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J Autism Dev Disord. 2018 Dec;48(12):4222-4230. doi: 10.1007/s10803-018-3630-x.

Expanding the Capacity of Primary Care to Treat Co-morbidities in Children with Autism Spectrum Disorder.

Author information

1
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. jeannemarie.vancleave@childrenscolorado.org.
2
Department of Pediatrics, Harvard Medical School, A-111, 25 Shattuck Street, Boston, MA, 02115, USA. jeannemarie.vancleave@childrenscolorado.org.
3
Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA. jeannemarie.vancleave@childrenscolorado.org.
4
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA. jeannemarie.vancleave@childrenscolorado.org.
5
Department of Pediatrics, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
6
Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA.
7
Lurie Center for Autism, MassGeneral Hospital for Children, 1 Maguire Rd, Lexington, MA, 02421, USA.
8
Department of Neurology, Harvard Medical School, A-111, 25 Shattuck Street, Boston, MA, 02115, USA.
9
Department of Pediatrics, Harvard Medical School, A-111, 25 Shattuck Street, Boston, MA, 02115, USA.
10
University of California, Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA, 92617, USA.
11
Touro College of Osteopathic Medicine, 230 West 125th Street, New York, NY, 10027, USA.

Abstract

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.

KEYWORDS:

Autism spectrum disorders; Healthcare delivery; Primary care; Quality improvement; Subspecialty care

PMID:
29982896
DOI:
10.1007/s10803-018-3630-x
[Indexed for MEDLINE]

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