Evaluating medically at-risk drivers: A survey of assessment practices in Canada

Background. Assessing medical fitness to drive (FTD) can include both off-and on-road testing, although consistency of practice is unclear. Purpose. To examine actual practices being used to assess FTD at driver assessment centres (DACs) across Canada. Method. Surveys e-mailed to 90 DACs were returned by 47 assessors. Findings. The majority of respondents (89%) were occupational therapists. Assessors reported doing an average of eight FTD assessments per month (range = 1 to 40) at an average cost of $366 (SD = $225; range = $40 to $985). Referrals came from physicians (96%), other health professionals (70%), and licensing authorities (66%). Clients with stroke, dementia, traumatic brain injury, mild cognitive impairment, and multiple sclerosis composed 62% of estimated caseloads. Assessments took 3 hr on average (range = 1.24 to 4.5 hr); 64% reported they always took clients on road regardless of clinic results. Implications. Evidence-based guidelines for training and assessment are clearly needed given the inconsistency in practice.