Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, 13199 E. Montview Blvd Suite 300, Aurora, CO, 80045, USA.
Department of Pediatrics, Harvard Medical School, A-111, 25 Shattuck Street, Boston, MA, 02115, USA.
J Autism Dev Disord. 2018 Dec;48(12):4222-4230. doi: 10.1007/s10803-018-3630-x.
We examined barriers and facilitators to expanding primary care's capacity to manage conditions associated with autism spectrum disorder (ASD). We conducted semi-structured interviews with specialists, primary care providers (PCPs), primary care staff, and parents of children with ASD, discussing health/behavior problems encountered, co-management, and patient/family experience. Participants endorsed primary care as the right place for ASD-associated conditions. Specialists advising PCPs, in lieu of referrals, efficiently uses their expertise. PCPs' ability to manage ASD-associated conditions hinged on how behavioral aspects of ASD affected care delivery. Practices lacked ASD-specific policies but made individual-level accommodations and broader improvements benefitting children with ASD. Enhancing access to specialty expertise, particularly around ASD-associated behaviors, and building on current quality improvements appear important to expanding primary care.
我们研究了扩大基层医疗服务能力以管理自闭症谱系障碍（ASD）相关疾病的障碍和促进因素。我们与专家、基层医疗服务提供者（PCP）、基层医疗服务人员和 ASD 儿童的家长进行了半结构化访谈，讨论了遇到的健康/行为问题、共同管理以及患者/家庭的体验。参与者认为基层医疗服务是管理 ASD 相关疾病的合适场所。专家为 PCP 提供咨询建议，而不是转诊，这种方式可以有效地利用他们的专业知识。PCP 管理 ASD 相关疾病的能力取决于 ASD 的行为方面如何影响医疗服务的提供。实践中缺乏 ASD 特定政策，但进行了个别层面的调整，并进行了更广泛的改进，使 ASD 儿童受益。增加获得专业知识的机会，特别是围绕 ASD 相关行为的知识，并在现有质量改进的基础上进一步发展，这对于扩大基层医疗服务非常重要。
