Exploring interdisciplinary management of Parkinson's disease

Abstract

ABSTRACT Speech and/or swallowing impairment occurs in a high percentage of patients with Parkinson's disease. Mutch et al. (1986) report that in a study of 249 Parkinson's disease patients, 65% had speech difficulty and 18.5% of 265 Parkinson's disease patients surveyed reported swallowing impairment. The benefits of speech and language therapy for these patients have been recognised. Clearly, these patients can only benefit if they can access a speech and language therapy service. This pilot interdisciplinary project, between a speech and language therapy service and a general practice unit, set out to audit access to and awareness of the speech and language therapy service for patients with Parkinson's disease in a primary care setting. All the Parkinson's disease patients in one general practice unit were identified and invited to a speech and language therapy assessment. A survey of these patients and their carers was completed by interview investigating their awareness of their communication/swallowing difficulties and perceived need for speech and language therapy. A postal survey of all general practitioners in the Trust area was carried, out examining attitudes and past practice of general practitioners concerning referral of adult patients to the speech and language therapy service. Past referrals of Parkinson's disease patients to the service were analysed to establish historic access routes to the service. Speech and language therapy assessment and patient interviews were completed for 13 Parksinson's disease patients. Interviews were carried out with 10 carers. Questionnaires were sent to 69 general practitioners and 37 responses (54%) were received. Results of the general practitioner survey indicated poor awareness of the role of speech and language therapy for this client group. Patient and carer survey findings highlighted accurate perceptions regarding patient dysarthria symptoms. Speech and language assessment identified four of 13 patients requiring direct therapy and a further eight patients who could benefit from advice and information. Only one patient had no dysarthria symptoms. Referral analysis indicated that of 18 patients referred with Parkinson's disease to speech and language therapy, one had been referred by a general practitioner. The findings highlight the need for increased awareness among patients, carers and members of the primary healthcare team about the role of speech and language therapy with this client group, in order to ensure timely and appropriate referral. The outcome of this interdisciplinary audit project indicates benefits for patients, carers and general practitioners through improved identification of need and mutual education. The aims, process and issues involved in interdisciplinary audit of this kind are described, along with guidelines for the selection of suitable interdisciplinary audit topics.