Do autistic patients change healthcare services utilisation through the transition age? An Italian longitudinal retrospective study

Abstract

ObjectivesThis paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in healthcare service use during the healthcare transition age of 18.DesignThis research is based on a longitudinal retrospective cohort study.SettingThe data is drawn from the Italian Administrative Healthcare Database (2010–2017).ParticipantsWe identified 5607 ASD patients; 331 ASD patients from 2012 to 2015 in the calendar year of their 18th birthday were selected and their health service utilisation during a 5-year period—ranging from 2 years preceding and succeeding their 18th year—were investigated.InterventionsNone.Primary and secondary outcome measuresPrevalence, incidence and proportion of ASD patients receiving specific healthcare services were included in the outcome measures.ResultsPrevalence of ASD at age 8 was 5.4/1000. Global access to health and social services was lower both before and after age 18 (46.5% at 16; 68.0% at 18; 54.1% at 20). The percentage of patients receiving a neuropsychiatric consultation decreased after age 18 (30.8% at 18; 5.4% at 20). Community mental health services (CMHS) utilisation rate increased above 18 years of age. Regarding psychiatric visits, for both outpatient and CMHS, an increase was observed from 17.8% at age 18 to 25.4% at age 20. The utilisation of rehabilitation services decreased with age, dropping from 17.8% at age 16 to 1.8% at age 20. Psychiatric outpatient services remained stable across ages at about 14%.ConclusionOur findings suggest that ASD patients changed clinical reference services with age from neuropsychiatric and rehabilitative services towards psychiatric and community-based services as they transitioned from paediatric to adult healthcare services.

Population-based incidence and prevalence of inflammatory bowel diseases in Milan (Northern Italy), and estimates for Italy

“…This is a real-world study carried out in a northern Italian area where the health services are highly digitized and belong to a unique informatics system. Such administrative records have been widely used to evaluate a broad range of diseases [18][19][20][21][22], including the economic burden of IBDs [23]. The AHP provides care to about three 3 500 000 inhabitants.…”

Building Bricks of Integrated Care Pathway for Autism Spectrum Disorder: A Systematic Review

“…A study analyzing the Italian Administrative Healthcare Database, from 2010 to 2017, observed a sharp decrease in the percentage of patients receiving a neuropsychiatric consultation after the age of 18, and in the utilization of rehabilitation services with age [ 47 ]. Autistic individuals changed clinical referral services as they aged, moving from neuropsychiatric and rehabilitation services to psychiatric and community services as they transitioned from developmental to adult health services.…”

Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

“…Data extraction – Neurodevelopmental disorders). Three studies included young people with ASD (Laxman, Taylor, DaWalt, Greenberg, & Mailick, 2019; Merrick et al., 2020; Tunesi, Bosio, & Russo, 2019), four included young people with any neurodevelopmental condition (Asl, 2014; Maslow, 2016; Patwardhan, Singh, & Kanster, 2019; Singh et al., 2021), one focused on learning disabilities (Sharif, 2021), one on hyperkinetic disorder (Blasco‐Fontecilla et al., 2012) and the remainder focussed on ADHD (Ayyash et al., 2018; Eke et al., 2019; Eke et al., 2018; Heron et al., 2020; Janssens et al., 2020; Magon, Latheesh, & Muller, 2015; McCarthy et al., 2009; McNicholas & Singh, 2015; Moosa & Sandhu, 2015; Ogundele, 2013; Ogundele & Omenaka, 2012; Price, Newlove‐Delgado, et al., 2019; Reale et al., 2018; Reale, Frassica, Gollner, & Bonati, 2015; Tatlow‐Golden et al., 2018). However, most studies included young people with comorbidity, including those with comorbid ADHD/ASD.…”

“…Laxman’s USA study of service use patterns reported that all individuals with ASD experienced reduced levels of service use at transition age, but those without intellectual disabilities experienced a far steeper decline in service use prior to high school exit, which suggested discharge or disengagement prior to the age of transition (Laxman et al., 2019). Tunesi studied health service utilisation in a cohort ( n = 331) of transition aged young people with ASD drawn from the Italian Administrative Healthcare Database (Tunesi et al., 2019). Over the transition period, there was a drop in the use of services categorised as psychological or rehabilitative and in the percentage of patients having a ‘neuropsychiatric consultation’.…”