Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia.
Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.
BMC Prim Care. 2023 Aug 10;24(1):159. doi: 10.1186/s12875-023-02121-6.
Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics.
A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program ("GP Surveillance for Autism") were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically.
Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services.
The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.
在社区中早期识别儿童发育障碍仍然存在重大挑战。在生命早期实施支持和服务已被证明可以促进有发育障碍高风险的儿童（包括自闭症）的积极发育结果。作为一项集群随机对照试验的一部分，本研究旨在检查和比较澳大利亚全科医生（GP）对自闭症数字发育监测计划和一般实践诊所中常规护理途径的看法和经验。
采用半结构式访谈和以扎根理论为基础的主题归纳分析的定性研究方法。邀请参与主要项目（“自闭症 GP 监测”）的所有来自新南威尔士州西南部（新南威尔士州）和墨尔本（维多利亚州）的全科医生参加访谈。同意参与的全科医生通过在线或面对面会议接受访谈。访谈进行录音、转录和使用 NVivo12 软件进行编码。采用归纳解释方法进行数据分析和主题分析。
来自两个地点（新南威尔士州：n=11；维多利亚州：n=12）的 23 名全科医生同意接受访谈；在达到这个参与者数量后，数据达到了饱和。归纳主题编码和分析产生了八个主要主题，并强调了共同的促成因素，例如全科医生在早期识别和后续支持中的作用、临床医生/专业人员之间增强的沟通、与患者建立关系以及使用标准化筛查工具。数字筛查程序对早期识别发育障碍（包括自闭症的早期迹象）的可行性和可接受性的具体促进因素，以及鼓励全科医生进行研究和教育。然而，除了有限的儿童发育筛查工具的知识和采用以及 COVID-19 封锁的影响外，还确定了一些实际和社会经济障碍。常见和具体的建议涉及支持全科医生进行发育/儿科培训、简化筛查流程以及在初级保健服务中提供资金和资源。
该研究强调了实践和政策变革的必要性，包括对全科医生进行进一步培训，同时有足够的时间完成发育检查，并通过医疗保险计费项目获得适当的经济报酬。需要进一步研究在全国范围内实施和扩大早期识别发育障碍（包括自闭症）的监测计划。
