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Speech Pathology: Access for all

Analysing the efficacy of Telepractice

Amongst the allied health professions, speech pathology is leading the way with studies about the efficacy of telehealth. This is really exciting, because speech pathologists are delivering services across a wide spectrum of demographics, clinical environments, and health providers — lessons learnt here are applicable to many other clinician services.

Did you know that speech pathologists assist:

  • children with diverse speech disorders (stuttering, articulation, language understanding, literacy challenges)
  • disabled children & adults (autism, intellectual disability, cerebral palsy)
  • people with hearing impairments
  • people with swallowing difficulties (dysphagia), vocal cord dysfunction, and similar physical damage to their vocal tract
  • people with aphasia most often caused by a stroke, head injury, brain cancer, Parkinson’s disease or dementia
  • people who received a tracheostomy
  • English language learners with their accent and language challenges
  • people in jail, in retirement homes, schools, hospitals, community centers.

In Australia we have about 10,000 speech pathologists, with less than 5% of them in rural and remote areas where a third of the Australian population lives (ref). The need for telepractice services has long been recognized and in some places is already business as usual.

What we need next is to make it business as usual for all practices. Why? The scientific evidence is there that telepractice is not just more convenient and cheaper to deliver, and therefore leads to less no-shows, but also brings some extra perks such as:

  • a higher engagement by children who typically love technology,
  • a more natural behaviour with less stress since clients are in their own comfortable environment, and
  • higher therapy adherence, particularly when family members also get involved during the telepractice session.

At the recent National Speech Pathology Conference in Sydney, a whole track was dedicated to “Access for all”. Here are some of the awesome talks given during that track and key outcomes I took away:

  • What about me? The accessibility of services for children who are deaf or hard of hearing who live outside major cities
    Megan Barr, et al
    -
    rural areas provide delayed access to qualified professionals
    - the tele-intervention sessions were much more successful than expected
    - as a practitioner you do feel a bit like you’re on playschool
    - practitioners need a checklist of funding options
  • “SwallowIT”: A randomised controlled trial investigating the delivery of prophylactic swallowing therapy to head/neck cancer patients via telepractice
    Laurelie Wall et al
    -
    SwallowIT is a mobile app that includes guided videos for therapy
    - no video consultations were made
    - the adherence was best f2f, but SwallowIT did almost as well
    [my thought: add video consultations to SwallowIT and it becomes unbeatable]
  • “Even the dog got involved”: How telepractice can promote family-centred early intervention for children with hearing loss and their families
    Monique Waite et al
    -
    telepractice for hearing-impaired children in the naturalistic home environment
    - the whole family got involved and learnt skills
    - access was maintained even during family holidays
  • “He doesn’t like us as his therapists”: The parent experience of telehealth and caregiver-delivered ReST treatment for Childhood Apraxia of Speech
    Donna Thomas et al
    -
    apraxia needs 2–5 sessions per week, even in cities, this is hard work
    - it’s not possible to turn parents into therapists — they have a different role with their children
    - telehealth is a million times easier, time efficient and the kids enjoy it
clinical applications of telehealth
  • Parent-mediated social communication intervention for children with Autism: A telepractice group training approach
    Robyn Garne et al
    -
    telepractice delivery of the Hanen Certified Speech Pathologist program
    - program needed some adaptation
    - results indicate doubling of parent & child responsive behaviour
Telehealth presentation
  • Rural disability services: The illusion of choice and control
    Edward Johnson et al
    -
    analysis of the service options for families with a child with disabilities in rural areas
    - there is no blending-in, there is community exclusion
    - specialisations are not available in rural areas, only generalists, often with limited skills
  • Evaluation of a speech pathology telepractice service for parents with head and neck cancer
    Clare Burns et al
    -
    10 years of experience with head & neck cancer cases
    - telepractice delivered between 3 regional hubs and a central hospital with specialised medical camera system, only 3% technical difficulties
    - lower cost, better quality of life, better identification of issues
Telehealth Model of Care

In addition to this new research, there is plenty of older research in speech pathology about efficacy, see for example a list published by thePrimary Health Care Research and Information Service (PHCRIS) in 2013 (ref). Speech Pathology Australia in 2014 have also done a tremendous job in listing existing research (ref).

This report from Maine, USA even goes as far as calculating the cost savings to the government health department MaineCare and puts it at 72%.

In summary, not only does telepractice bring convenience to patients and practitioners, but also creates more effective results and real cost savings for the healthcare system.

You do have to wonder why our Australian healthcare system continues to subsidise patient travel instead of starting to introduce Medicare reimbursements for telepractice services — the clinical evidence certainly exists.