Speech Pathology-led Clinic for Respiratory Patients

Aim

The project aims to establish a speech pathology-led chronic cough clinic to improve access and reduce specialist wait times, create a model of care and learning framework for speech pathologists, and develop a guide for clinic establishment and governance for broader implementation.

Outcomes

• A primary contact chronic cough clinic provided by an advanced speech pathologist who has undertaken additional training to provide full scope of practice care, can provide safe and efficient care for low-risk chronic cough patients to help support patient flow and reduce pressures on specialist waiting lists.
• The SP-led chronic cough primary contact clinic demonstrates high patient engagement (100% acceptance), timely access to services (Average wait < 30 days), < 1% re-referral to Respiratory Waitlist, (n=1), and high patient satisfaction.
• Publication of a chronic cough model of care, learning framework and service establishment and sustainability guide

Background

Chronic cough (CC), lasting over 8 weeks, affects up to 18% of adults and significantly impacts quality of life, causing secondary diagnoses and impact on quality of life.   CC is typically low risk, with common causes including asthma, reflux, and upper airway cough syndrome, hence standard care involves these patients being triaged as non-urgent by respiratory physicians, resulting in long wait times due to high demand on specialist waiting lists.

Speech pathologists (SP) play a crucial role in managing CC in up to 80% of cases following diagnosis. SPs provide comprehensive assessment and education, vocal health and behavioural strategies, to help reduce cough severity and improve patient outcomes. It is recognised that there is variation in the scope of SP-led CC services across the state with inconsistent clinical training and education for clinicians, impacting equity of access and care delivery across the state.

Advanced clinical roles for allied health practitioners (AHPs) have emerged to assist in supporting speciality outpatient consultant workforce shortages allowing them to effectively manage low-risk patients from the Respiratory wait lists Research shows that SP-led primary clinics for conditions like dysphonia and dysphagia improve access to care and patient outcomes. Despite evidence supporting non-consultant models of care, no speech pathology led primary contact for CC have been reported in the literature.

Discussion

Demands on public hospital specialist waiting lists have led to the development of allied health providing alternative models of care, such as the SP primary care CC clinic. This study demonstrates that the SP-led primary care CC clinic significantly reduces wait times, maintains high levels of patient engagement, safety, and satisfaction, and effectively manages low-risk respiratory patients.

Of the first 100 patients seen by the advanced SP, 97% were discharged from the specialist waiting list. The study highlights the effectiveness of robust inclusion/exclusion criteria and respiratory physician triaging in identifying appropriate referrals for the SP-led CC clinic. The success of the SP-led CC clinic model is attributed to strong multidisciplinary team relationship, establishment of appropriate clinical governance and training and support of the advanced SP to work to full scope.

In conclusion, the SP-led CC clinic is an innovative model that maximises the scope of the allied health workforce, reduces wait times, and achieves high patient satisfaction. It contributes to the growing evidence that AHPs working within an expanded scope of practice can improve patient quality of life and alleviate pressures on respiratory services and the broader health system.

The model has proven safe and sustainable, with no adverse events reported during the pilot phase, leading to recurrent clinic funding and succession planning for key roles. Additionally, the Office of the Chief Allied Health Officer, has provided funding for the development of a CC model of care, learning framework and clinical guideline to allow for scale and spread to enhance SPs ability to comprehensively manage CC. Additionally to enable appropriately trained SP to offer alternative CC care models, improving patient access to safe, high-quality clinical care across the state.

References

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