Impact of a State Law on Physician Practice in Sports-Related Concussions.
OBJECTIVE
To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation.


METHODS
Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics.


RESULTS
The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools.


CONCLUSIONS
Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice.
Department of Pediatric Critical Care, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: mrflaherty@partners.org.
Michael R
MR
Flaherty
Department of Surgery, Division of Trauma, Emergency Services, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
Toby
T
Raybould
Department of Surgery, Division of Trauma, Emergency Services, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
Aziza
A
Jamal-Allial
Harvard Medical School, Boston, MA; Department of Surgery, Division of Trauma, Emergency Services, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
Haytham M A
HM
Kaafarani
Harvard Medical School, Boston, MA; Department of Surgery, Division of Trauma, Emergency Services, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
Jarone
J
Lee
Harvard Medical School, Boston, MA; Department of Surgery, Division of Trauma, Emergency Services, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
Alice
A
Gervasini
Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Richard
R
Ginsburg
Department of Pediatric Critical Care, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Mark
M
Mandell
Harvard Medical School, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
Karen
K
Donelan
Harvard Medical School, Boston, MA; Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.
Peter T
PT
Masiakos
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D058007:Physicians, Primary Care; D011795:Surveys and Questionnaires
adolescent health; concussion; health policy