39 Perspectives of preventive care physicians on early detection of autism spectrum disorder 2 4b. Time constraints Another obstacle in the use of screening instruments mentioned by PCPs is time constraints. Within preventive care, the use of multiple national guidelines and screening instruments are prescribed for a range of developmental and medical problems. However, due to limited time and subsequent work pressure, PCPs feel that they cannot implement guidelines in full manner. 4c. Parental acceptance Furthermore, PCPs are afraid that it will jolt and intimidate parents when they introduce a screening list (CoSoS) that specifically targets possible ASD. 5. Perceptions regarding cultural and language differences All PCPs noted the importance of understanding and taking into account families’ cultural background, customs, parental beliefs and language. Some PCPs expressed their concerns that cultural differences make it more difficult to discuss developmental problems and suspicion of ASD. For example, one PCP expressed her thoughts about parents not truthfully telling how things are at home. Another PCP said she had the idea that parents found it more difficult to accept that there could be something going on with the child, and that parents were less likely to express concerns and ask for help. Language barriers could also contribute to poor detection of ASD, but all PCPs may contact a translator. Opinions of this service varied amongst PCPs. Most of them were glad to be able to communicate in the families’ language. One PCP however expressed her doubts regarding sharing personal information with an external party. 6. Availability of healthcare services Lastly, PCPs are worried about the availability of healthcare services. Waiting lists for (special) healthcare services such as audiologic centers and child psychiatry centers are often months long. Another obstacle regarding the availability of healthcare services is that the provision of healthcare is subject to the financial rules of the market. In the Netherlands, healthcare is purchased by municipalities. Because of this, the offer of healthcare services differs greatly per region. Some regions have more healthcare services available for young children with/at risk for ASD then others. One PCP who worked in a region with a restricted offer of healthcare services mentioned that she missed the ability to refer children to easy and accessible healthcare, for example an infant team. Strategies needed to optimize early detection of ASD in preventive care Participants were also asked which strategies are needed to optimize early detection of ASD at well-baby clinics. Two themes were extracted from data analysis: training needs and closer collaboration between healthcare organizations. Representative quotes are presented in Table 2.
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