Introduction
Screening for swallowing problems has been advocated due to its high prevalence among post stroke patients. However, local data has showed awareness among health professionals with regards to screening and utilisation of speech and language therapy (SLT) services is low resulting in scarcity of data on prevalence of swallowing disorders among stroke survivors. A screening checklist with a simplified care algorithm was designed aimed to alert the primary care team to detect potential patients likely to benefit from SLT assessment and intervention
Methods
Expert panel discussions comprising Family Physicians, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from both Ministry of Health and acadaemia were conducted. Problems related to management of swallowing disorders among post stroke patients were identified. Further discussions among SLT team were conducted to design the Integrated Care Pathway for Post Stroke patients-Swallowing screen checklist (iCaPPS-swallow) to guide primary care team to facilitate timely referrals and intervention from the community to centres providing SLT services. Modified Delphi technique was employed to facilitate variances in practice.
Results
The iCaPPS-swallow checklist addressed 3 main categories of post stroke patients encountered in primary care: (1) patients on nasogastric tube feeding beyond 6 weeks duration, (2) patients who developed symptoms after discharge from tertiary care and had not been screened (3) patients who developed symptoms suggestive of swallowing disorders while residing at home in the community
Discussion
The iCaPPS-swallow caters for missed opportunities for screening of swallowing disorders among post stroke patients residing at home in the community and those managed at primary care-led post stroke services. Future studies assessing incidence and prevalence of swallowing disorders detected among post stroke patients using iCaPPS-swallow are recommended
