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Speech Pathology 2030 - making futures happen
11
Leading the way...
Using telepractice to enhance delivery of adult dysphagia and head and
neck cancer services
Speech pathologists at the Royal
Brisbane and Women’s Hospital
(RBWH) in collaboration with
researchers from the Centre for
Functioning and Health Research,
Queensland Health, and the Centre
for Research in Telerehabilitation,
The University of Queensland,
have developed and implemented
new telepractice models of care to
enhance delivery of speech pathology
services for adults with dysphagia and
head and neck cancer.
The application of telepractice in
adult clinical swallowing assessments
was initially examined in a series of
studies, which confirmed that the new
telepractice model was both safe and
valid as per face-to-face care. In this
service model, the telepractice speech
pathologist (at a hub site) directs the
patient, supported by a trained health
care support worker (at a spoke site),
to complete the required assessment
tasks. Enhanced technical features
such as remote camera zoom and
a lapel microphone enables the
telepractice system to transmit the
necessary audio-visual information
for the assessment. Funding from
Allied Health Professions’ Office of
Queensland (AHPOQ) is currently
supporting the clinical implementation
of this new model of care through
the development of statewide
implementation and training packages,
and the evaluation of newly-
established telepractice service across
19 sites within Queensland Health.
A multisite hub-spoke telepractice
service has been established to
enhance speech pathology services
for patients with head and neck
cancer within non-metropolitan areas
in Queensland Health. Using a share-
care approach, specialist clinical
support is provided by the RBWH (hub
site) during live clinical telepractice
consultations with the patient and their
local speech pathologist at Nambour,
Hervey Bay or Rockhampton Hospital
sites (spoke sites). A purpose built
telepractice unit incorporating a
medical camera system transmits
fine detailed images to support
all aspects of speech pathology
assessment and management (e.g.
voice prosthesis sizing and insertion).
Patients have also been supported
by multidisciplinary consultations
with a dietitian or physiotherapist.
Online workforce training has been
highlighted as an additional benefit
of the service. Evaluation of the
telepractice service compared to
standard care (i.e. email/phone
support or face-to-face appointments
at RBWH) has confirmed significant
service and cost efficiencies along
with high consumer and clinician
satisfaction when using telepractice.
These telepractice models improve
access to speech pathology services
by providing care at the patient’s
local health facility. This reduces
travel and costs for the patient
and health service, contributes to
reducing patient risk, optimises
patient outcomes, improves speech
pathology service efficiency, and
provides greater opportunities for
workforce training/mentoring for
clinicians. Additional projects by
this team are underway, including
exploring application of telepractice
to support remote delivery of
instrumental swallowing assessments
such as videofluoroscopic swallow
studies and fibreoptic endoscopic
evaluation of swallowing, as well as
home based intervention for head and
neck cancer patient care.