Fenikilé Tsehaiwork Sunny, Ellerbeck Kathryn, Filippi Melissa K, Daley Christine M
1Department of Pediatrics,University of Kansas Medical Center,Kansas City,Kansas,USA.
3Department of Family Medicine,University of Kansas Medical Center,Kansas City,Kansas,USA.
Prim Health Care Res Dev. 2015 Jul;16(4):356-66. doi: 10.1017/S1463423614000449. Epub 2014 Nov 4.
We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.
The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism.
Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis.
Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.
我们探讨了家庭医生在18个月和24个月儿童健康检查时采用推荐的自闭症筛查方法的潜在障碍。
美国儿科学会建议，在18个月和24个月儿童健康检查时，通过使用标准化的自闭症特异性筛查工具，对所有儿童进行自闭症的早期检测和干预。然而，并非所有家庭医生都会进行自闭症筛查。
对堪萨斯城都会区的15名家庭医生进行了3个焦点小组讨论和6次半结构化访谈。对逐字记录进行归纳编码；使用标准文本分析方法对数据进行分析。
参与者对自闭症发病率上升的看法各不相同。大多数参与者将发病率上升归因于诊断标准的变化。对于在18个月或24个月检查时实施自闭症普遍筛查的益处，没有达成共识。许多人更倾向于通过一般发育评估和观察来发现潜在问题。没有参与者使用特定的自闭症筛查工具，只有一名参与者知道这样一种工具（M-CHAT）。缺乏关于儿童发育和筛查方法的充分培训，以及社区管理自闭症儿童的资源有限，被视为常规筛查的主要障碍。建议的解决方案包括努力建立更坚实的证据基础、改善医生培训和继续教育，以及在医疗保健方面进行系统性变革。总之，在18个月和24个月检查时进行自闭症普遍筛查并未被广泛接受，家庭医生也未实施。
