Coyle James
Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Int J Telerehabil. 2012 Apr 13;4(1):37-40. doi: 10.5195/IJT.2012.6093. eCollection 2012 Spring.
Many patients survive severe stroke because of aggressive management in intensive care units. However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP), a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians. Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas. Tele-dysphagia management has the potential to increase patients' survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year. Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.
许多患者因在重症监护病房接受积极治疗而在严重中风后存活下来。然而，中风后发生肺炎会显著降低生存质量和生存可能性。吸入性肺炎（AP）是肺炎种类中较新增加的一种，与吞咽困难有关，吞咽困难是一种吞咽障碍，可能导致吞咽的食物或液体与唾液中常见的细菌病原体一起被误吸，或者因呕吐或胃食管反流而误吸胃内容物。虽然言语病理学家负责对吞咽困难进行评估、治疗和管理，但吞咽困难患者的数量增长速度超过了合格的吞咽困难临床医生的数量。由于从技术角度来看，通过远程医疗进行吞咽困难会诊是可行的且相对容易获得，因此它们提供了一种有前景的策略，可将远程吞咽困难专家的专业知识带给服务不足地区的患者。远程吞咽困难管理有可能提高患者的生存率，增强基层当地临床医生的专业知识，并降低医疗成本。即使吸入性肺炎的住院人数或AP的住院时间略有减少，每年也可为美国医疗保健系统节省数亿美元。广泛开展远程吞咽困难管理为预防、节省成本和高级培训提供了重大机遇，因此值得医疗保健系统的利益相关者和大学培训项目予以考虑。
