medical needs, more medical pathology, and greater difficulties in
identifying and communicating their symptoms than general population.
Medical assistance to ASD subjects is usually poor across contexts. To
provide access to high quality medical care for individuals affected
with ASD, a comprehensive medical care program was designed and
implemented recently in an urban population, in Madrid (Spain). This
program is open to individuals of all ages and serves the whole city’s
catchment area.
Objectives: 1. Centralizing medical attention and facilitating access
to specialized medical care 2. Facilitating differential diagnosis of
medical problems, including those leading to behavioural
deterioration. 3. To provide access to a Psychiatry Specialized Unit.
4. Improving ASD individuals’ health, taking care of daily problems as
diet, sleep, dental health. 5. Providing coordination with different
medical services to cover medical needs in an organized fashion
(reducing waiting times, adjusting spaces with visual sequences and
pictograms, performing several procedures in the same day, etc). 6.
Enhancing knowledge about ASD among health professionals and promoting
specific adaptation of general medical procedures when treating ASD
patients.
Methods: Population: ASD individuals of all ages throughout all city’s
territory (6 million people) Procedure: 1.Setting up a specialised
Psychiatry Unit in a Tertiary Hospital for the treatment of ASD
patients. 2.Setting up a case management approach. 3.Meetings with the
heads of the most demanded specialities. 4.Development of good
practice guidelines for the physical environment, medical procedures
and diagnostic techniques. 5.Design and application of questionnaires
for the evaluation of the effectiveness and satisfaction with the
Program 6.Divulgation of the Program among ASD parent associations and
educational services.
Results: During the period 1st April 2009 to 30th March 2012, 851 new
patients have been attended by this program, 78% children (18
months-17 years) and 22% adults (18 years and older). There have been
3244 follow-up psychiatry visits. In addition, 2733 visits have been
organised to other medical specialities and 954 patients have received
a medical procedure or a diagnostic technique. The most demanded
specialities were Neuropediatrics (N=498), Nutrition (N=394),
Ophthalmology (N=334), Gastroenterology-Digestive (N=192), Neurology
(N=180), Trauma-Orthopaedics (N=170), Dermatology (N=125), and
Estomatology (N=106) The most common procedures and diagnostic
techniques were blood test (n=399), electroencephalography (N=145),
X-Ray (N=97), echocardiogram (N=86), metabolic and genetic exams
(N=83), MRI (N=54) and electrocardiogram (n=51). Preliminary results
seem to confirm the presence of more physical pathology in this
population.
Conclusions: Persons with ASD display difficulties attending
conventional medical settings. A case management approach, with
emphasis on information and teaching of professionals, support to
patients and families, and coordination between and within medical
specialties can cover these needs and improve the medical assistance
of ASD population.
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