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Brisson V, Fournier C, Pelletier A, Joyal M, Defoy L, Tremblay P. Vocal Health and Vocal Health Knowledge Among Occupational Voice Users in the Province of Quebec. J Voice 2024; 38:799.e15-799.e27. [PMID: 35082049 DOI: 10.1016/j.jvoice.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
Voice disorders are frequent among occupational voice users such as teachers. Although these disorders can have serious personal and professional consequences, they are not often recognized as occupational diseases and little attention is paid to their prevention. This study aimed to provide a portrait of the self-reported vocal health and vocal health knowledge of occupational voice users in Quebec, Canada, and to identify risk factors associated with voice disorder symptoms. We conducted an online survey targeting occupational voice users in the province of Quebec, Canada, with a focus on those involved in teaching or training. The final sample, after excluding incomplete surveys, included 808 respondents (665 women, M = 41.5 ± 10.4 years old). The survey responses were analyzed using descriptive and inferential statistics. Results indicated that 9.8% of the respondents had a history of a diagnosed voice disorder and 68.8% of the respondents experienced at least one voice symptom on a regular basis. Ordinal logistic regressions revealed that several personal and environmental factors are associated with an increased risk of developing voice disorders symptoms: being a woman, suffering from a breathing disorder, allergies, acid reflux and/or hearing impairment, having less work experience, working with elementary school children and/or with continuous or speech noise in the background. Most of the respondents (94.6%) had never received information regarding voice disorders during their academic training and less than half of them (47.7%) knew which professionals can treat voice disorders. These findings highlight the need for formal vocal health education among both occupational voice users and their employers to improve prevention and treatment for voice disorders in an at-risk population.
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Affiliation(s)
- Valérie Brisson
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada; CERVO Brain Research Center, Quebec City, Canada
| | - Constance Fournier
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada
| | - Alicia Pelletier
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada
| | | | - Lyne Defoy
- CHU de Quebec-Université Laval, Hôpital St-François d'Assise, Quebec City, Canada
| | - Pascale Tremblay
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City, Canada; CERVO Brain Research Center, Quebec City, Canada.
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Davis J, Ward EC, Seabrook M, Gundara J, Whitfield BCS. Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:963-975. [PMID: 37921245 DOI: 10.1111/1460-6984.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. METHODS & PROCEDURES The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. RESULTS Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. CONCLUSION & IMPLICATIONS The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.
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Affiliation(s)
- Jennifer Davis
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Australian Catholic University, School of Allied Health, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Justin Gundara
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Department of Surgery, Redland Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Bernard C S Whitfield
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
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Brandenburg C, Ward EC, Schwarz M, Palmer M, Hartley C, Byrnes J, Coccetti A, Phillips R, Wishart LR. 'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care. Int J Qual Health Care 2024; 36:mzae021. [PMID: 38442741 DOI: 10.1093/intqhc/mzae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| | - Maria Schwarz
- Allied Health, Metro South Health, Cnr Armstrong and Loganlea Roads Brisbane, Queensland 4131 Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Carina Hartley
- Occupational Therapy, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 1 Parklands Dr, Gold Coast, Queensland 4215, Australia
| | - Anne Coccetti
- Metro South Health, QEII Jubilee Hospital, Cnr Kessels and Troughton Roads, Brisbane, Queensland 4108, Australia
| | - Rachel Phillips
- Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Laurelie R Wishart
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
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Bradley PT, Patterson J. Attitudes to the Implementation of Speech and Language Therapist Led Low Risk Two Week Wait Clinic in the UK: A Survey Exploration Using Normalization Process Theory. J Voice 2024; 38:86-95. [PMID: 34312024 DOI: 10.1016/j.jvoice.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to identify the factors which might shape the implementation of speech and language therapist led low risk 2 week wait clinic (SLTLR-2WW). STUDY DESIGN An online survey was designed, piloted, and disseminated through UK speech and language professional groups. The survey asked questions about, the skills of, and equipment available, to SLT respondents. Using a modified NoMAD instrument (based on Normalization Process Theory) the survey explored attitudes to the prospect of the development of the SLTLR-2WW clinical model in the UK. Responses were tallied and calculated as percentage of responses. The free text question responses were analyzed using a qualitative content approach, responses were coded and grouped into categories and mapped onto the Normalization Process Theory domains by the two authors. RESULTS There were 129 responses to the survey questions from SLTs from all regions of the UK and 72 respondents supplied free text comments for analysis. CONCLUSIONS The collected responses indicate there is enthusiasm for the potential development of SLTLR-2WW clinics. The survey demonstrates that there are disparities in terms of resource availability, departmental, management and clinical support, around the UK. There is limited but successful experience of SLTLR-2WW in the UK but the survey responses indicate there is potential for expanding the scope of practice for SLTs into the delivery of clinical care for patients referred as suspected cancer with hoarseness and swallowing issues. The responses to the NoMAD derived questions and free text analysis identify some factors which could impede the development of this new service model include, resistance, lack of training, supervision, and support from colleagues and management.
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Affiliation(s)
- Paula T Bradley
- Medical School, University of Sunderland, Sunderland, England
| | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, England.
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Chalmers S, Harrall K, Wong SY, Kablan W, Clunie G. A retrospective study of patients presenting with speech and language therapy needs within multidisciplinary Long COVID services: A service evaluation describing and comparing two cohorts across two NHS Trusts. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1424-1439. [PMID: 36916685 DOI: 10.1111/1460-6984.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Post-COVID Syndrome (also known as Long COVID) refers to the multi-system condition affecting individuals following COVID-19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. AIMS To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. OUTCOMES & RESULTS The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. CONCLUSIONS & IMPLICATIONS This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. WHAT THIS PAPER ADDS What is already known on this subject SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work? The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post-COVID voice, swallowing, communication and upper airway symptoms.
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Affiliation(s)
- Sophie Chalmers
- Long COVID Service, Long Term Conditions, Integrated Community Services Division, Bolton NHS Foundation Trust, Bolton, UK
- Allied Health Research Unit, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Kate Harrall
- Speech and Language Therapy Dept, Integrated Pathways Division, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- Research and Development Unit, Strategy, Research and Innovation Division, East Suffold and North Essex NHS Foundation Trust, Colchester, UK
| | - Sze Yin Wong
- Speech and Language Therapy Dept, Integrated Pathways Division, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Widad Kablan
- Paediatric Speech and Language Therapy, Family Care Division, Bolton NHS Foundation Trust, Bolton, UK
| | - Gemma Clunie
- Speech and Language Therapy, Surgery and Cancer, Imperial College London Healthcare NHS Trust & Imperial College London, London, UK
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Allen JE, Cleland J, Smith M. An initial framework for use of ultrasound by speech and language therapists in the UK: Scope of practice, education and governance. ULTRASOUND 2022; 31:92-103. [PMID: 37144231 PMCID: PMC10152317 DOI: 10.1177/1742271x221122562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
Background: There is growing evidence to support the use of ultrasound as a tool for the assessment and treatment of speech, voice and swallowing disorders across the Speech and Language Therapy profession. Research has shown that development of training competencies, engagement with employers and the professional body are vital to progressing ultrasound into practice. Methods: We present a framework to support translation of ultrasound into Speech and Language Therapy. The framework comprises three elements: (1) scope of practice, (2) education and competency and (3) governance. These elements align to provide a foundation for sustainable and high-quality ultrasound application across the profession. Results: Scope of practice includes the tissues to be imaged, the clinical and sonographic differentials and subsequent clinical decision-making. Defining this provides transformational clarity to Speech and Language Therapists, other imaging professionals and those designing care pathways. Education and competency are explicitly aligned with the scope of practice and include requisite training content and mechanisms for supervision/support from an appropriately trained individual in this area. Governance elements include legal, professional and insurance considerations. Quality assurance recommendations include data protection, storage of images, testing of ultrasound devices as well as continuous professional development and access to a second opinion. Conclusion: The framework provides an adaptable model for supporting expansion of ultrasound across a range of Speech and Language Therapy specialities. By taking an integrated approach, this multifaceted solution provides the foundation for those with speech, voice and swallowing disorders to benefit from advances in imaging-informed healthcare.
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Affiliation(s)
- Jodi Elizabeth Allen
- The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mike Smith
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Hall AE, Brandenburg C, Ward EC, Pokorny MA, Trafford K, Seabrook M, Whitfield BCS. Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study. Int J Audiol 2022:1-9. [DOI: 10.1080/14992027.2022.2073477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amber E. Hall
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Elizabeth C. Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michelle A. Pokorny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katye Trafford
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Bernard C. S. Whitfield
- Integrated Specialist ENT Service, Department of Otolaryngology Head and Neck Surgery, Logan Hospital, Meadowbrook, Australia
- School of Medicine, Griffith University, Southport, Australia
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Frakking TT, Waugh J, Carty C, Burmeister A, Marozza A, Hobbins S, Kilah M, David M, Kane L, McCormick S, Carter HE. The effect of different service models on quality of care in the assessment of autism spectrum disorder in children: study protocol for a multi-centre randomised controlled trial. BMC Pediatr 2022; 22:173. [PMID: 35366839 PMCID: PMC8976356 DOI: 10.1186/s12887-022-03244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is significant variability in clinical pathways available in the diagnostic assessment of ASD, including the order and timing of allied health assessments in relation to paediatrician consultations. Allied health professionals in first-contact models are increasingly used to improve the timeliness of healthcare access, whilst complementing medical specialty workforce shortages. Anecdotally, the implementation of allied health first-contact models in paediatrics has improved waitlists and timely access to healthcare. However, no rigorous studies have been conducted to evaluate the outcomes of these models. This study aims to determine the impacts of an allied health first-contact model on health service use and costs and patient quality of life and satisfaction. Methods An open, semi-blinded, multi-centre randomised controlled trial in paediatric outpatient clinics at two Australian metropolitan public hospitals. 56 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for assessment of ASD: (1) allied health first-contact or (2) medical first-contact model. Cost outcomes will be collected from both health service and family perspectives. Caregiver-reported outcome measures include: Pediatric Quality of Life Inventory (PedsQL), the EuroQOL Five Dimension Youth Version (EQ-5D-Y), the Autism Family Experience Questionnaire (AFEQ) and Measure of Processes of Care. Discussion Evidence of improvements in service and consumer centric outcomes will help inform the development and implementation of high-value, evidenced based models of care for the assessment of ASD in children. The findings from this study are expected to contribute to the evidence base around the costs and consequences of allied health first contact models for the assessment of children with ASD in the Australian setting. Findings of this study may help to inform the allocation of health care resources while maintaining, or potentially improving, patient and family quality of life and experience of care. These findings may be useful in informing the wider adoption of these models in Australia and internationally, particularly in healthcare settings where medical specialist shortages exist. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12621001433897. Registered: 25th October, 2021.
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Schwarz M, Ward EC, Seabrook M, Davis J, Whitfield BCS. Outcomes from an extended scope of practice speech-language pathology service for low risk ENT outpatients: A 5-year service review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:3-11. [PMID: 34075843 DOI: 10.1080/17549507.2021.1916592] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Early evidence supports the safety and efficiency of extended scope speech-language pathology (SLP) clinics designed to manage low risk ear nose and throat (ENT) outpatient referrals, however long-term data is lacking. The aim of this study was to complete a 5-year audit of clinical outcomes, including rates of re-referral, for a SLP Allied Health Practitioner (SLP AHP) led dysphagia and dysphonia service within an Integrated Specialist ENT Service.Method: A retrospective audit was undertaken of all patients referred with non-urgent dysphonia and/or dysphagia symptoms over a 5-year period since establishment of the SLP AHP service. Clinical outcomes, rates and reasons for re-referral to the specialist ENT waiting list were investigated.Result: Of 616 patient referrals, 462 patients were seen by the SLP AHP service. Most (72%, n = 333) received all required management through the clinical model, with only 28% (n = 129) requiring additional ENT intervention, consistent with previously published data. Only 36 of the 616 (6%) were re-referred/re-presented within 12 months of first presentation, of which only 12 were referred for same condition as initial referral. No adverse outcomes were recorded on the clinical database during this 5-year period.Conclusion: Results provide further evidence that the SLP AHP service is a safe and efficient method for managing low risk ENT outpatient referrals.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Jennifer Davis
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Bernard C S Whitfield
- Department of Otolaryngology Head and Neck Surgery, Division of Surgery, Integrated Specialist Ear Nose and Throat Service, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- School of Medicine, Griffith Medical School, Griffith University, Brisbane, Australia
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Payten CL, Nguyen DD, Novakovic D, O'Neill J, Chacon AM, Weir KA, Madill CJ. Telehealth voice assessment by speech language pathologists during a global pandemic using principles of a primary contact model: an observational cohort study protocol. BMJ Open 2022; 12:e052518. [PMID: 35039289 PMCID: PMC8764716 DOI: 10.1136/bmjopen-2021-052518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION SARS-CoV-2, a highly contagious severe acute respiratory syndrome, has spread to most countries in the world and resulted in a change to practice patterns for the assessment and diagnosis of people with voice disorders. Many services are transitioning to telehealth models to maintain physical distancing measures and conserve personal protective equipment used by healthcare workers during laryngoscopy examinations. The speech-language pathology primary contact (SLPPC) assessment for patients referred to ear, nose and throat (ENT) services in Australia has been shown to reduce waiting times for assessment while streamlining access to ENT assessment and allied health practitioner treatment pathways. METHODS AND ANALYSIS A prospective observational cohort study will see patients in a newly developed telehealth model which uses the principles from a usual care SLPPC assessment protocol. Participants will be offered an initial telehealth assessment (speech-language pathology primary contact telehealth (SLPPC-T)) prior to being prioritised for a face-to-face laryngoscopy assessment to complete the diagnostic process. The telehealth assessment will collect sociodemographic information, personal and family medical history, key symptoms, onset and variability of symptoms, red-flag signs or symptoms for laryngeal malignancy, and clinical voice assessment data for auditory-perceptual and acoustic analysis. The study outcomes include (1) association of signs, symptoms and specific voice measures collected during SLPPC-T with voice disorder classification provided after laryngoscopy; (2) degree of concordance between voice disorder classification after SLPPC-T and after laryngoscopy; (3) health service and patient-related costs and health outcomes of the SLPPC-T; (4) patient and stakeholder views and beliefs about the SLPPC-T process. ETHICS AND DISSEMINATION Ethical approval has been granted prior to commencement of the study enrolment by the Gold Coast Hospital and Health Service Human Research Ethics Committee (reference number HREC/2020/QGC/62832). Results will be shared through the publication of articles in peer-reviewed medical journals and presentation at national and international scientific meetings. TRIAL REGISTRATION NUMBER ACTRN12621000427875.
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Affiliation(s)
- Christopher L Payten
- Department of Speech Pathology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Duy Duong Nguyen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John O'Neill
- Department of Ear, Nose and Throat, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Antonia M Chacon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kelly A Weir
- School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
- Department of Research and Education, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Catherine J Madill
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Vertigan AE, Bone SL, Gibson PG. The Impact of Functional Laryngoscopy on the Diagnosis of Laryngeal Hypersensitivity Syndromes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:597-601.e1. [PMID: 34666207 DOI: 10.1016/j.jaip.2021.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic cough and vocal cord dysfunction are manifestations of laryngeal hypersensitivity syndrome. OBJECTIVE The aim of the study was to determine the clinical utility of functional transnasal laryngoscopy in patients with laryngeal hypersensitivity syndromes. METHODS This study was a prospective observational cross-sectional study design of 71 participants with laryngeal hypersensitivity syndrome referred for functional transnasal laryngoscopy. Participants had a clinical assessment with a speech pathologist after which a provisional diagnosis of chronic cough, suspected vocal cord dysfunction, suspected muscle tension dysphonia, or a combination was made. A laryngoscopy with provocation was performed and the diagnosis revised after which the provisional and revised diagnoses were compared. RESULTS The diagnosis changed in 67% of participants after laryngoscopy. Vocal cord dysfunction was diagnosed in an additional 17 cases when not expected clinically but discounted when suspected clinically in 12 participants. Muscle tension dysphonia was diagnosed in an additional 31 cases when not suspected clinically and not confirmed when suspected in 2. CONCLUSION This study demonstrated that conditions such as muscle tension dysphonia and vocal cord dysfunction cannot be diagnosed based on symptoms alone. In addition to diagnostic accuracy, functional laryngoscopy enhances treatment planning and provides immediate feedback regarding laryngeal movement during respiration and phonation.
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Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia; Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Sarah L Bone
- Speech Pathology Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Priority Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory & Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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Occomore-Kent LC, Hatch E, Cruice M. Scoping opinion: Speech and language therapists' views on extending their role to the urgent ear, nose and throat pathway. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:975-988. [PMID: 34309979 DOI: 10.1111/1460-6984.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In the UK, there is increasing pressure on ear, nose and throat (ENT) clinicians and departments, which is anticipated to amplify in the coming months and years due to the coronavirus disease 2019 pandemic and other workforce pressures. In the context of a national drive to advance practice of Allied Health Professionals to address some key challenges facing the National Health Service, we explored whether UK speech and language therapists (SLTs) felt it is possible to utilize and extend their existing skills to patients on the urgent 2-week wait (2ww) ENT pathway. AIMS To explore SLTs' views of extending their role to work with patients referred on the ENT 2ww pathway. METHODS & PROCEDURES Two separate focus groups were conducted using nominal group technique to generate and rank benefits and challenges of the proposed extension of role. Participants were invited to take part through Clinical Excellence Networks relevant to head and neck cancer and voice sub-specialties. Participants were competent in performing nasendscopy in at least a highly specialist role in voice or head and neck subspecialties. OUTCOMES & RESULTS Nine SLTs from England, Wales and Northern Ireland attended two focus groups. All were employed in band 8 roles in head and neck and/or voice. Eight were competent to Royal College of Speech and Language Therapists' scoping level 3. Important benefits of the proposed novel service delivery model were generated and ranked by participants, with both groups identifying improved quality and efficiency of service for patients among the most important. Disadvantages were then generated and ranked across the two groups with potential for misdiagnosis ranked as the most important by both. CONCLUSIONS & IMPLICATIONS Participants responded that extending the SLT role into assessment of 2ww patients would provide benefits for quality of care, healthcare efficiency and the SLT workforce. The identified disadvantages require addressing if the proposed SLT-led model of service delivery is piloted in the UK. These include practical matters such as referral and prescribing rights, alongside wider implications such as support, governance, indemnity, acknowledgement and remuneration for the extended role. Nationally agreed competencies and training for the role are required if this model is to be successful. WHAT THIS PAPER ADDS What is already known on this subject? International studies have shown that SLTs provide safe and effective assessment for routine ENT referrals with dysphonia and dysphagia, reducing ENT waiting lists in the process (Payten et al., 2020; Seabrook et al., 2019). The current study is the first, to the authors' knowledge, to explore views of the profession regarding SLTs' involvement in assessing patients on the more urgent ENT 2ww pathway in the UK, particularly in the primary care setting. What this study adds The greatest benefits of SLTs assessing patients with dysphonia and dysphagia in the 2ww wait clinic were felt to be for patients through prompt, holistic consultation from a clinician with expert knowledge in their disorder. The greatest disadvantages were posed for the workforce such as potential to miss diagnoses, risk of litigation and the increased burden of responsibility. While advantages are clear for service users, the disadvantages must be addressed if such a model is to be implemented. Clinical implications of this study Expert SLTs communicated strongly that SLTs would be a beneficial addition to the 2ww assessment clinic for patients with dysphonia and dysphagia. For this role to be piloted and implemented successfully, their concerns around increased responsibility, potential for litigation and missed diagnoses need to be addressed. If the SLT role is to be extended to the 2ww clinic, robust training, competencies, supervision, guidance and recognition are necessary to support clinicians in this role and protect patients. Some practical matters such as referral and prescription rights also require exploration.
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Affiliation(s)
- Louise C Occomore-Kent
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
| | - Ellie Hatch
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
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Occomore-Kent L, Slade S. Speech and language therapy assessment of patients on the 2-week wait head and neck cancer referral pathway: evidence and opinion following a pilot study. Curr Opin Otolaryngol Head Neck Surg 2021; 29:179-186. [PMID: 33896909 DOI: 10.1097/moo.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. RECENT FINDINGS Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future. SUMMARY The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.
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Affiliation(s)
- Louise Occomore-Kent
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, London
| | - Suzanne Slade
- Department of Otorhinolaryngology and Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Távora-Vieira D, Voola M, Majteles L, Timms L, Acharya A, Kuthubutheen J. Extended scope of practice audiology in the ENT outpatient clinic - a pilot study. Int J Audiol 2021; 61:29-33. [PMID: 33771083 DOI: 10.1080/14992027.2021.1900610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the feasibility of using an extended scope (ES) audiology service to provide care to non-urgent adult patients waiting for an Ear Nose and Throat (ENT) appointment. DESIGN Based on suitability criteria developed by the Audiology and ENT departments, an internal review of the ENT wait list identified patients who would be suitable for an ES audiology clinic. STUDY SAMPLE 220 non-urgent patients on the ENT wait list with hearing loss and/or tinnitus. RESULTS A total of 220 patients were transferred from the ENT wait list to the ES audiology clinic: 200 (90.9%) were seen by the ES Audiologist and 20 (9.1%) patients self-discharged or did not attend the appointment. Out of the 200 patients seen, 175 (87.5%) were assessed, managed and discharged without the need for input from an Otologist. The remaining 25 (12.5%) patients needed an Otologist's input. CONCLUSION This study has demonstrated the feasibility of an ES audiology clinic in a tertiary teaching hospital. Of those seen by ES audiologist, 87.5% were discharged from the ENT wait list without medical intervention. This model may represent an effective alternative pathway for lengthy outpatient waiting list management whilst providing patients with timely access to care.
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Affiliation(s)
- Dayse Távora-Vieira
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Marcus Voola
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
| | - Lisa Majteles
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Lydia Timms
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Aanand Acharya
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
| | - Jafri Kuthubutheen
- Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, Australia
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Payten CL, Eakin J, Smith T, Stewart V, Madill CJ, Weir KA. Outcomes of a multidisciplinary Ear, Nose and Throat Allied Health Primary Contact outpatient assessment service. Clin Otolaryngol 2020; 45:904-913. [PMID: 32780943 PMCID: PMC7821116 DOI: 10.1111/coa.13631] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/20/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traditionally, patients are seen by an ear, nose and throat (ENT) surgeon prior to allied health referral for treatment of swallowing, voice, hearing and dizziness. Wait-times for ENT consultations often exceed those clinically recommended. We evaluated the service impact of five allied health primary contact clinics (AHPC-ENT) on wait-times and access to treatment. SETTING A metropolitan Australian University Hospital Outpatient ENT Department. PARTICIPANTS We created five AHPC-ENT pathways (dysphonia, dysphagia, vestibular, adult and paediatric audiology) for low-acuity patients referred to ENT with symptoms of dysphonia, dysphagia, dizziness and hearing loss. MAIN OUTCOME MEASURES Using multiple regression analysis, we compared waiting times in the 24-month pre- and 12-month post-implementation of the AHPC-ENT service. In addition, we measured the number of patients requiring specialist ENT intervention after assessment in the AHPC-ENT, adverse events and evaluation of service delivery costs. RESULTS Seven hundred and thirty-eight patients were seen in the AHPC-ENT over the first 12 months of implementation (dysphagia, 66; dysphonia, 153; vestibular, 151; retro-cochlear, 60; and paediatric glue ear, 308). All pathways significantly reduced the waiting times for patients by an average of 277 days, compared with usual care. The majority of patients were able to be discharged without ongoing ENT intervention (72% dysphagia; 81% dysphonia; 74% vestibular; 53% retro-cochlear; and 32% paediatric glue ear). No adverse events were recorded. CONCLUSIONS The AHPC-ENT improved waiting times for assessment and access to treatment. Future research on cost-effectiveness and diagnostic agreement between AHPs and ENT clinicians would provide further confidence in the model.
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Affiliation(s)
- Christopher L Payten
- The University of Sydney, Sydney, NSW, Australia.,Department of Speech Pathology and Audiology, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - Jennifer Eakin
- Department of Speech Pathology and Audiology, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - Tamsin Smith
- Department of Physiotherapy, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - Vicky Stewart
- Department of Physiotherapy, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - Catherine J Madill
- Dr Liang Voice Program, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Kelly A Weir
- Menzies Health Institute Queensland & Allied Health Sciences, Griffith University, Gold Coast, Qld, Australia.,Department of Clinical Governance, Education and Research, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
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Effectiveness and Safety of Advanced Audiology-Led Triage in Pediatric Otolaryngology Services. Ear Hear 2020; 41:1103-1110. [DOI: 10.1097/aud.0000000000000855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ward EC. Elizabeth Usher memorial lecture: Expanding scope of practice - inspiring practice change and raising new considerations. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:228-239. [PMID: 30898019 DOI: 10.1080/17549507.2019.1572224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
As the speech-language pathology (SLP) profession matures and evolves, there will continue to be an ongoing need for practice change. Practice change has many drivers: consumer need; an advancing evidence base; clinical innovations; financial efficiency; local service needs; population change; government policy etc. If we are to continue to have a profession with a strong identity and the capacity to make meaningful contributions to the modern education and healthcare landscape, then practice change is a necessity. To achieve practice change we must step away from long-held traditional paradigms and service delivery models. We need a workforce that is ready, committed and willing to accept change. We need organisations that are willing and open to adopt new service models, and we must have the evidence base to support these new roles and responsibilities. Making change to ensure clinicians are working to full scope or considering extended scope models (when appropriate) is actively encouraged to help achieve a more client-centred, cost-effective health service. In this discussion paper, the benefits, issues and impacts of expanding scope of practice are discussed, and ways that individual clinicians, services, training institutions, and researchers can help support the future growth of our profession are highlighted.
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Affiliation(s)
- Elizabeth C Ward
- a Centre for Functioning and Health Research, Metro South Hospital and Health Service , Brisbane , Australia
- b School of Health & Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
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