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

Jeanne Van Cleave; Chloe Holifield; Ann M Neumeyer; James M Perrin; Erin Powers; Linda Van; Karen A Kuhlthau

doi:10.1007/s10803-018-3630-x

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

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

Authors

Jeanne Van Cleave^{1

2

3

4}, Chloe Holifield^{5

6}, Ann M Neumeyer^{7

8}, James M Perrin^{9

6}, Erin Powers¹⁰, Linda Van¹¹, Karen A Kuhlthau^{9

6}

Affiliations

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.

PMID: 29982896
DOI: 10.1007/s10803-018-3630-x

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.

MeSH terms

Attention Deficit Disorder with Hyperactivity / complications
Attention Deficit Disorder with Hyperactivity / therapy*
Autism Spectrum Disorder / complications
Autism Spectrum Disorder / therapy*
Child
Delivery of Health Care
Female
Health Personnel
Humans
Male
Parents
Primary Health Care*
Qualitative Research
Quality Improvement
Specialization

Grants and funding

UA3 MC 11054/Maternal and Child Health Bureau