Evaluation of a medically coordinated care program in the management of autism.

IF 1.2 4区 医学 Q4 NEUROSCIENCES
Elodie Schembri, Elisabeth Jouve, François Poinso, Laure Encely, Marine Viellard, Arnaud Fernandez, Jokthan Guivarch
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引用次数: 0

Abstract

Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response.

Objectives: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.

Methods: Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score.

Results: We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant.

Conclusions: As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.

评估自闭症管理中的医疗协调护理计划。
自闭症谱系障碍(ASD)是一种神经发育障碍,其严重程度和残疾程度各不相同。在法国,日间护理医院(DCH)是护理患有自闭症的幼儿的参考医疗策略。由于日间护理医院的床位不足,心理健康咨询中心(MHCC)正在开发医疗协调护理项目:我们的目标是评估精神健康咨询中心的医疗协调护理项目与儿童精神病院护理项目的效果:这项非劣效性回顾性研究将20名患有ASD的儿童分为两组,分别在DCH和MHCC接受一年的治疗,比较两组的治疗效果。在 DCH ASD 组,儿童每周在日间医院接受两个半天的护理,并接受个别教育护理。在 MHCC ASD 组,儿童受益于医疗协调护理计划。医疗护理通过更频繁、更长时间的咨询和向家长提供指导得到加强。在这两组中,患儿在私人诊所接受言语治疗和心理运动治疗的费用相同。比较采用 CARS-2 和 VABS-II 的综合标准。自闭症医疗协调护理项目与 DCH 相比的非劣效性是通过变化之间的差异(DCH 组变化 - MHCC 组变化)来检验的,非劣效性阈值为每项评分初始值的 10%:结果:我们观察到,两组患者的 CARS-2 自闭症严重程度都有所下降,VABS-II 社会适应行为也有适度改善。这一趋势在 MHCC 组比在 DCH 组更为明显,但只有 MHCC 组 CARS-2 严重程度的降低幅度更大才具有统计学意义:结论:由于有必要将两个量表整合为综合标准,因此无法保留 MHCC 与护理计划的非劣效性。不过,接受区儿童保健中心治疗和护理计划的儿童都取得了进步。这表明,在大医院空间日益缺乏的情况下,医疗保健中心为患有自闭症的儿童提供的护理服务是有意义的。继续开展这项研究工作,进行人数更多的多中心研究,可以证明医疗保健中心的协调护理项目与大医院的协调护理项目相比并无劣势。此外,还可以根据儿童的初始特征设立分组,以便更准确地说明每种治疗方法的相关性。
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来源期刊
CiteScore
4.60
自引率
7.40%
发文量
162
审稿时长
6-12 weeks
期刊介绍: Une revue française de renommée internationale. - Un comite de rédaction représentant tous les aspects de la prise en charge psychiatrique du patient. - Une sélection rigoureuse d''articles faisant l''objet de plusieurs expertises. - Des travaux d''auteurs et de chercheurs de renommée internationale. - Des indexations dans les grandes bases de données (Current Contents, Excerpta Medica, etc.). - Un facteur d''impact qui témoigne de la grande notoriété de la revue. La tribune des publications originales de haut niveau. - Une très grande diversité des sujets traités, rigoureusement sélectionnés à travers des sommaires dynamiques : - des éditoriaux de médecins référents, - une revue de presse sur les actualités internationales, - des articles originaux pour approfondir vos connaissances, - des mises au point et des cas cliniques pour engager votre réflexion sur les indications et choix possibles au travers de mises en situation clinique, - des dossiers thématiques pour faire le tour d''une question. - L''actualité de l''AFPB : L''Encéphale publie régulièrement des comptes rendus de l''Association française de psychiatrie clinique.
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