Mazurek Micah O, Kuhlthau Karen, Parker Robert A, Chan James, Sohl Kristin
Department of Human Services, University of Virginia, Charlottesville, VA.
Department of Pediatrics, Harvard Medical School, Boston, MA.
J Dev Behav Pediatr. 2021;42(5):355-362. doi: 10.1097/DBP.0000000000000909.
Using standardized screening tools increases accuracy in early identification of autism. The American Academy of Pediatrics recommends systematic developmental screening at all 9-, 18-, and 24- or 30-month well-child visits (WCVs) and autism-specific screening at all 18- and 24-month WCVs. The study objectives were to examine the extent to which these guidelines have been adopted in practice among primary care providers (PCPs) and to identify potential provider-level factors associated with screening practices.
Participants included 94 PCPs (79% pediatricians) from 13 states enrolled in a study of an autism training program. Self-report and chart-review data collected before training were examined. Screening practices were assessed through chart review of all 9-, 18-, and 24-month WCVs within a 30-day window.
Sixty-four percent of PCPs administered developmental screening tools at all 9-month WCVs, and 62% at all 18-month WCVs. Fifty-one percent administered autism screening tools at all 18-month WCVs, and 41% at all 24-month WCVs. Screening practices varied by provider type (pediatrician vs other PCP), self-efficacy in screening and identification, and previous autism training (autism screening only), but not by years of experience.
Overall, general developmental and autism-specific screenings are not being consistently administered across recommended WCVs in primary care practices. Provider self-efficacy in autism identification and screening and previous autism training were associated with increased autism screening. As such, these results suggest a need for increased training and dissemination of information on screening implementation for practicing PCPs.
使用标准化筛查工具可提高自闭症早期识别的准确性。美国儿科学会建议在所有9个月、18个月以及24或30个月的健康儿童访视（WCV）时进行系统的发育筛查，并在所有18个月和24个月的WCV时进行自闭症专项筛查。本研究的目的是检验这些指南在基层医疗服务提供者（PCP）的实际工作中被采用的程度，并确定与筛查实践相关的潜在提供者层面的因素。
参与者包括来自13个州的94名PCP（79%为儿科医生），他们参与了一项自闭症培训项目的研究。对培训前收集的自我报告和病历审查数据进行了检查。通过在30天内对所有9个月、18个月和24个月的WCV病历进行审查来评估筛查实践。
64%的PCP在所有9个月的WCV时使用发育筛查工具，62%在所有18个月的WCV时使用。51%的PCP在所有18个月的WCV时使用自闭症筛查工具，41%在所有24个月的WCV时使用。筛查实践因提供者类型（儿科医生与其他PCP）、筛查和识别的自我效能以及先前的自闭症培训（仅自闭症筛查）而有所不同，但与工作年限无关。
总体而言，在基层医疗实践中，并未按照建议的WCV一致地进行一般发育和自闭症专项筛查。提供者在自闭症识别和筛查方面的自我效能以及先前的自闭症培训与自闭症筛查的增加有关。因此，这些结果表明需要加强对执业PCP的培训以及关于筛查实施的信息传播。
