We investigated patterns and predictors of health service utilization (HSU) among children with autism spectrum disorder (ASD) and global developmental delays (GDD, non-ASD) attending tertiary services in a resource-constrained setting.
Caregivers and children (diagnosed with either ASD or GDD) attending the developmental service were enrolled into a retrospective cohort study. Sociodemographic factors, clinical factors, and service use over the preceding year were collected using structured questionnaires and medical record reviews.
We enrolled 240 households (116 ASD, 124 GDD; ages 3–8 years; male:female ratio 2:1). The majority (84%) had moderate-to-severe symptoms, and 42% were nonverbal. Children with GDD had higher levels of underlying syndromic diagnoses than those with ASD (46, 37.1%; 14, 9.5%); (p < 0.01) and more co-occurring comorbidities (51, 41.0%; 14, 12.1%; p = 0.0001). Those with GDD had higher mean total HSU visits (13.3; 11.5; p = 0.02), higher mean specialist visits (4.0:2.0; p = 0.001), and more hospitalizations than those with ASD (38, 31%; 16, 14%; p = 0.02). Other services were similarly attended by both groups: therapy 6.0 (2.0–10.0), emergency visits 1.0 (1.0–2.0), auxiliary services 0 (0–1.0), and primary care visits 0 (0–1.0). Having an employed parent was the strongest predictor of increased HSU (p = 0.05).
Despite high functional impairment in this cohort, many households underutilized therapy services. There was skewed attendance of emergency and specialist services over primary care services. Children with GDD had greater HSU compared with those with ASD, primarily because of more specialist visits. HSU could be improved by caregiver education, household economic empowerment, and strengthening of primary care services.