Rural Primary Care Providers’ Experience and Usage of Clinical Recommendations in the CDC Pediatric Mild Traumatic Brain Injury Guideline: A Qualitative Study

Abstract

Purpose In 2018, the Centers for Disease Control and Prevention (CDC) released an evidence‐based guideline on pediatric mild traumatic brain injury (mTBI) to educate health care providers on best practices of mTBI diagnosis, prognosis, and management/treatment. As residents living in rural areas have higher rates of mTBI, and may have limited access to care, it is particularly important to disseminate the CDC guideline to rural health care providers. The purpose of this paper is to describe rural health care providers’ experience with pediatric mTBI patients and their perceptions on incorporating the guideline recommendations into their practice. Method Interviews with 9 pediatric rural health care providers from all US regions were conducted. Interview transcripts were coded and analyzed for themes for each of the main topic areas covered in the interview guide. Findings Common causes of mTBI reported by health care providers included sports and all‐terrain vehicles. While health care providers found the guideline recommendations to be helpful and feasible, they reported barriers to implementation, such as lack of access to specialists. To help with uptake of the CDC guideline, they suggested the development of concise implementation tools that can be referenced quickly, integrated into electronic health record‐based systems, and that are customized by visit type and health care setting (eg, initial vs follow‐up visits and emergency department vs primary care visits). Conclusion Length, accessibility, and usability are important considerations when designing clinical tools for busy rural health care providers caring for pediatric patients with mTBI. Customized information, in both print and digital formats, may help with uptake of best practices.

Service Delivery Models for the Management of Pediatric and Adolescent Concussion: A Systematic Review

“… PCPs often did not document important aspects of concussion history or physical examination. Retrospective chart review Daughery et al 23 2021 Rural health care providers No intervention was completed. Health care providers found CDC guideline recommendations to be helpful and feasible.…”

“…A qualitative study by Daugherty et al 23 described the opinion of PCPs in rural communities on the Centers for Disease Control and Prevention's evidence-based guidelines on pediatric mTBI. PCPs were concerned that the Centers for Disease Control and Prevention guidelines were lengthy and nonspecific to rural communities.…”

Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective

“…The current update examines important trends in healthcare utilization, provider practices and perceptions, and gaps in care and implementation across EDs, primary care, and school-based settings across two large retrospective studies and three focused survey studies in the US and Canada [29][30][31][32][33].…”

Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population

“…Care can differ by practice location. Primary and acute care clinicians care for the majority of concussions in youth, with studies reporting gaps in knowledge, lack of use of established guidelines, challenges with specialist access, and perceived limited training for such providers 13–15. Ultimately, varied care can lead to sociodemographic disparities related to pediatric concussion care.…”

“…Primary and acute care clinicians care for the majority of concussions in youth, with studies reporting gaps in knowledge, lack of use of established guidelines, challenges with specialist access, and perceived limited training for such providers. [13][14][15] Ultimately, varied care can lead to sociodemographic disparities related to pediatric concussion care. Specifically, previous studies have found racial disparities in concussion symptom recognition, 16 reporting of concussions, 17 and utilization of the emergency department (ED) for concussion.…”