa) and the Canadian Council of Motor transportation administrators (CCMta) publish documents to guide Canadian physicians' driver fitness assessments. Objectives: We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions. Methods: We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians' philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. of the nine scenarios, CCMta and CMa recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test. Results: overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). for the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). a majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. the lack of consistency in respondents' agreement attained statistical significance (p<0.001). Conclusions: Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. this study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada. COPYRIGHT
UR - http://www.scopus.com/inward/record.url?scp=84901793203&partnerID=8YFLogxK
U2 - 10.1017/S0317167100018424
DO - 10.1017/S0317167100018424
M3 - Article
C2 - 24878463
AN - SCOPUS:84901793203
SN - 0317-1671
VL - 41
SP - 413
EP - 420
JO - Canadian Journal of Neurological Sciences
JF - Canadian Journal of Neurological Sciences
IS - 4
ER -