Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
Speech Pathology Program, School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
Dysphagia. 2019 Oct;34(5):681-691. doi: 10.1007/s00455-018-09971-8. Epub 2019 Jan 7.
Factors including health policy reform and the aging population are increasing demand for quality healthcare in the community. People with dysphagia are supported by speech-language pathologists (SLPs) in hospital and community settings; however, little is known about the nature of dysphagia services offered by SLPs in the community. The aim of this study was to investigate SLP services and practices provided to community-based adults with dysphagia. A national cohort (n = 144) of SLPs working with community-based clients with dysphagia completed an online survey. Results revealed that clients with neurological conditions comprised the largest proportion of the caseload. Primary referral sources were family doctors (42.4%) or other health professionals (37.5%), with low rates of self-referral. Services were primarily delivered via individual sessions (84.1%), usually within the client's home (80% saw clients at home). While many clinicians were using both clinical and instrumental assessments, half had to refer clients to the other services to access instrumental assessment. Most provided assessment and rehabilitation services, though a few (28.5%) reported using formal outcome or quality-of-life measures. Only 43.8% referred or encouraged clients or caregivers to access support or social groups and a few SLPs incorporated social participation or client well-being aspects in treatment. Speech-language pathology (SLP) practices in the community appear similar to what occurs in the acute setting, which are inherently biomedical. This may not be optimal care for clients with dysphagia who live at home and their caregivers. Further exploration about what clients and caregivers want from community-based SLP services is warranted.
包括卫生政策改革和人口老龄化在内的诸多因素增加了社区对高质量医疗保健的需求。言语治疗师（SLP）在医院和社区环境中为吞咽困难患者提供支持；然而，对于 SLP 在社区中提供的吞咽困难服务的性质，我们知之甚少。本研究旨在调查 SLP 在社区中为吞咽困难的成年人提供的服务和实践。一个由 144 名在社区中与吞咽困难患者合作的 SLP 组成的全国队列完成了一项在线调查。结果表明，患有神经系统疾病的客户构成了最大的病例群体。主要的转介来源是家庭医生（42.4%）或其他卫生专业人员（37.5%），自我转介率较低。服务主要通过个别会议提供（84.1%），通常在客户家中（80%的客户在家中接受治疗）。虽然许多临床医生同时使用临床和仪器评估，但一半的人必须将客户转介到其他服务机构以进行仪器评估。大多数人提供评估和康复服务，但也有少数（28.5%）报告使用正式的结果或生活质量措施。只有 43.8%的人转介或鼓励客户或照顾者寻求支持或社交团体，少数言语治疗师在治疗中纳入社交参与或客户福祉方面。社区中的言语病理学（SLP）实践似乎与急性环境中的情况相似，本质上是生物医学的。这可能不是对居住在家中的吞咽困难患者及其照顾者的最佳护理。需要进一步探讨客户和照顾者对社区 SLP 服务的需求。
