Department of Developmental Pediatrics, Ummeed Child Development Center, Mumbai, India ; and.
Autism Intervention Services, Ummeed Child Development Center, Mumbai, India.
J Dev Behav Pediatr. 2022 Aug 1;43(6):335-345. doi: 10.1097/DBP.0000000000001060. Epub 2022 Jan 10.
Training pediatricians in low- and middle-income countries (LMICs) in early diagnosis and comprehensive management of autism spectrum disorder (ASD) is crucial to ensure optimal developmental outcomes for a substantial number of children with ASD in this region. This study evaluates the relevance and effectiveness of an evidence-based telementoring model Extension for Community Healthcare Outcomes (ECHO) Autism in increasing pediatricians' access to best-practice care for children with ASD in LMIC contexts.
ECHO Autism was launched by a ‟hub" team of multidisciplinary ASD experts at a child development center in Mumbai, India. The culturally modified model included 13 biweekly sessions conducted annually using video-conferencing technology. Sessions combined expert-delivered didactics and facilitated case-based discussions on best-practice methods in screening, diagnosing, and managing autism and its comorbidities. Sixty-two physicians, including 59 pediatricians across 2 cohorts (2019-2020), participated in the mixed-methods study to evaluate participants' reactions, knowledge, behaviors, and impact on children and families.
Participants represented a broad geographic reach across India (n = 47) and other LMICs (n = 15). Both quantitative and qualitative data revealed high levels of participant satisfaction and improved knowledge and self-efficacy in ASD diagnosis and management. Qualitative themes highlighted the adult-learning processes of ECHO Autism that participants considered novel and beneficial, such as reflective discussions, respectful mentoring, having a parent as ‟expert," and cultural relevance, alongside changes in practice behaviors.
ECHO Autism clinics facilitated by local experts in LMICs can improve access to early diagnosis and evidence-based, comprehensive management for children with ASD and their families by positively influencing pediatricians' knowledge, attitudes, and practice behaviors.
在中低收入国家（LMICs）培训儿科医生，使其能够对自闭症谱系障碍（ASD）进行早期诊断和综合管理，这对于确保该地区大量 ASD 儿童获得最佳发育结果至关重要。本研究评估了基于证据的远程医疗模式Extension for Community Healthcare Outcomes（ECHO）自闭症在增加儿科医生为 LMIC 背景下的 ASD 儿童提供最佳实践护理方面的相关性和有效性。
ECHO 自闭症由印度孟买儿童发展中心的多学科 ASD 专家“中心”团队发起。该文化适应性模型包括每年进行 13 次双周会议，使用视频会议技术。会议结合了专家提供的教学和促进基于案例的讨论，以探讨筛查、诊断和管理自闭症及其合并症的最佳实践方法。62 名医生参加了这项混合方法研究，其中包括 2 个队列（2019-2020 年）的 59 名儿科医生，以评估参与者的反应、知识、行为以及对儿童和家庭的影响。
参与者代表了印度（n=47）和其他 LMICs（n=15）广泛的地理分布。定量和定性数据均显示，参与者对 ECHO 自闭症的满意度以及在 ASD 诊断和管理方面的知识和自我效能感均有较高水平的提高。定性主题突出了 ECHO 自闭症的成人学习过程，参与者认为这些过程新颖且有益，例如反思性讨论、尊重性指导、让家长成为“专家”以及文化相关性，同时还改变了实践行为。
在 LMICs 中由当地专家主持的 ECHO 自闭症诊所可以通过积极影响儿科医生的知识、态度和实践行为，改善 ASD 儿童及其家庭获得早期诊断和基于证据的全面管理的机会。
