Optimising general practice support for autistic adults: A realist review.

Aim: To find out how, why, and to what extent general practice supports autistic adults without co-occurring intellectual disabilities throughout their lives, in order to suggest improvements. Background: Autism refers to lifelong neurological differences that affect how people experience the world.

Some autistic people have strong memory skills, very good attention to detail, can focus on certain tasks for a long time, are very creative, and feel intense empathy. Without appropriate support or adjustments, some autistic people may experience difficulties, to different degrees.

For example, difficulties with executive functioning, focusing attention, being in social situations, alexithymia, interoception, and sensory sensitivities (including over- or under-sensitivity to certain stimuli). Some autistic people may be non-speaking, have co-occurring intellectual disabilities, or both.

Mental and physical health conditions are more common in autistic people, including anxiety, depression, gastrointestinal problems, cancer, epilepsy, and heart disease. Unmet health needs, complex intersectionalities and stress from stigma may contribute to this.

General practice is often the first point of contact for patients, yet research has found that autistic people face barriers to healthcare, report lower satisfaction with healthcare, and have more unmet health needs than non-autistic people.

This can be due to misunderstandings about the needs of autistic people, different communication styles, the clinic environment, and challenges making and getting to appointments, compounded by slow dissemination of research findings.

This project builds on existing research and is in line with the UK government s strategy to reduce the health and care inequalities that autistic people face.

Methods: We will conduct a realist review, which is a theory-driven systematic review, informed by the principles of scientific realism.

We will examine existing evidence to develop a programme theory to explain how, why, and to what extent general practice supports autistic adults throughout their lifespan.

Evidence may be identified from bibliographic databases (qualitative, quantitative, and mixed methods articles), grey literature, and sources suggested by stakeholders.

We will involve stakeholders in each stage of the review, including autistic individuals, family members, and general practice staff.

There will be six stages of the review, to be worked through iteratively: 1) clarifying the scope of the review; 2) searching for evidence; 3) article selection and evidence appraisal; 4) extracting and organising the data; 5) synthesising the data and drawing conclusions; 6) dissemination of the findings.

Outputs and impact: Based on the findings, we will produce guidance for 1) general practice on potentially helpful changes to services, and 2) autistic people to help them gain the support they need.

General practice staff and autistic individuals will be involved in the creation of the guidance to ensure it is accessible and meaningful.

The findings and the guidance will be shared with patients, community organisations, general practices, and researchers using a range of formats, including academic journals, lay summaries, and video summaries.

This will help to improve access to and engagement with general practice care, and thus improve the health and wellbeing of autistic individuals.