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Audit from preschool developmental surveillance of vision, hearing, and language referrals
R J Rona1, A Reynolds, M Allsop
1Department of Public Health Medicine, United Medical School, London.
Insights
Preschool referrals for vision, hearing, and speech services revealed significant delays and low attendance, particularly for speech therapy. Many children had undetected health issues, highlighting service gaps.
Area of Science:
- Pediatric Healthcare
- Public Health Audits
- Early Childhood Development Services
Background:
- Preschool medical examinations identify potential health issues in children.
- Follow-up services are crucial for addressing identified conditions.
- Inner-city areas may face unique challenges in accessing specialized pediatric care.
Purpose of the Study:
- To evaluate the effectiveness of referral follow-up services for preschool children.
- To assess attendance rates, waiting times, referral appropriateness, and diagnostic outcomes.
- To identify deficiencies in service provision and suggest improvements.
Main Methods:
- A two-year follow-up study of children referred from preschool medical examinations.
- Data collection on attendance, waiting times, referral justification, diagnoses, and management.
- Analysis of referrals for ophthalmology, audiology, and speech therapy.
Main Results:
- Median waiting times varied significantly: 46 days (ophthalmology), 175 days (audiology), 83 days (speech therapy).
- Speech therapy had the poorest attendance (75%).
- Significant percentages of children had justified referrals and detected conditions: 60% (ophthalmology), 55% (audiology - hearing impairment), 80% (speech therapy - language problem).
- Many undiagnosed health problems were identified, indicating parental unawareness or service underutilization.
Conclusions:
- Current referral follow-up services show deficiencies in attendance and waiting times, particularly for speech therapy.
- A substantial number of children have undetected or untreated vision, hearing, and language problems.
- Organizational changes are needed to improve the effectiveness of preschool referral services and address health disparities.
Abstract:
Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.