Nolan Robyn, Walker Tarik, Hanson Janice L, Friedman Sandra
Departments of *Neurodevelopmental and Behavioral Pediatrics, †Pediatrics, University of Colorado School of Medicine, Denver, CO.
J Dev Behav Pediatr. 2016 Nov/Dec;37(9):687-693. doi: 10.1097/DBP.0000000000000348.
To identify challenges primary care providers (PCPs) experience providing a Medical Home for children with autism spectrum disorders (ASDs) and to describe the role developmental behavioral pediatricians (DBPs) play in the Medical Home Neighborhood.
The authors used purposeful sampling to recruit 25 PCPs from around Colorado to participate in 4 focus groups. Member checking was performed at the end of each group. Sampling continued until themes repeated and saturation was achieved. Focus groups were transcribed verbatim, and transcripts were analyzed using content analysis; an outside reviewer audited the data.
Qualitative analysis yielded 30 codes that fell into 7 themes: provider education, shared model of care, initial diagnostic evaluation by the DBP, communication, office factors, cost and coverage, and access. PCPs identified knowledge gaps that led to decreased comfort and desired ongoing education and a centralized resource for providers. They envisioned a shared care model with ongoing specialist collaboration and improved communication within the care team. A specific role desired of the DBP was to provide the initial diagnostic evaluation and treatment plan with specific resources. Office factors, high cost and variable coverage, and poor access to services were barriers to providing a Medical Home for children with ASD.
Working to remove barriers to shared care as well as providing continued educational opportunities will help improve access to a Medical Home Neighborhood for children with ASD. Advocacy is needed to help remove barriers related to cost, coverage, and access to services.
确定基层医疗服务提供者（PCP）在为自闭症谱系障碍（ASD）儿童提供医疗之家时所面临的挑战，并描述发育行为儿科医生（DBP）在医疗之家社区中所起的作用。
作者采用目的抽样法，从科罗拉多州各地招募了25名基层医疗服务提供者参与4个焦点小组。在每个小组结束时进行成员核对。抽样持续进行，直到主题重复且达到饱和。焦点小组的内容逐字记录，并使用内容分析法对记录进行分析；由外部审核员对数据进行审核。
定性分析得出30个编码，分为7个主题：提供者教育、共享护理模式、发育行为儿科医生的初始诊断评估、沟通、办公室因素、成本和保险范围以及可及性。基层医疗服务提供者发现了知识差距，这导致他们信心下降，他们希望获得持续教育以及为提供者提供一个集中的资源。他们设想了一种共享护理模式，即持续进行专家协作并改善护理团队内部的沟通。发育行为儿科医生期望发挥的一个特定作用是提供带有特定资源的初始诊断评估和治疗计划。办公室因素、高成本和保险范围多变以及服务可及性差是为ASD儿童提供医疗之家的障碍。
努力消除共享护理的障碍以及提供持续的教育机会，将有助于改善ASD儿童获得医疗之家社区服务的机会。需要进行倡导，以帮助消除与成本、保险范围和服务可及性相关的障碍。
