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Sample characteristics were summarized using means SDs for continuous variables and using frequencies and percentages for categorical variables. Responses to survey items were summarized with frequencies and percentages by collapsing responses to a 3-point scale as follows: 1 strongly disagree or disagree, 2 neither agree nor disagree, and 3 agree or strongly agree. Ordinal logistic regression was used to identify significant predictors of responses to individual survey items using the same 3-point response scale. Covariates investigated included provider and practice characteristics Table 1 gives the entire list.

Model selection was performed using the method of best subsets. The largest model in which all covariates were significant was chosen as the final model. The proportional odds assumption was found to be reasonable for all models.

SAS STAT User's Guide: The GLIMMIX Procedure (Book Excerpt) - [PDF Document]

As a result, effects are interpreted as the odds of responding more positively to survey items rather than negatively regardless of how the outcome was dichotomized. Commercially available software SAS, version 9. Among eligible VCPs identified, response rate, Two MDs did not indicate whether they were specialists or generalists.

Of participants who were initially mailed surveys, 20 2 ODs and 18 MDs were replaced when found to be ineligible. Table 1 summarizes the provider and practice characteristics of the VCPs.

Most The mean SD number of years in practice was Ophthalmologists were categorized as generalists More than half of the VCPs In terms of the percentage of older patients in their practice, Attitudes and behaviors in discussing driving are summarized in Table 2. While Almost two-thirds of our sample responded that they routinely inquire about their older patients' driving. When a change in driving status is deemed necessary, Approximately one-quarter of VCPs Conversely, almost half of the VCPs Neither lack of personnel nor time constraints in the office visit were seen as major barriers to inquiring about driving.


Table 4 gives the model findings from analyzing associations between provider or practice characteristics and survey responses. Most significant differences in responses were seen between VCPs who were ophthalmologists specifically specialists and to a lesser degree generalists compared with VCPs who were optometrists. Other significant associations with some attitudes and barriers were found between female vs male VCPs, between VCPs with more vs fewer years in practice, between VCPs working in practices with a larger vs a smaller number of providers, and between VCPs with vs without access to a social worker or psychologist.

All significant associations between provider or practice type and survey items are given in Table 4. Findings about VCPs' self-reported referral patterns are shown in the Figure. More than one-third When driving concerns are identified, VCPs are more likely to report referring patients for a road test The MDs were more likely to report making such referrals than the ODs; however, the percentages of VCPs reporting the use of any of these referrals are low. Endorsement of patient-focused resources included written literature about safe driving The increasing number of older drivers renders age-related driving difficulties an important public health issue.

We assessed VCPs' attitudes, barriers, and desired resources in evaluating and advising patients about driving safety, as well as their self-reported referral patterns when driving concerns are identified. Most VCPs report routinely inquiring about driving with older patients, and most endorse that advising on safe driving is their responsibility.

Many VCPs reported concerns about the effect of reporting unsafe drivers to governmental agencies, citing liability risk as a barrier to reporting and to not reporting. Liability issues have previously been identified as a barrier to reporting drivers who are deemed unsafe.


States across the country vary in whether they accept, encourage, or mandate reporting patients, with only 30 states providing legal immunity to VCPs related to reporting. Providers are concerned about potentially deleterious effects of reporting patients to a governmental agency on the physician-patient relationship and its influence on confidentiality.

Other studies 24 , 25 , 32 found that most physicians believe the risks posed to the patient, his or her passengers, and the public by failing to report outweigh the negative consequences. One-third of VCPs herein were reluctant to recommend stopping driving given the influence on patient quality of life. Structural and operational issues, such as time constraints and limited personnel, were not frequently endorsed as barriers to advising about safe driving. We are unaware of other studies that have examined differences in addressing driving concerns by provider or practice characteristics.

The largest magnitude of differences occurred between provider types. It is beyond the scope of this study to explain why these differences might exist. Observational and qualitative research is needed to more thoroughly understand the provider-patient exchanges around driving assessment and safety. Such findings may have implications for interventions and in-service training needs tailored for particular provider subgroups. Because of the multiple factors that determine an individual's ability to drive safely including cognitive function , improving communication between VCPs and other health professionals could increase the likelihood that older adults receive the assistance required to remain safe drivers and that potentially unsafe drivers are identified more often.

Prior studies 33 , 34 demonstrated the importance of coordinated care, and the Institute of Medicine 35 called for increasing use of strategies, such as the electronic health record, to improve health care coordination and quality. Even fewer VCPs endorsed using other referral opportunities, such as sending patients to driving rehabilitation specialists or to driving schools. Further studies should investigate why communication among providers regarding concerns about patients' driving seems to be infrequent and should consider additional models of communication, which might include provider teams, patients, and family members.

Many VCPs expressed interest in additional driving assessment resources, and most would find such guidelines beneficial to their practice. In addition, most VCPs reported that a clinical screening instrument would be valuable. The literature on driving assessment stresses the need for practical, easy-to-administer, clinically valid assessment tools.

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While American Academy of Ophthalmology 41 and American Optometric Association 42 policy statements suggest that driving assessment should include more than evaluating visual function, a standardized set of procedures including an assessment tool that is focused on a planned transition from driver to nondriver status would benefit providers and patients. The desire for more education and access to standardized screening tools that could determine fitness to drive has been echoed by family physicians as well. The strengths of this study include a large, representative sample of VCPs across a state with urban and rural settings, as well as a high survey response rate.

Our study is limited insofar as the findings are based on what providers self-reported and may not reflect what happens in a typical physician-patient interaction. Although this study assured VCPs confidentiality, an important next step is to research actual provider behavior as it relates to driving assessment and counseling.

Further limitations include the restriction of our sample to one state and the limited generalizability of our findings to VCPs who are members of their respective Michigan professional organizations. Last, the findings from this study do not represent what patients perceive as the role of their VCPs. Further research could focus on the concordance between patients' and providers' perspectives of how providers can be helpful in addressing driving concerns. In summary, while VCPs consider that addressing driving concerns is an important part of their job, they express uncertainties and concerns about their role in counseling patients about driving safety.

Our findings suggest that providers of vision care in Michigan do not have faith in the current reporting system. Better communication among VCPs and their patients, other health care professionals, and driving experts is needed. Existing resources must be more widely disseminated, and new driving assessment resources should be developed and evaluated. Correspondence: Rebecca L. Submitted for Publication: April 9, ; final revision received July 19, ; accepted July 19, Published Online: October 8, Author Contributions: Dr Musch had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Additional Contributions: The Michigan Optometric Association and the Michigan Society of Eye Physicians and Surgeons endorsed this research and granted access to their membership rolls for participant recruitment purposes. Provides information about what each procedure does and, if relevant, the kind of output that it produces. SAS 9.

9.2 User s Guide SAS/STAT. The MIXED Procedure. (Book Excerpt) SAS Documentation

Sas 9. You can use the GTL either to modify these templates or to create your own highly customized charts and plots. Information covered includes how to combine language elements to build a custom graph, creating panels that contain multiple graphs, managing plot axes, using legends, modifying style elements to control appearance characteristics, and using functions, expressions, and conditional processing. Using jmp 12 by SAS Institute Book 2 editions published in in Undetermined and English and held by 3 WorldCat member libraries worldwide This book shows you how to perform common tasks such as importing data, setting column properties, exporting analyses as graphics or HTML, and modifying JMP preferences.

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This section provides examples that illustrate the most basic uses of ODS Graphics with a few ofthe many plots that are produced by statistical procedures. These examples also illustrate severalODS styles that are useful for statistical analysis. It uses the following data from a study of 19 children:. The graphical output consists of a fit diagnostics panel, a residual plot, and a fit plot. These plotsare integrated with the tabular output and are shown in Figure ODS styles control the colors and general appearance of all graphs and tables, and SAS providesseveral styles that are recommended for use with statistical graphics.

These and other styles are shownin this chapter. For more information about styles, see the section Graph Styles on page andthe section Styles on page This example is taken from Example It showshow to construct a product-limit survival estimate plot. Published on Dec View Download 0.

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SAS Institute Inc. Other brand and product names are trademarks of their respective companies. ODS Graphics is enabled when you specify the following statement: ods graphics on; When ODS Graphics is enabled, procedures that support ODS Graphics create appropriate graphs,either by default or when you specify procedure options for requesting specific graphs. Alternatively, youcan turn it off as follows: ods graphics off; For example, you might consider disabling ODS Graphics if your goal is solely to produce computa-tional results.