Barriers to Healthcare for Persons with Autism: A Systematic Review of the Literature and Development of A Taxonomy

Purpose: This review aimed to 1) synthesize extant research on barriers to healthcare access experienced by persons with autism, their caregivers, and health-care providers; and 2) present a taxonomy of barriers to physical healthcare for individuals with autism. Method: Systematic searches were conducted in five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Thematic analysis was used to classify barriers and to develop a taxonomy. Results: In total, 31 articles were included in the review. The resulting taxonomy consisted of four themes: 1) Challenges Associated with Autism-related Characteristics; 2) Health-care Provider-based Issues; 3) Healthcare System Issues; and 4) Patient-related factors. Conclusions: Barriers to healthcare access for persons with autism are prevalent and occur at the patient, provider, and system levels. The taxonomy developed may facilitate measurement of barriers within health-care facilities and prompt identification of areas where interventions are warranted to improve care.本综述旨在达成两大目标：1）系统梳理现有关于自闭症患者、其照护者以及医疗服务提供者所面临的医疗服务获取障碍相关研究；2）提出针对自闭症个体的实体医疗保健障碍分类框架。方法：在五个电子数据库中开展系统性文献检索。采用《多设计研究质量评估工具》（Quality Assessment Tool for Studies with Diverse Designs）对纳入研究的方法学严谨性进行评估。通过主题分析法对各类医疗障碍进行归类，并据此构建障碍分类框架。结果：本综述最终纳入31篇相关文献。所构建的分类框架包含四大主题：1）与自闭症相关特征相关的挑战；2）医疗服务提供者层面问题；3）医疗保健系统层面问题；4）患者相关因素。结论：自闭症群体获取医疗服务的障碍普遍存在，且涉及患者、服务提供者与系统三个层级。本研究开发的分类框架可助力医疗机构开展医疗障碍评估，并推动识别亟需实施干预以优化医疗服务的领域。