Golnik Allison, Ireland Marjorie, Borowsky Iris Wagman
University of Minnesota, Department of Pediatrics, Division of General Pediatrics, 717 Delaware St SE, 3rd Floor (West), Room 370E, Minneapolis, MN 55414, USA.
Pediatrics. 2009 Mar;123(3):966-71. doi: 10.1542/peds.2008-1321.
Primary care physicians can enhance the health and quality of life of children with autism by providing high-quality and comprehensive primary care.
To explore physicians' perspectives on primary care for children with autism.
National mail and e-mail surveys were sent to a random sample of 2325 general pediatricians and 775 family physicians from April 2007 to October 2007.
The response rate was 19%. Physicians reported significantly lower overall self-perceived competency, a greater need for primary care improvement, and a greater desire for education for children with autism compared with both children with other neurodevelopmental conditions and those with chronic/complex medical conditions. The following barriers to providing primary care were endorsed as greater for children with autism: lack of care coordination, reimbursement and physician education, family skeptical of traditional medicine and vaccines, and patients using complementary alternative medicine. Adjusting for key demographic variables, predictors of both higher perceived autism competency and encouraging an empirically supported therapy, applied behavior analysis, included having a greater number of autism patient visits, having a friend or relative with autism, and previous training about autism.
Primary care physicians report a lack of self-perceived competency, a desire for education, and a need for improvement in primary care for children with autism. Physician education is needed to improve primary care for children with autism. Practice parameters and models of care should address physician-reported barriers to care.
基层医疗医生可以通过提供高质量的综合基层医疗服务来提高自闭症儿童的健康水平和生活质量。
探讨医生对自闭症儿童基层医疗服务的看法。
2007年4月至2007年10月，对2325名普通儿科医生和775名家庭医生进行随机抽样，通过邮件和电子邮件进行全国性调查。
回复率为19%。与患有其他神经发育疾病的儿童以及患有慢性/复杂疾病的儿童相比，医生报告称，他们对自身能力的总体自我认知明显较低，对改善基层医疗服务的需求更大，对自闭症儿童教育的渴望也更强烈。对于自闭症儿童，以下提供基层医疗服务的障碍被认为更为突出：缺乏护理协调、报销和医生教育，家庭对传统医学和疫苗持怀疑态度，以及患者使用补充替代医学。在对关键人口统计学变量进行调整后，较高的自闭症能力认知以及鼓励采用经验支持疗法——应用行为分析的预测因素包括自闭症患者就诊次数较多、有自闭症朋友或亲戚以及之前接受过自闭症相关培训。
基层医疗医生报告称，他们缺乏自我能力认知，渴望接受教育，并且需要改善自闭症儿童的基层医疗服务。需要开展医生教育，以改善自闭症儿童的基层医疗服务。实践参数和护理模式应解决医生报告的护理障碍问题。
