Extension for Community Health Outcome (ECHO) Autism - Uruguay: A Coordinated Strategy to Improve Access to Health Care for Children with Autism Spectrum Disorders.

Background: Uruguay provides universal healthcare through an Integrated National Health System with public and private providers. Although in recent years this system has contributed to improving the health of children, the special care required for children with neurodevelopmental disorders presents difficulties including delays in early diagnosis and lack of access to autism specialists and rehabilitation services. Children with developmental concerns and/or autism often have long waits to see a specialist and receive services. In 2014, the Universidad de la República partnered with Project ECHO at University of New Mexico Health Sciences Center (UNMHSC) to use this model to increase capacity to evidence based medicine in Uruguay. Project ECHO is an innovate framework that uses multipoint video-conferencing to support community physicians and practitioners through case based learning via an “all teach, all learn” approach. ECHO is a cost effective mechanism to improve access to health care for conditions like autism. A multidisciplinary team including pediatricians, neuro-pediatricians and child psychiatrists started the ECHO Autism program in Uruguay in 2015. The goals of ECHO Autism Uruguay include increasing community physician knowledge about identification of symptoms of autism and treatment of autism in the community.

Objectives: To share the experience of the ECHO Autism program in Uruguay during the first three years of implementation, including analysis of case presentations and participates self-perception of skills and knowledge gained.

Methods: Analysis of ECHO Autism clinics from June 12, 2015 to June 8, 2018 including clinical cases presented and participant’s self-perception of changes in skills and competences. The following skills and competencies were assessed: identifying developmental delay including autism before age 3, autism diagnosis, support family needs, comorbidity management, psychopharmacology, resource attainment and interprofessional communication.

Results: 30 ECHO Autism clinics were conducted during the study period. Thirty clinical cases were presented: mean age 4.5 years old (range 1– 12); most of them were male (n=25). Twenty patients presented with medical and psychiatric comorbidities, eight of them with two or more. Reasons for presentation in the ECHO Autism clinic were: difficulties in therapeutic approach focused on management of comorbidities (n=22) and diagnosis (n=8). Median age at time of concern was 18th months (range 12-60). Forty-five participants were connected in at least 50% of ECHO Autism clinics. After ECHO Autism implementation, a statistically significant improvement in participant self-perception of skills and competences in all fields evaluated was observed.

Conclusions: ECHO Autism is the first ECHO project in Uruguay focused on a primarily pediatric condition. The results of this experience shows that ECHO Autism is feasible and effective in this population. Additionally, it has an important role to improve access to diagnosis and treatment of children with autism spectrum disorder. A community of practice was achieved through participation in the ECHO Autism clinics, and self-perception about skills and competences in diagnosis and treatment of ASD improved. ECHO Autism in Uruguay is a meaningful approach to autism care and offers improved access to best practice care.