Mobility Services for Drivers with Medical Conditions : Lessons learned from a study of the change in mobility services provided in Sweden in 1998 compared to 2007

Abstract: Background. The Swedish government states that participation and influence are among the most fundamental prerequisites of public health. Mobility services provide professional and high quality information, advice, and assessment to individuals with a medical condition or recovering from an accident or injury that may affect their ability to drive, access, or egress a motor vehicle. Although Swedish physicians must report drivers with medical conditions, rehabilitative training for driving licenses following injury or severe medical conditions does not exist within contemporary Swedish healthcare systems. Aim. This study aimed primarily to describe and compare two driving assessment models, i.e., the model used by Traffic Medicine Center (TRMC) Stockholm in 1998 and the model provided by Mobilitetscenter.se (MC.se) Gothenburg in 2007. The study also sought to determine the context of the changed provision of driving assessments and identify the significant components of this change. Method A literature review, synthesised with the author’s research and complemented by practice-based evidence, provided the knowledge base and starting point of this essay. Action research paired with intervention propelled the changes in the provision of mobility services in Sweden between 1998 and 2007. The author used John Ovretveit’s identification of significant change components to illuminate the complex change process that occurred.  Selection of an appropriate list of variables to compare the two assessment models derived from FORUM of Mobility Centres, the umbrella organization of British Mobility Centres that developed national guidelines for driving ability assessments in the UK; the QEF Mobility Centre was a member of that organization. The author used a questionnaire and a semi-structured interview to gather relevant data from the compared centers. Results TRMC aims primarily to provide services for society through its contributions to road safety. A Mobility Center focuses on providing assessment and rehabilitation services, optimizing impaired drivers’ mobility potential and minimizing collision risks. Cognitive assessment at TRMC accounted for a large part of this study’s time allotment. MC.se’s practical driving test in a suitably modified car provides the most significant difference between the two models.  In addition, MC.se has replaced physicians and psychologists with occupational therapists. Conclusion TRMC aims to ensure that current drivers comply with medical driving laws and regulations. MC.se provides assessments that maximize mobility potential and also ensure low collision rates. Thus, safety is balanced against the right to mobility. The study also explores coping strategies, training, adaptations, and choice of vehicle.