title: Perspectives on Tiered Older Driver Assessment in Primary Care Settings.
abstract: OBJECTIVE
  Widespread screening of older drivers, with in-depth evaluation only of those who screen positive ("tiered assessment"), might efficiently balance driver safety and mobility. To inform program development, we sought to examine the perspectives of older drivers and clinicians on the concept of tiered assessment in primary care settings.
  
  
  METHODS
  Iterative focus groups and interviews with 33 community-dwelling current drivers aged ≥65 years and 8 primary care providers. We used inductive and deductive theme analysis to explore driver and clinician perspectives and to identify barriers and facilitators to establishing a tiered older driver assessment program in primary care settings.
  
  
  RESULTS
  Four dominant themes emerged. Two themes addressed the overall concept: (a) support for the concept of tiered older driver assessment and (b) concerns about the consequences of older driver assessment and how these could affect program viability. Two themes addressed screening: (c) tension inherent in using a generalized approach to the highly individualized issue of driving and (d) logistical considerations for screening in primary care settings.
  
  
  CONCLUSIONS
  Standardized older driver screening and referral might improve clinician-driver communication, but screening should occur in a context that includes personalized mobility counseling.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora. Department of Epidemiology, Colorado School of Public Health, Aurora. marian.betz@ucdenver.edu.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Betz
authors.affiliation: College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: VISN 19 Mental Illness Research, Education and Clinical Care Center, Veterans Affairs Eastern Colorado Healthcare System, Denver.
authors.forename: Emma
authors.initials: E
authors.lastname: Genco
authors.affiliation: Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology , Washington University School of Medicine, St Louis, Missouri.
authors.forename: David B
authors.initials: DB
authors.lastname: Carr
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora.
authors.forename: Carolyn
authors.initials: C
authors.lastname: DiGuiseppi
authors.affiliation: Denver Health Medical Center, Denver.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lowenstein
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000523:psychology*; D000368:Aged; D001334:Automobile Driving / Q000523:psychology*; D003142:Communication; D017144:Focus Groups / Q000379:methods*; D006801:Humans; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations / Q000941:ethics*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
keywords: Clinical practice; Driving; Physician-patient communication/relationships; Preventive medicine/care/services; Qualitative research methods