Integral management oropharyngeal dysphagia

Abstract

Dysphagia is a symptom that indicates difficulty in swallowing. The etiology of dysphagia is multiple. Patients with dysphagia were referred to different hospital services (Otorhinolaryngology (ENT), Rehabilitation, Nutrition..). These referrals involved, multiple appointments. From October 2013 with the idea of providing accessible and comprehensive care to the patient, we have a unified dysphagia clinic creating a multidisciplinary practice in which after the joint assessment of the patient, we decide the optimal treatment for each case. In the case of hospitalized patients, a circuit has been generated to speed up the assessment and treatment of oropharyngeal dysphagia, which is occasionally performed bedside when the patient's condition so requires. We analyze patients reffered in 2017. Their diagnosis, etiology, treatments applied and number of medical visits needed. During 2017,97 patients have been referred to dysphagia tmultidisciplinary practice. 57.3% of patients dysphagia was of Neurological etiologiy (Vascular 21%, Neuromuscular 18.3% Demyelinating diseases 5% Extrapyramidal 1% Others 12%; Otolaryngology pathology 18% (Oncological 15% and Non-oncological 4%). 424 in-hospital consultations have been carried out, 80% of those performed at the ENT department. Nutritional status assessment showed, 30% of moderate malnutrition. After the joint consultation, dietary recommendations were indicated in 44%, modification in the texture of the diet in 22%, prescription of speech therapy in 30% and gastrostomy in 4%. Following the consultation, In 55% of the cases, only one visit was necessary to diagnose and give a therapeutic orientation. The remaining 45% required follow-up. We consider that multidisciplinary joint visits are high-resolutive, as they imply fewer visits per patient with lower health care costs and provide higher quality care.