Abstract：
BACKGROUND: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：获得性吞咽障碍是一个主要的公共卫生问题，通常会导致发病率增加和恢复缓慢。言语和语言治疗师（SLT）率先评估和治疗吞咽困难，这反映在建议早期干预的指南中。这是除了SLT在获得性沟通障碍管理中发挥的核心作用之外，因为研究表明，沟通困难的患者受益于SLT的早期和强化治疗。对SLT不断增长的需求预计会在其工作负载中造成冲突的压力，因此有利于考虑劳动力规划。这项研究的目的是检查英国的真实世界数据，以调查随着时间的推移，吞咽困难和/或沟通障碍患者的转诊模式的变化。协助劳动力规划。
方法：我们询问了皇家语言和语言治疗师学院在线结果工具，一个国家数据库,在这项回顾性队列研究中。我们纳入了2018年至2022年评估的患者。我们对年龄≥40岁的患者进行了初级医学诊断为中风的亚组分析。年龄数据,初步诊断,案件量的时间，检查主要治疗结果测量(TOM)量表和损害的初始TOMs评分.
结果：从44,444人推荐言语和语言治疗的数据库中，5,254次转诊纳入卒中和总体亚组分析。推荐的男性占55.1%，平均年龄71岁。超过一半（56.1％）的转诊是吞咽困难。在COVID-19大流行期间，推荐人数减少，但从2021年起开始恢复。多年来，SLT病例数的时间从2018年的中位数14天（四分位数间距（IQR）0-56）增加到2022年的20天（IQR3-81）。虽然在整个人群中，SLT服务的评估和管理吞咽困难的转介比沟通更多，在中风亚组中，从2020年起，沟通障碍的转诊人数超过吞咽困难的转诊人数。此外,转诊时受损的严重程度多年来有所增加.
结论：现实世界的数据表明，随着时间的推移，对SLT服务的转诊正在发生变化，包括更复杂和严重受损的患者，对吞咽障碍和交流障碍都有需求。这些发现应告知工作人员分配和重塑SLT的教育/培训，以更好地满足临床和公共卫生需求。这项研究的回顾性性质限制了这些数据的强度和普遍性，这个话题值得进一步调查。
方法：我们询问了皇家语言和语言治疗师学院在线结果工具，一个国家数据库,在这项回顾性队列研究中。我们纳入了2018年至2022年评估的患者。我们对年龄≥40岁的患者进行了初级医学诊断为中风的亚组分析。年龄数据,初步诊断,案件量的时间，检查主要治疗结果测量(TOM)量表和损害的初始TOMs评分.
结果：从44,444人推荐言语和语言治疗的数据库中，5,254次转诊纳入卒中和总体亚组分析。推荐的男性占55.1%，平均年龄71岁。超过一半（56.1％）的转诊是吞咽困难。在COVID-19大流行期间，推荐人数减少，但从2021年起开始恢复。多年来，SLT病例数的时间从2018年的中位数14天（四分位数间距（IQR）0-56）增加到2022年的20天（IQR3-81）。虽然在整个人群中，SLT服务的评估和管理吞咽困难的转介比沟通更多，在中风亚组中，从2020年起，沟通障碍的转诊人数超过吞咽困难的转诊人数。此外,转诊时受损的严重程度多年来有所增加.
结论：现实世界的数据表明，随着时间的推移，对SLT服务的转诊正在发生变化，包括更复杂和严重受损的患者，对吞咽障碍和交流障碍都有需求。这些发现应告知工作人员分配和重塑SLT的教育/培训，以更好地满足临床和公共卫生需求。这项研究的回顾性性质限制了这些数据的强度和普遍性，这个话题值得进一步调查。
