Objective: 

We investigated patterns and predictors of health service utilization (HSU) among children with autism spectrum disorder (ASD) and global developmental delays (GDD, non-ASD) attending tertiary services in a resource-constrained setting.

Method: 

Caregivers and children (diagnosed with either ASD or GDD) attending the developmental service were enrolled into a retrospective cohort study. Sociodemographic factors, clinical factors, and service use over the preceding year were collected using structured questionnaires and medical record reviews.

Results: 

We enrolled 240 households (116 ASD, 124 GDD; ages 3–8 years; male:female ratio 2:1). The majority (84%) had moderate-to-severe symptoms, and 42% were nonverbal. Children with GDD had higher levels of underlying syndromic diagnoses than those with ASD (46, 37.1%; 14, 9.5%); (p < 0.01) and more co-occurring comorbidities (51, 41.0%; 14, 12.1%; p = 0.0001). Those with GDD had higher mean total HSU visits (13.3; 11.5; p = 0.02), higher mean specialist visits (4.0:2.0; p = 0.001), and more hospitalizations than those with ASD (38, 31%; 16, 14%; p = 0.02). Other services were similarly attended by both groups: therapy 6.0 (2.0–10.0), emergency visits 1.0 (1.0–2.0), auxiliary services 0 (0–1.0), and primary care visits 0 (0–1.0). Having an employed parent was the strongest predictor of increased HSU (p = 0.05).

Conclusion: 

Despite high functional impairment in this cohort, many households underutilized therapy services. There was skewed attendance of emergency and specialist services over primary care services. Children with GDD had greater HSU compared with those with ASD, primarily because of more specialist visits. HSU could be improved by caregiver education, household economic empowerment, and strengthening of primary care services.

中文翻译：

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资源有限环境下三级中心患有自闭症谱系障碍的幼儿对健康服务的利用与整体发育迟缓

客观的： 

我们调查了在资源有限的环境中就读三级服务的患有自闭症谱系障碍 (ASD) 和整体发育迟缓（GDD，非 ASD）儿童的卫生服务利用 (HSU) 模式和预测因素。

方法： 

参加发育服务的看护者和儿童（被诊断患有 ASD 或 GDD）被纳入一项回顾性队列研究。使用结构化问卷和病历审查收集了上一年的社会人口因素、临床因素和服务使用情况。

结果： 

我们纳入了 240 个家庭（116 个 ASD，124 个 GDD；年龄 3-8 岁；男女比例 2:1）。大多数（84%）有中度至重度症状，42% 是非语言症状。GDD 儿童的潜在综合征诊断水平高于 ASD 儿童（46 名，37.1%；14 名，9.5%）；( p < 0.01) 和更多同时发生的合并症 (51, 41.0%; 14, 12.1%; p = 0.0001)。与 ASD 患者相比，GDD 患者平均总 HSU 就诊次数较高 (13.3; 11.5; p = 0.02)，平均专家就诊次数较高 (4.0:2.0; p = 0.001)，住院次数也较多 (38, 31%; 16, 14%) ；p = 0.02）。两组的其他服务参与情况相似：治疗 6.0 (2.0–10.0)、紧急就诊 1.0 (1.0–2.0)、辅助服务 0 (0–1.0) 和初级保健就诊 0 (0–1.0)。父母有工作是 HSU 增加的最强预测因素 ( p = 0.05)。

结论： 

尽管该群体的功能障碍严重，但许多家庭并未充分利用治疗服务。急诊和专科服务的就诊率高于初级保健服务。与自闭症谱系障碍 (ASD) 儿童相比，患有 GDD 的儿童的 HSU 更高，这主要是因为更多的专家就诊。HSU 可以通过护理人员教育、家庭经济赋权和加强初级保健服务来改善。