Author: Elizabeth W. Barnhardt

Publisher:

Published: 2022

Total Pages: 0

ISBN-13:

Although there appears to be a significant increase in the rates of screening for autism spectrum disorders (ASD), the average age of diagnosis is not decreasing. Even when formal ASD screening tools are used, physicians might not place referrals for developmental supports and ASD evaluations. The primary objective of this study was to explore, using a mixed-methods approach, the educational needs of primary care providers (PCPs) in the primary care network at a large children's hospital so that future educational and quality improvement efforts might more accurately meet their needs. The qualitative methodology of Interpretive Phenomenological Analysis was utilized to complete semi-structured interviews with 7 primary care pediatricians with a goal of exploring how primary care providers understand their role in the process of identifying children with ASD and how they integrate knowledge from clinical exams, parental history, developmental screening tools, behavioral observations, and their accumulated experience in making identification decisions and subsequent referrals for further treatment and evaluation. In addition, a survey was distributed using REDCap and completed by 42 PCPs which included demographic questions as well as portions of the Autism Spectrum Knowledge Scale Professional Version, Revised (ASKSP-R), and the Primary Care Autism Self-Efficacy (PCASE) Survey. On the PCASE, PCPs had an average score of 4.38, indicating overall confidence in their ASD screening practices. The average score was 58% on the ASKSP-R. The items with the lowest scores inquired about ASD epidemiology as well as restricted and repetitive patterns of interests and behaviors. Five salient themes were created based upon the semi-structured interviews completed with seven primary care pediatricians in the primary care network at Nationwide Children's Hospital which serve to highlight the factors which might influence a provider's decision-making during the process of screening for ASD and subsequent care. Providers were noted to be influenced by their own backgrounds and experiences in training and practice, often desiring to utilize their clinical skills gleaned from years of medical training when making decisions during the screening process. Providers also expressed frustration at the office and system-level factors which impact their decision-making, from long wait times to diagnostic evaluation and insufficient time during office visits to concerns about overwhelming families with placing too many referrals. They also reviewed how a lack of continuity impacts their ability to engage in discussions about their concerns for ASD. Providers also value the perspectives of the families themselves during the screening process and cite this as a common reason for not placing what would be recommended referrals. On the whole, providers demonstrated a strong desire to improve both their individual care as well as the care of children with ASD at the system-level and are interested in future educational programming which allows them to more effectively identify children at risk for ASD and connect them to appropriate resources in a timelier fashion.