Referral Patterns to Speech and Language Therapy in the UK before, during, and after the COVID-19 Pandemic: Dysphagia Compared with Communication Disorders.

IF 1.1 4区 医学 Q3 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
Yuki Yoshimatsu, Pamela Mary Enderby, Dharinee Hansjee, David G Smithard
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引用次数: 0

Abstract

Introduction: Acquired swallowing impairment is a major public health issue that often leads to increased morbidity and slower recovery. Speech and language therapists (SLTs) have taken the lead in the assessment and treatment of dysphagia, which is reflected in guidelines where early intervention is recommended. This is in addition to the central role that SLTs play in the management of acquired communication impairments since research indicates that patients with communication difficulties benefit from early and intensive therapy by SLTs. This increasing demand for SLTs is expected to cause conflicting pressures in their workload and, therefore, beneficial to consider workforce planning. The aim of this study was to examine real-world data in the UK to investigate this issue regarding changes in referral patterns of patients with dysphagia and/or communication disorders to SLTs over time, to assist with workforce planning.

Methods: We interrogated the Royal College of Speech and Language Therapists Online Outcome Tool, a national database, in this retrospective cohort study. We included patients evaluated between 2018 and 2022. We performed a subgroup analysis of patients aged ≥40 years who had a primary medical diagnosis of stroke. Data on age, primary diagnosis, time on caseload, primary Therapeutic Outcome Measure (TOM) scale and initial TOM score on impairment were examined.

Results: From the database of 44,444 referrals to speech and language therapy, 5,254 referrals were included in the stroke and overall subgroup analyses. Referrals were 55.1% male, with a median age of 71 years. More than half (56.1%) of these referrals were for dysphagia. Referrals decreased during the COVID-19 pandemic but began to recover from 2021 onwards. The time on the SLT caseload has increased over the years from a median of 14 days (interquartile range [IQR] 0-56) in 2018 to 20 days (IQR: 3-81) in 2022. While there were more referrals to SLT services for assessment and management of dysphagia than for communication in the overall population, in the stroke subgroup, referrals for communication disorders outnumbered referrals for dysphagia from 2020 onwards. Additionally, the severity of impairment on referral increased over the years.

Conclusion: Real-world data indicates that referrals to SLT services are changing over time to include more complex and severely impaired patients, with a demand for both swallowing and communication disorders. These findings should inform staff allocation and remodelling of education/training for SLTs to better meet clinical and public health needs. The retrospective nature of this study limits the strength and generalisability of these data, and this topic warrants further investigation.

英国在 Covid-19 大流行之前、期间和之后的言语和语言治疗转诊模式:吞咽困难与交流障碍的比较。
导言:后天性吞咽障碍是一个重大的公共卫生问题,通常会导致发病率增加和康复速度减慢。言语和语言治疗师(SLT)在吞咽困难的评估和治疗方面发挥着主导作用,这体现在建议早期干预的指南中。此外,言语和语言治疗师在后天性沟通障碍的治疗中也发挥着核心作用,因为研究表明,有沟通障碍的病人可以从言语和语言治疗师的早期强化治疗中获益。对语言治疗师的需求不断增加,预计会给他们的工作量带来相互冲突的压力,因此,考虑劳动力规划是有益的。本研究的目的是检查英国的真实数据,以调查吞咽困难和/或交流障碍患者转诊至 SLT 的模式随时间推移而发生的变化,从而协助劳动力规划:在这项回顾性队列研究中,我们查询了英国皇家语言治疗师学院在线结果工具(一个全国性数据库)。我们纳入了 2018 年至 2022 年期间接受评估的患者。我们对年龄≥40岁、主要医学诊断为中风的患者进行了亚组分析。我们对年龄、主要诊断、病例时间、主要治疗结果测量(TOM)量表和最初的 TOMs 损伤评分等数据进行了研究:数据库中有 44,444 例言语和语言治疗转介患者,其中 5,254 例转介患者被纳入中风和总体亚组分析。55.1%的转诊者为男性,中位年龄为 71 岁。超过一半(56.1%)的转诊患者是因为吞咽困难。在 COVID-19 大流行期间,转诊人数有所减少,但从 2021 年起开始恢复。SLT案件量的时间逐年增加,从2018年的中位数14天(四分位距(IQR)0-56)增加到2022年的20天(IQR 3-81)。虽然在总体人群中,因吞咽困难的评估和管理而转介到 SLT 服务的人数多于因交流障碍而转介的人数,但在中风亚组中,自 2020 年起,因交流障碍而转介的人数超过了因吞咽困难而转介的人数。此外,转诊时损伤的严重程度逐年增加:真实世界的数据表明,随着时间的推移,SLT 服务的转诊情况正在发生变化,包括更复杂和严重受损的患者,以及对吞咽和交流障碍的需求。这些研究结果应为 SLT 人员的分配和教育/培训的调整提供参考,以更好地满足临床和公共卫生需求。这项研究的回顾性质限制了这些数据的强度和普遍性,这一课题值得进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Folia Phoniatrica et Logopaedica
Folia Phoniatrica et Logopaedica AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-OTORHINOLARYNGOLOGY
CiteScore
2.30
自引率
10.00%
发文量
28
审稿时长
>12 weeks
期刊介绍: Published since 1947, ''Folia Phoniatrica et Logopaedica'' provides a forum for international research on the anatomy, physiology, and pathology of structures of the speech, language, and hearing mechanisms. Original papers published in this journal report new findings on basic function, assessment, management, and test development in communication sciences and disorders, as well as experiments designed to test specific theories of speech, language, and hearing function. Review papers of high quality are also welcomed.
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