Evaluating The Impact Of The Speech-Language Pathology Primary Contact Model Of Care In Diagnostic Assessment Of Voice Disorders.

Abstract

Voice disorders affect millions and are costly. Early assessment is vital, but access to ENT and multidisciplinary clinics is limited. The speech-language pathology primary contact (SLP-PC) model offers quicker evaluation before or instead of ENT assessments, though its reliability and diagnostic contribution need more evidence. This thesis presents five studies on SLP-PC in adult VD diagnosis: an observational cohort, a literature review, a global MDT survey, a GP referral review, and another cohort study, examining outcomes, frameworks, practice patterns, predictors, and diagnostic agreement.

Integrating SLP-PC into an ENT MDT pathway reduced wait times by an average of 277 days compared to traditional pathways. Most patients (81%) managed by SLP didn't need ENT assessment, but 7% of urgent cases required ENT. SLP-PC was estimated to cut staffing costs by 27%. A review of 20 frameworks across 2,675 publications highlighted the need for clearer classification systems for VDs suitable for first-line SLP intervention, a need that was subsequently addressed. A survey of 109 clinicians showed growing support for diverse diagnostic pathways, including SLP-PC, emphasising the importance of case history. An analysis of GP referrals found no strong predictors of assessment approach, underscoring the need for better triage information and GP training. The SLP-PC telehealth model showed promise in predicting urgent ENT needs, with substantial diagnostic agreement. Overall, these studies demonstrate that SLP-PC is a reliable, effective model that improves access and diagnostic efficiency while enhancing clinical skills among ENT and SLPs within an integrated MDT VD service.

This research advances global voice assessment practices, supports SLP-first pathways, offers insight for GPs, and highlights the need for standardised classification systems. Further research is needed to understand the diagnostic reasoning of SLPs and ENTs in VDs and the economic impact of SLP-PC.