Objective: Determine the referral rates and associated disparities in referral to Speech Language Pathology (SLP) in a large healthcare system in Central Massachusetts.

Background: People with PD (PwPD) frequently suffer from speech impairments, making speech therapy an efficacious tool for improving speech function. However, a previous study reported that <10% of PwPD are referred to SLP [1]. We sought to investigate demographic and clinical characteristics associated with low referral rates in a single U.S. site.

Method: This study is a retrospective chart review including all patients treated at UMass Memorial Healthcare in Central Massachusetts from 2017 – 2023. Using electronic medical record query, 3543 PwPD were identified by ICD-10 code G20. Demographic information and all instances of SLP referral were obtained. Social deprivation index (SDI) was calculated based on zip code. Patients were 59.55% male, predominantly White (89.86%), and 92% non-Hispanic/Latino. English was the most common primary language (92.45%) followed by Spanish (3.62%). Most patients had Medicare (78.97%) followed by commercial insurance (12.28%). Logistic regression was used to determine odds of SLP referral, with demographic variables as independent variables. Poisson regression was used to obtain incidence rate ratio (IRR) for the association between the number of SLP referrals and demographic variables.

Results: We found that 10.87% of PwPD were referred to SLP at least once, with 67.1% of those referred once, 19.17% twice, and 13.48% 3+ times. In a logistic regression model, age (OR=0.98, p<0.0001), English-speaking (OR=1.8, p=0.02) and married status (OR=1.51, p<.0001) were significantly associated with SLP referral. Race, ethnicity, primary language and SDI were not significant predictors of SLP referral. In a Poisson regression model, being male (IRR=1.19, p=0.04), English-speaking (IRR=1.6, p=0.008), married (IRR=1.5, p<.0001, having commercial insurance (IRR=0.61, p<.001) and age (IRR=0.97, p<.0001) were significantly associated with increased number of SLP referrals.

Conclusion: Our results support prior studies that a minority of PwPD are referred to SLP. Younger, married English-speaking men had higher rates of referral. More research is needed to further explore disparities in referral and completion of therapy to improve utilization of SLP..

References: 1. Roberts AC, Rafferty MR, Wu SS, Miao G, Cubillos F, Simuni T; Parkinson’s Foundation Quality Improvement Initiative Investigators Steering Committee Members; PF QII Principal Investigators. Patterns and predictors of referrals to allied health services for individuals with Parkinson’s disease: A Parkinson’s foundation (PF) QII study. Parkinsonism Relat Disord. 2021 Feb;83:115-122. doi: 10.1016/j.parkreldis.2020.11.024. Epub 2020 Dec 4. PMID: 33339716

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MDS Abstracts - https://www.mdsabstracts.org/abstract/speaking-out-for-speech-therapy-referral-patterns-and-disparities-in-pd/