Stransky Michelle L, Oshita Jennifer Y, Morris Megan A
Department of Pediatrics, Boston Medical Center, 801 Albany St., Boston, MA 02119, USA.
Clinical and Translational Sciences Program, University of Vermont, USA; University of Vermont Medical Center, Rehabilitation Therapies Department, 111 Colchester Ave, Burlington, VT 05401, USA.
J Commun Disord. 2021 Nov-Dec;94:106148. doi: 10.1016/j.jcomdis.2021.106148. Epub 2021 Aug 31.
A robust body of literature exists on clinical research outcomes for persons with communication disorders (CD). Comparatively few studies have examined population-based health service outcomes for CD-related services, which capture persons with CDs who may not be part of clinical or administrative data. This is important to describe access to treatment and the factors impacting access. We address this gap, describing four CD-related healthcare outcomes among adults reporting problems with communication (voice, speech, and language): (1) utilization, (2) utilization determinants, (3) professionals providing CD care, and (4) patient-reported service-related outcomes.
We conducted a retrospective, cross-sectional study of community-dwelling adults (≥18 years) in the US self-reporting CD on the nationally representative 2012 National Health Interview Survey. Separate analyses examined adults with voice (n = 1,323), speech (n = 658), and language (n = 396) disorders. We used survey weighted logistic regression to assess the likelihood of treatment, controlling for health, disorder, and sociodemographic characteristics; Pearson's chi square was calculated for other outcomes.
An estimated 10% of adults reporting CD described receiving care addressing their CD. Employment, sociodemographic and economic status, health insurance, level of severity, and presence of co-occurring CD were associated with receiving treatment. Over half of respondents with speech and language disorders and less than a fifth of respondents with voice disorders reported receiving care from speech-language pathologists. Adults who received CD-related services reported improvements in activities (52-69% overall) and CD (33-48% overall).
This population-based study shows that general access to CD services is low. Underserved populations have less access to treatment than their counterparts with more resources. Improving access to CD services requires creative interventions addressing patient and provider needs, as well as healthcare system design. Population-based follow-up studies are necessary to track progress toward improving access to care.
关于沟通障碍（CD）患者的临床研究结果已有大量文献。相对较少的研究考察了基于人群的CD相关服务的健康服务结果，这些研究涵盖了可能未纳入临床或管理数据的CD患者。描述治疗的可及性以及影响可及性的因素非常重要。我们填补了这一空白，描述了报告沟通问题（嗓音、言语和语言）的成年人中与CD相关的四项医疗保健结果：（1）利用率，（2）利用率决定因素，（3）提供CD护理的专业人员，以及（4）患者报告的与服务相关的结果。
我们对参与具有全国代表性的2012年国民健康访谈调查且自我报告有CD的美国社区居住成年人（≥18岁）进行了一项回顾性横断面研究。分别对患有嗓音障碍（n = 1323）、言语障碍（n = 658）和语言障碍（n = 396）的成年人进行分析。我们使用调查加权逻辑回归来评估治疗的可能性，并控制健康、障碍和社会人口学特征；对其他结果计算Pearson卡方检验。
估计报告有CD的成年人中有10%表示接受了针对其CD的护理。就业、社会人口学和经济状况、医疗保险、严重程度以及是否同时存在CD与接受治疗相关。超过一半的言语和语言障碍受访者以及不到五分之一的嗓音障碍受访者表示接受过言语治疗师的护理。接受CD相关服务的成年人报告活动方面有所改善（总体为52 - 69%）以及CD方面有所改善（总体为33 - 48%）。
这项基于人群的研究表明，CD服务的总体可及性较低。资源较少人群比资源较多人群获得治疗的机会更少。改善CD服务的可及性需要针对患者和提供者需求以及医疗保健系统设计的创新干预措施。有必要进行基于人群的随访研究以跟踪在改善护理可及性方面的进展。
