Training Program in Autism to Primary Care Professionals in São Paulo, Brazil - PILOT Study

Background:  

Pervasive Developmental Disorders’ treatment early on can be cost effective and lead to improvement on the prognostic and quality of life for individuals later on. However, late identification of Pervasive Developmental Disorders (PDD) is an universal problem and even more complicated in South America.

In Brazil, the Unified National Health System provides universal access to health services for the entire Brazilian population. This system is organized regionally, composed of clinics that integrate primary and specialty care; the Brazilian mental health system is fully integrated with the Unified National Health System. For the treatment of PDD children and adolescents the main service are the Psychosocial Community Care Centers for Children and Adolescents (CAPSI), while for identification of these cases, the main resource are primary care health clinics. The CAPSI team comprises specialized mental health professionals, but professionals from primary care health clinics don´t have training in mental health, neither about PDD, therefore they need to be trained.

 

Objectives:  

This study aimed to evaluate the impact of a training course about autism to pediatricians and other primary care professionals in the north region of São Paulo city in Brazil.

Methods:  

The course was conducted in five weekly meetings, 3 hours each: 2 hours of lectures offered by PDD experts, plus 1 hour of case discussion. The main topics were: (1) main symptoms of PDD, (2) epidemiology, (3) instruments, (4) early signs and (5) evidence based treatments for PDD.

The participants were 22 professionals from primary care clinics from the north region of São Paulo city: 17 Pediatricians, 4 General Practitioners and 1 Psychologist. All of them were evaluated before and after training according to a structured questionnaire with 13 questions about PDD knowledge. 

Results:  

Overall, there was a statistically significant improvement in PDD knowledge after training in comparison to the knowledge before training: mean 6.73 x 8.18 (p<0.01). They correctly answered 148 questions before the training, and 203 question, after the training (improvement of 37%).

The results also showed a change in clinical practice: after training: the trained professionals referred 3 times more suspected PDD cases to CAPSI (4 months after training in comparison to 4 months prior training). In addition, all of the suspect case had clinical symptoms compatible with PDD or sufficiently complex that required a specialized evaluation for differential diagnosis.

Conclusions:  

This training course seems feasible, low cost, and able to improve knowledge and referrals among primary care professionals. 

This pilot study has several limitations, but can be considered successful, since it reached its main goal: to sensitize primary care professionals to identify suspected cases of PDD and immediately refer them to specialized service (CAPSI) to be better evaluated and adequately treated.