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Autistic patients could benefit from new SPACE model in primary care

The SPACE model addresses barriers to ensure autistic people ‘are able to access healthcare as a basic right'

Autistic patients in primary care could benefit from a new model called SPACE,  which aims to address the barriers they face in accessing healthcare services.

The sensory, predictability, acceptance, communication and empathy (SPACE) model was developed in response to a survey of 1,248 autistic adults by autistic medical researchers at Brighton and Sussex Medical School (BSMS).

In their study, 80% reported difficulty accessing a doctor when required, facing barriers in adjusting to the clinical environment, appointment delays and lack of understanding from clinicians.

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Dr Sebastian Shaw, lead author of the study told Independent Nurse, ‘It’s deeply concerning that autistic people are encountering so many barriers to healthcare in this modern age - to the extent that many are needing to avoid seeing a doctor, even when it means putting their health at serious risk.’

The model prescribes specific accommodations to address the challenges autistic patients face in each component of SPACE, particularly the intense sensory elements in the clinical environment.

‘Avoiding bright and fluorescent lights, proximity to a noisy road and strong smells will help reduce sensory stresses,’ said Dr Shaw.

Respondents in the study reported extreme anxiety with unexpected change and needed predictability in appointments.

‘Often I’m so distressed after waiting so long in the waiting room – especially because the appointment time advertised is rarely the time I actually go in for consultation. This confusion and unknowns means I am often very close to meltdown by the time I get in for the consultation,’ said one autistic respondent.

Dr Shaw recommends that GPs provide information about possible changes in advance ‘to avoid confusion and ensure patients know what to expect.’

‘Video walk throughs or floor maps on GP websites are also fabulous ways to help autistic patients get a sense of what an appointment will look like and ensure predictability in their day,’ he added.

The researchers call for better acceptance and understanding of the challenges that autistic patients face, to ‘empathise with their needs and provide adequate medical support’.

‘A sympathetic and understanding GP means I feel less anxiety at appointments means I will be willing to go to the doctors when needed and means I attend regular screening check-ups,’ said an autistic respondent.

Dr Shaw told Independent Nurse that the acceptance and empathy components of SPACE advocate for a ‘neurodivergent affirmative approach and calls for GPs to reduce healthcare inequities that autistic patients face.’

‘Communication in autistic patients is quite different,’ said Dr Mary Doherty, who conceptualised the SPACE model in the study. ‘Literal interpretation of words and phrases is usual.’ ‘Their use of eye contact, posture and gazes can also be different from non-autistic patients.’

Dr Shaw suggests ‘avoiding idioms and verbalising what you are doing’ to ensure clear communication and transparency.

‘GPs should speak out loud, their thought processes, diagnostics and maintain constant conversation, such as “I am just going to feel your tummy and you need to tell me if it hurts and where it is painful and then I’ll ask some more detailed questions”’. 

With over one-third of respondents avoiding medical help because of these barriers, the SPACE framework offers a resolution at a critical time.

Dr Doherty struck a hopeful note, saying that with active discussions about implementing this model with the NHS and practitioners across UK, ‘we hope the SPACE model is widely rolled out and ensures autistic people are able to access healthcare as a basic right.’