Interprofessional collaboration between audiologists, speech therapists: The Hearing Journal
Interprofessional Collaborative Practice (PIP) provides a healthcare team model in which providers from two or more different professions work collaboratively to provide the highest quality of patient care.1 In recent years, many healthcare professions have adopted the PPI model with the aim of improving the coordination of care in order to provide the best possible outcomes for patients, improving communication with other healthcare professionals and reduce the possibility of duplicate services.2-3
Although audiologists’ participation in PIP has increased in recent years, a recent PIP survey indicated that significantly fewer audiologists (AUD) participate in PIP than speech-language pathologists (speech-language pathologists).4 In addition, only 33% of AUD and 43-44% of speech-language pathologists felt ready to participate effectively in PPI teams.4 Although AUD and speech-language pathologists often see patients with co-morbid speech and hearing impairments, PIP patterns between AUD and speech-language pathologists remain unknown. For this reason, we developed a survey to determine common communication disorders, barriers to collaboration, and attitudes of AUD and clinical speech-language pathologists towards working collaboratively within a healthcare team. The results of the entire survey are presented in Davis et al.5
Respondents, including 131 speech-language pathologists and 106 AUD, responded to an online survey on demographics, communication disorder workload trends, collaborative practice trends, and barriers to collaborative practice. In addition, respondents completed an adapted scale of attitudes towards health care teams,6 which was designed to assess general attitudes towards interprofessional teams from different professions. Open-ended, scaled and multiple-choice questions have been included.
Regarding trends in the number of cases, the majority of AUD (61%) reported that they assess hearing (dys) function in patients with speech and language impairment on a daily or weekly basis. The most common pediatric communication disorders assessed by AUD for possible hearing dysfunction were autism spectrum disorders (70%), speech sound disorders (66%), and language disorders (65%) ( table 1).
However, significantly fewer AUDs reported collaborating with a speech-language pathologist for these disorders (autism spectrum disorder = 46%, speech sound disorders = 45%, language disorders = 50%), as shown in Table 2. The most common communication disorders in adults assessed by AUD for potential hearing dysfunction were dementia (63%), traumatic brain injury (52%), and other cognitive communication disorders (33%) . In contrast, fewer AUDs reported collaborating with a speech-language pathologist for dementia (23%), traumatic brain injury (33%), and other cognitive communication disorders (23%).
It is important to note that almost a quarter of AUD (22%) said they had not worked with a speech-language pathologist for any speech and language disorder. These results suggest that although AUD routinely assess patients with various speech and language disorders, many AUD regularly collaborate with a speech therapist colleague for these disorders, particularly neurogenic communication disorders.
We asked AUD and speech-language pathologists two questions relating respectively to barriers encountered in IPP and beliefs about barriers to IPP. As shown in Table 2, AUD and speech-language pathologists described access as the main barrier to collaboration between professions (39.5% and 20.5%, respectively). However, they differed on subsequent factors. The top three barriers faced by speech-language pathologists were access, time, and communication, while the top three barriers faced by AUD were access, knowledge, and attitude / perceptions.
On the other hand, when asked about their beliefs and perceptions regarding barriers to IPP, speech-language pathologists indicated access as the main barrier to working with AUD while AUD indicated attitudes and skills. perceptions as the main obstacle to working with speech-language pathologists (Table 2). The three barriers that speech-language pathologists thought about the most were access, time, and practice management, while the three most commonly recognized barriers by AUD were attitudes / perceptions, knowledge, and time. Given the divergent beliefs and experiences of audiologists with PIP, further investigation of the attitudes of AUD and speech-language pathologists towards PIP is warranted.
ATTITUDE TOWARDS TEAMS
Responses at the Attitudes towards Healthcare Teams scale revealed that AUDs and speech-language pathologists agree that interprofessional collaborative practice improves the quality of patient care, treats the patient holistically, does not take too much time, helps avoid errors, and supports an understanding of the scope of practice of other health professionals. This was supported by statistical analysis. On the other hand, the results of analyzes of covariance indicated that speech-language pathologists (M = 5.12, SD = 0.66) had significantly higher scores on the “Quality of care” subscale than AUD. (M = 4.88, SD = 0.71; F (1,196) = 6.422, p = 0.012). Specifically, compared to AUD, speech-language pathologists more strongly agreed that the interprofessional approach improves the efficiency of care delivery and better meets the needs of family caregivers and patients. Speech-language pathologists were also more likely than AUD to agree that team communication helps in making decisions about patient care.
Likewise, speech-language pathologists (M = 4.48, SD = 0.83) obtained higher scores on the “Time constraints” subscale than AUD (M = 4.13, SD = 0.96 ; F (1,196) = 7.126, p = 0.008). For example, speech-language pathologists were more supportive of the time spent on IPP, while AUDs might wish to reallocate their time to other activities. These significant results suggest that speech-language pathologists have a more positive attitude towards interprofessional collaborative practice than AUD.
TO TAKE AWAY
This survey of trends in interprofessional collaborative practice between clinical audiologists and speech-language pathologists revealed three important points to remember:
AUD and speech-language pathologists may underestimate the frequency with which they assess and / or treat patients with co-morbid speech and hearing disorders that require collaborative practice. For example, although 63% of AUD had dementia patients in their number of cases, only 23% of AUD reported collaborating with a speech-language pathologist for this patient population. Increased interprofessional collaboration can improve patient outcomes because 1) AUD can help speech-language pathologists understand the impact of hearing loss on cognitive communication assessment and therapy and 2) speech-language pathologists can help AUD in understand the nature of the patient’s communication disorder, which may necessitate modification of the audiologic examination to meet the patient’s needs.
AUDs and speech-language pathologists have different opinions on the biggest barrier to collaborative practice between the two professions. While speech-language pathologists believed that “access” was the biggest barrier to working with AUD, AUD believed “attitudes and perceptions” to be the biggest barrier to working with speech-language pathologists. The finding that AUDs identified attitudes and perceptions as the primary barrier with speech-language pathologists may reflect stereotypes in our fields, a perceived violation of speech-language pathologists in the AUD’s scope of practice and / or a large disparity in the number of AUDs compared to speech therapists. More research is needed to better understand the differences in the alleged barriers to collaboration between these two professions.
Access to audiologists and audiology services must be improved by promoting the expertise and scope of practice of the profession. Perhaps the most important point to take away from this survey is that many speech-language pathologists have expressed a desire to become more involved with AUD in collaborative practice; however, access to AUD was limited due to physical distance or different practice settings. Through the pandemic, however, we have learned that physical distance is no longer a barrier to interprofessional practice between the two professions. Perhaps the lessons learned from the pandemic will reduce future barriers to access, as we have leveraged technology to communicate in a remote environment. In the spirit of Audiology Awareness Month, let’s learn how AUD can become more accessible to speech-language pathologists and other types of healthcare professionals.