Barriers to Accessing Rural Paediatric Speech Pathlogy Services

7/24/2019 Barriers to Accessing Rural Paediatric Speech Pathlogy Services

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BARRIERS TO RURAL SPEECH PATHOLOGY SERVICES 163

Results

Three hundred and twenty-nine members (30%) of theICPA responded to the questionnaire, and whilst areturn rate of 30% may not be considered a represen-tative sample, with cautious interpretation it offers goodpreliminary results.

Access barriers to speech pathology services

Seventy-five (63%) of the 139 informants who neededto access speech pathology services reported problemsin doing so. The access barriers that these informantsreported are summarised in Table 4. Informants indi-cated these difficulties by answering a closed question

What is already known on thissubject : Numerous studies have described the

inequities of rural health at a systemic level (e.g.

rural health policies of centralisation,

rationalisation, fiscal constraint) and at the level

of health professionals (e.g. no support, sole positions, and reduced access to resources and

professional development). However, few have

explored the barriers that consumers face when

attempting to access rural health services,

particularly if allied health services such as

speech pathology are needed.

What this study adds: This paper reports on a

study that investigated the perceived barriers

experienced by consumers when attempting to

access paediatric speech pathology services in

rural and remote NSW. Key findings from this

study are that rural and remote consumers inNSW experience a number of barriers that affect

their ability to access speech pathology services.

Potential solutions to these barriers are

proposed.

TABLE 1: Sources of inequity of rural health services

Problems leading to inequities References

Access to health services

Travel difficulties (i.e. cost and availability) 4

Lack of available health services 4,5

Delays in treatment due to waiting lists 6

Low levels of awareness of health services 4Limited choice of health services 4

Appropriateness of rural and remote speech pathology services

Home programs for others to carry out 7–9

Reliance on other professionals to provide follow-up 7,8

Delegation of tasks to nonhealth professionals 7,8

Emphasis on client self-management 7,8

Telephone consultations 7–9

One-off visits for assessment and provisions of intervention strategies 7,8

Improvisation 7,8

Use of less specialised equipment 7,8

Rural health-care policies

Centralisation 4,10Rationalisation 5,11

Fiscal constraint 12

Recruitment and retention of health professionals

Professional isolation 13–15

Perceived decrease in professional development opportunities 13–15

Lack of supervision and support 13,15

Large caseloads 13–15

Reduced access to resources 16

Inadequate leave and locum provision 13

Separation from family and friends 13



164 A. M. O’CALLAGHAN ET AL.

that offered a list of potential access barriers. Infor-mants were also given the opportunity to cite otherbarriers not included in this list.

Consumers’ proposed solutions toaccess barriers

Of the 75 informants who experienced barriers access-ing speech pathology services, 61 (82%) listed ways inwhich they believed these barriers could be overcome.These possible solutions are listed in Table 5. Fifteen percent thought students should have compulsory ruralplacements.

Travel schemes

One of the possible solutions, proposed by informants,to alleviate the access barriers listed above includedsubsidised client travel. However, only 42 (13%) of the329 informants reported that they were eligible for anyform of travel allowance in order to access speechpathology services. The travel schemes reported to havebeen accessed by informants to subsidise the cost of

travel to speech pathology services are summarised inTable 6.

Discussion

This study identified that rural and remote consumersin NSW experience a number of barriers that affect theirability to access paediatric speech pathology services.

Potential solutions to these barriers have also been iden-tified. To date, this appears to be the only rural andremote, consumer-based, speech pathology study com-pleted in Australia, and as such it provides the firstavailable set of data examining consumers’ experienceswhen accessing speech pathology services in ruralenvironments.

Access barriers

The majority of informants included in this study expe-rienced some form of barrier when attempting to access

paediatric speech pathology services. A summary of these barriers is presented below.

Service availability

Over 85% of consumers who reported access barrierscited the lack of available speech pathologists as a primeconcern. This finding is supported by the speech pathol-ogy labour force survey compiled by Lambier,2 whichfound that only 4.5% of respondents to the survey wereemployed in moderately accessible, remote or veryremote regions of Australia, compared to 94% of theworkforce being employed in accessible or highly acces-sible areas.

Results from this study show that the current lengthof wait for rural and remote paediatric speech pathologyservices varies from less than 1 month to up to 2 years,with the average being greater than 6 months. Themajority of informants stated that they found the cur-rent length of waiting lists unacceptable. Keen’s studyof parents’ acceptance of waiting list times when dealingwith paediatric speech pathology services in a commu-nity hospital in Western Australia also identified thatparents believed waiting list periods of between 4 and

TABLE 2: Informants’ background information

Range Mode

Age 25 to >65 years 35 to 44 years (44.4%)

Number of children 1 to >5 children 3 children (37.1%)

Income <$10 000 to >$100 000 $35 000 to $50 000 (23.7%)

Education level Primary school to postgraduate degree Undergraduate degree (33.7%)

TABLE 3: Informants’ characteristics

n (%)

Sex

Male 25 (7.6)

Female 295 (89.7)

Missing data 9 (2.7)

EthnicityATSI 0

Caucasian 317 (96.3)

Other 2 (0.6)


Marital status

Partnered 312 (94.8)

Single 8 (2.4)


ATSI, Aboriginal or Torres Strait Islander




TABLE 4: Barriers experienced by consumers when accessing speech pathology services

Barriers Frequency Percentage

Lack of availability of speech pathology services 63 86

Long distances to travel to access speech pathology 56 76

Delays in treatment due to waiting lists 43 59

Expensive travel costs 38 53

Limited choice of speech pathologists 33 45

No public transport 25 36

Lack of awareness of speech pathology services 24 32

Other† 12 16

†Other category responses included local residents’ negative experiences, which led to an informant’s decision to not access

services; cancelled appointments; no cooperation between states, for example one informant found that she was unable to access

Queensland community services as she lived in New South Wales; and lack of consistency of services.

TABLE 5: Ways in which consumers believe barriers can be overcome

Resolution strategies n (%)

General rural health solutions

Implement changes to students’ education 9 (15)

Increase incentives for rural practice 5 (8)

Subsidise client travel 3 (5)

Speech pathology-specific solutions

Increase the number of speech pathologists employed in rural areas 31 (51)

Increase the number of mobile/visiting speech pathology services 10 (16)

Greater collaboration between schools and speech pathology services 10 (16)

Other† 8 (13)

Increase regularity of speech pathology services 7 (12)

Increase funding for rural speech pathology services 7 (15)

Speech pathologists to be more flexible in service delivery 4 (7)

Increase public’s awareness of speech pathology services 3 (5)

Agent training 3 (5)

†Other category responses include greater public transport, screening of all kindergarten children, reducing government red

tape, greater department collaboration (i.e. between the Department of Disability and Aged Care and the Department of Health

Services) and the use of information technology and telecommunications for the delivery of services.

TABLE 6: Travel allowance schemes reported to be accessed by isolated families to travel to speech pathology services

Travel schemes Frequency Percentage

Home and Community Care (HACC) 0 0.0

New South Wales Community Transport (CPT) 0 0.0

Area Assistance Scheme (AAS) 0 0.0

Isolated Patients’ Travel and Accommodation Assistance Scheme (IPTAAS) 35 83.3

Other† 5 11.9

Missing data 2 4.8

†Other category responses included that the Royal Far West Children’s Health Service paid for its clients and one parent to

travel to Sydney, and according to one informant Medicare Benefit Fund subsidises travel if it is over 100 kilometres.




six months were largely unacceptable, with acceptablewaiting list times being four weeks or less.6

Distance decay

Distance decay refers to the phenomenon whereby the

further away a health service is located from a con-sumer’s home, the less likely it is to be accessed.9,17 Theeffect of distance decay on the failure of consumers toaccess paediatric speech pathology services has beenquestioned.9 This study supports this as over 50% of consumers who reported difficulties accessing speechpathology services said the length of travel required wasan access barrier.

Choice of services

This study showed that because of the limited numberof speech pathologists employed in rural and remote

areas, choice of speech pathologists is not an option.Consequently, if consumers feel dissatisfied with the ser-vice they receive there is no alternative. This finding iscompounded by that of Bourke who stated that shouldany issue arise in rural and remote health care, consum-ers are unaware of where to complain.4 This implies thatrural and remote consumers accept difficulties in healthcare provision because they have few service optionsavailable.4

Consumers’ awareness of services

The lack of awareness of speech pathology services wasalso identified as a barrier to access. An awareness of health services and increasing health knowledge areimportant in small rural communities to ensure consum-ers make informed decisions regarding their healthneeds. However, gaining this knowledge is difficult, asthere are fewer educational programs available to themthan in urban areas.5 This is a subject that needs to betargeted because consumers who have felt a need forspeech pathology services may be unaware of where toaccess them, and may therefore forego these services.

Costs associated with accessing servicesAnother of the perceived access barriers identified in thepresent study was the expense associated with travellingto services. Bourke also noted that economic issues sur-rounding access to health services were of most concernamong rural consumers.4

Finally, the lack of public transport in rural areas toassist subsidised travel costs was identified as an accessbarrier. Public transport services are often inadequate inrural and remote areas, and any services that are avail-able are often of limited usefulness.5 However, without

public transport, consumers are left to rely on their ownmeans of transport, which, as noted above, can often beexpensive.

One of the potential solutions identified by consumersto access barriers is the provision of travel schemes tosubsidise the cost of travel. There are a number of travel

schemes currently in place in rural and remote areas of NSW as shown in Table 6. Nonetheless, only a smallminority of consumers in the present study stated thatthey were eligible to access any form of subsidy. Of thisminority, over 80% stated that they accessed the Iso-lated Patients’ Travel and Accommodation AssistanceScheme (IPTAAS), when according to the NSW exclu-sion criteria speech pathology services are not coveredby IPTAAS.18 In addition, the majority of informantsstated that they were unsure of their eligibility statusunder any scheme. Subsidised travel is an area thatneeds further examination as travel costs were identifiedby over half of informants as an access barrier.

Consumers’ proposed solutions to access barriers

Other solutions to access barriers proposed by consum-ers included that changes should be made to students’education to make rural work practicums compulsory.In addition, as recommended for other health profes-sionals, consumers suggested offering increased incen-tives (i.e. improved wages and conditions, travelsubsidies, professional supervision and support, andrelocation assistance) to attract speech pathologists to

rural and remote areas.5

Governmental and management changes were alsoproposed, such as increasing the number, frequency andfunding of speech pathology services provided to ruraland remote areas, and increasing the collaborationbetween health and education departments. Changes tothe models of service delivery that speech pathologistsprovide were also desired by consumers. For exampleconsumers also recommended that speech pathologistsbecome more flexible and accommodating of their needs(e.g. working weekends when they can be accessed), andprovide more training of school teachers and parents.

Another solution proposed by consumers includedthat the general public be made more aware of thelocation of speech pathology services, and the importantrole speech pathologists play in the remediation of com-munication and swallowing impairments. This is anarea that can be targeted by the promotion and advo-cacy of speech pathology services Australia wide.

Overall, this study has identified that rural andremote consumers face a number of barriers whenattempting to access paediatric speech pathology ser-vices. In addition, consumers suggested a range of solu-tions to these access barriers. However, collaboration




between speech pathologists, consumers and govern-ment and nongovernment organisations is required toovercome barriers and achieve equity of speech pathol-ogy service provision in rural and remote areas.

The results of this study gave rise to the formulationof a number of recommendations aimed at improving

the equity of paediatric speech pathology services. Theserecommendations include increased funding for morespeech pathologists and expanded speech pathology ser-vices in rural and remote areas; increased public aware-ness campaigns to make rural and remote consumersaware of speech pathology services; increased incentivesto attract speech pathologists to rural and remote areas;and improved schemes to enable consumers to travel tospeech pathology services together with better promo-tion of such schemes.

Acknowledgements

Speech Pathology Australia provided the first authorwith a research grant to subsidise the research costs of this project. The ICPA (NSW) assisted in the distribu-tion of the questionnaires to its members.

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Appendix I: Questionnaire




Appendix I: Continued











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Barriers to Accessing Rural Paediatric Speech Pathlogy Services