An evaluation of service outcomes, costs, and consumer engagement following implementation of telepractice services for the clinical assessment of dysphagia.

Dr Clare Burns1, Professor  Liz  Ward2, Ms  Brooke Cowie3, Dr  Robyn Saxon4, Ms  Amy  Gray5, Ms  Lisa  Baker6, Ms  Sarah Bignell7, Ms  Jodie  Turvey8, Ms  Natalie  Winter9, Ms  Rukmani  Rusch9, Associate Professor Tracy  Comans10

1Speech Pathology & Audiology Department, Royal Brisbane & Women’s Hospital , Herston , Australia, 2Centre for Functioning and Health Research, Metro South HHS  , Woolloongabba , Australia, 3Speech Pathology Department, Caboolture Hospital , Caboolture , Australia, 4Speech Pathology Department, Sunshine Coast University Hospital , Kawana , Australia, 5Speech Pathology Department, Gayndah Community Health, Gayndah, Australia, 6Speech Pathology Department, Wide Bay Rural Allied Health and Community Health Service , Gayndah, Australia, 7Speech Pathology Department, Charleville Hospital , Charleville , Australia, 8Safety and Quality Department, St George Hospital , St George , Australia, 9Speech Pathology Department, Cairns Hospital , Cairns , Australia, 10Metro North Hospital and Health Service , Herston, Australia

Abstract:

Purpose: The delivery of dysphagia services is impacted by travel distance; a geographically disperse population; and access to a skilled local workforce. These issues may be alleviated with telepractice. This study examined the service outcomes, costs, and consumer satisfaction of a telepractice service model for conducting clinical swallow examinations (CSEs) implemented across 5 public health services.

Method(s): Forty CSE sessions were conducted via videoconferencing, linking the assessing speech pathologists (n=8) with 30 patients in distant health facilities. Telepractice sessions followed published methodology with patient-end support provided by a trained local health support worker (HSW). Data was collected on waiting times, clinical and session outcomes, service costs and consumer satisfaction. Outcomes were compared to existing standard care,
which involved scheduled/on-demand clinician visits to remote services or patients travelling to face-to-face assessments.

Result(s): Telepractice services enabled a reduction in patient waiting times (mean=2 days); saved clinical time through avoided clinician travel (mean=2½ hours); and cost savings (mean=$229/session). Swallow safety and oral intake was optimized for 62% of patients who required diet/fluid changes post assessment. The HSW role was vital in providing patient support. Despite some technical issues, all sessions were completed successfully. Patient and
clinician satisfaction was high.

Conclusions: Telepractice can enable remote facilities to access CSEs in a more efficient manner, optimizing patient safety, and enhancing service, and cost efficiencies.


Biography:

Lisa Baker BSpPath 2001, GradCertRemote HlthPrac 2004, MRemoteHlth, 2009.

Lisa is the Rural Allied and Community Health team leader with the Wide Bay Hospital and Health Service, based at Gayndah Community Health and servicing multiple rural communities in Queensland’s Wide Bay region. Lisa has been actively involved in rural speech pathology and allied health service provision since 2002.