General practitioners’ perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study

BMC Primary Care

Research

Joseph Descallar¹  Natalie Ong²  Anne Masi³  Valsamma Eapen⁴  Abbie Lucien⁵  Feroza Khan⁵  Raisa Islam⁵  Iqbal Hasan⁵  Jane Kohlhoff⁵  Lisa Karlov⁶  Antonio Mendoza Diaz⁷  Teresa Winata⁷  John Eastwood⁸  Siaw-Teng Liaw⁹  Bin Jalaludin⁹  Chun Wah Michael Tam^1,10  Sue Woolfenden^1,11  Cheryl Dissanayake^1,12  Josephine Barbaro^1,12  Radhika Nair^1,12  Melissa Gilbert^1,12  Raghu Lingam^1,13 

[1] Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia;Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia;Children’s Hospital Westmead Clinical School, University of Sydney, Sydney, NSW, Australia;Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia;Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia;Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia;Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia;Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia;Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia;Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia;Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia;Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia;Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia;Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Sydney, NSW, Australia;Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia;Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney, NSW, Australia;Faculty of Medicine, School of Women and Children’s Health, University of New South Wales, Sydney, NSW, Australia;Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia;Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, NSW, Australia;Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia;Faculty of Medicine, School of Women and Children’s Health, University of New South Wales, Sydney, NSW, Australia;Population Child Health Research Group, Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia;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;Population Child Health Research Group, Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia;

关键词: Families;    Healthcare Professional;    Primary Healthcare;    Growth and development;    Autism;    Screening;   

DOI  :  10.1186/s12875-023-02121-6

 received in 2022-12-20, accepted in 2023-08-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSignificant 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.MethodsA 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.ResultsTwenty-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.ConclusionsThe 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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