Healthcare access and services use among US children with autism spectrum disorder.
Olivia J Lindly, Katharine E Zuckerman, Karen A Kuhlthau
PMID 30497274WHAT IT FOUND
29.0% of U.S. children with ASD had trouble getting healthcare, often delays.
These problems were associated with fewer well-child visits and more emergency visits, but not flu shots.
Key findings
0129.0% of U.S. children with ASD had at least one healthcare access problem; delays were the most common type, especially appointment timing and the office not being open.
02Children with ASD who had ≥1 healthcare access problem had lower adjusted odds of ≥1 well-child visit and prescription medication use, but higher adjusted odds of ≥4 office visits and ≥1 ED visit.
03The association between healthcare access problems and ED use was most pronounced for children with ASD who had any private insurance versus public insurance only; similar patterns appeared for children with two parents, a parent with a college degree or more, or who were White and non-Hispanic.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The data are cross-sectional, so the study cannot show whether healthcare access problems came before or after the services use patterns. The NHIS measures did not cover all possible access problems or the specific services provided during well-child visits. Access questions were not about a specific provider or service, and emergency department reason questions covered only the most recent visit. Uninsured children were excluded, so the findings do not describe the most vulnerable access situation. Small cell sizes limited analysis of some race and ethnicity groups and prevented more detailed socioeconomic analysis. There is potential self-selection bias because parents who participated may have been more advantaged or engaged. There was no explicit comparison group of children without ASD.
Declared interests
The supplied publication types indicate NIH extramural and U.S. Government P.H.S. research support. The article text does not include an author conflict-of-interest declaration or a statement that a sponsor designed or wrote the manuscript.
The easy way to misread this
Do not read these associations as proof that access problems cause fewer well-child visits or more emergency visits. The data are cross-sectional, so the study cannot show which came first.