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Fewer road crashes in the year after a medical warning

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6596 (Published 03 October 2012) Cite this as: BMJ 2012;345:e6596

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In 2006 the government of Ontario, Canada, introduced financial incentives to encourage doctors to warn patients who may be unfit to drive. Medical warnings have been recorded ever since, allowing researchers to track road crashes in all 100 075 adults from the state who were issued with a warning between 2006 and 2009. In the three baseline years before a medical warning, the rate of crashes serious enough to require a visit to the emergency department was 4.76 per 1000 people per year. The rate fell to 2.73 per 1000 people per year in the year after a warning. The difference was significant and consistent across all age groups; both sexes; and for patients with diverse diagnoses including alcoholism, dementia, dizzy spells, and stroke. Even after a warning, the overall rate of crashes in this cohort remained higher than in the general population of Ontario.

Does an official warning from a doctor prevent road crashes that result in injury? Possibly, say the authors. The rate of crashes in which the patient was a passenger or a pedestrian did not change after a warning.

Doctors in Ontario are paid $C36.3 (£22.8; €28.6; $37) each time they warn a patient who may be unfit to drive. Between 10% and 30% of patients lose their licence as a result. In this cohort, warnings were associated with a significant increase in emergency department visits for depression. Patients also made fewer visits to their doctor in the year after a warning, which may signal problems with doctor-patient relationships, say the authors.

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Cite this as: BMJ 2012;345:e6596