Improving Healthcare Encounters of Patients with Autism Spectrum Disorder: Deciding on a Care Plan

Finally, after working through our history, physical exam, and initial evaluation of our patient throughout this series; we have finally come to a diagnosis! No matter what the diagnosis, it is very important that we keep certain things in mind when determining a management plan. The first thing to keep in mind is that these patients may require more education than most patients.¹ This makes sense as the barriers to communication these patients have along with their need for predictability and routine require more information regarding the treatment, whether it is a procedure or a medication, before the treatment is implemented. For this reason, the treatment modality and the explanation of its implementation must be tailored to suit the needs and abilities of the patient.¹ Taking certain sensory sensitivities into account during this process may be needed in addition to the use of different resources and treatment modalities in order to help inform the patient as to what the treatment is going to look like may be needed.

                When it comes to care plans that involve the use of procedures, it may be especially important for the patient to become familiar with the tools that will be used and with an illustration of what the procedure will look like when performed. Specifically showing the patient the materials that will be used (for splinting and bandaging for example) and allowing them to feel the material has been shown to be a good way to better inform the patient as to what the procedure entails.² In addition to this, modeling the intervention with said materials on a caregiver or volunteer can give these patients the predictability they need in order to brace themselves for the procedure.²  

                Meanwhile, for management care plans that involve the use of medication, the taste of the medication should be taken into account. This makes sense as, given that many individuals on the spectrum have sensory sensitivities, aversive taste of a medication could be enough to scare the patient out of taking the medication, causing the intervention to have an aversive effect on treatment compliance. For this reason, pediatric formulations should still be considered for adult patients on the spectrum that might have sensory sensitivities related to taste that could have this effect on their adherence to the medication.²

                As with any patient, the provider should always keep in mind the financial aspect of the management options they provide. For the provider that serves the ASD population, it may be helpful to familiarize oneself with programs like Supplemental Security Income or Medical Assistance that many individuals on the spectrum are eligible for in order to obtain more affordable care.³ Doing this allows the provider to advocate for and implement affordable care plans for these patients.

                Lastly, many of these individuals on the spectrum have many different specialists that they see for different aspects of their care including physical therapy, occupational therapy, case management, psychiatry, etc. In order for a given care plan to be effective, it is important that these other members of this patient’s care team are aware of the treatment plan being used³ so that it can be supported an encouraged in a variety of contexts by each of the team members. This interdisciplinary communication ensures better treatment adherence as the patient is being encouraged by multiple people to stick to their current regimen. Although this is done increasingly more through the use of medical home models established for the patient, it can still be done by the single provider that cares for a patient by simply communicating and coordinating with the different specialists and professionals that the patient currently seeks care and services from.

                It is with these revelations that we now can take a moment and look back on everything that we have discussed in this series. No matter what locations and institutions we end up in throughout our training, we as future medical providers in training are bound to come across these individuals as our patients, as the overall prevalence of ASD within the United States is steadily increasing. For this reason, I hope that the “toolbox” of skills introduced in this series may be helpful to the soon-to-be healthcare provider in serving these patients and other patients with similar barriers to care, so that the healthcare encounters we share with these individuals yield positive outcomes.

                                                                                                               Alexis Matarangas   DUCOM 2019

REFERENCES:

1. Jain S. Teaching learners to care for children and youth with special healthcare needs. Fam Med 39, 85-87 (2007).
2. Venkat A, Jauch E, Russel WS, Crist CR, & Farrell R. Care of the Patient with an autism spectrum disorder by the general physician. Postgrad Med J 88, 472-481 (2012).
3. Bultas MW, Mcmillin SE, & Zand, DH. Reducing Barriers to Care in the Office-Based Health Care Setting for Children with Autism. J Pediatr Health Care 30, 5-14 (2016).