Socioeconomic Impact on Swallow Therapy Attendance

Dysphagia negatively impacts quality of life and increases health care costs. Swallow therapy is the primary and effective treatment for dysphagia of various etiologies, and attendance is critical to success. This study seeks to identify barriers to swallow therapy attendance at a tertiary care, safety-net hospital. A total of 309 patients were referred for swallow therapy from January 1, 2018, to April 30, 2019. Patients were divided into those who "Attended" at least one swallow therapy appointment and those who "Did not Attend" any swallow therapy appointment. Demographics, socioeconomic factors, and diagnosis prompting therapy referral were compared between the two groups. Socioeconomic status (SES) was based on insurance status and income. 177 patients (57%) attended at least one swallow therapy appointment and 132 (43%) did not attend any appointments. Overall, 240 (78%) patients had public insurance and 69 (22%) had private insurance. Analysis of SES status identified 106 (34%) patients as double-low SES, 157 (51%) as low SES, and 43 (14%) as high SES. Referral diagnoses were "Dysphagia-unspecified type" (n = 119, 38%), "Cancer" (n = 66, 21%), "Neurologic" (n = 46, 15%), "Globus" (n = 29, 9%), "Aspiration" (n = 17, 6%), "Reflux" (n = 17, 6%), and "Throat Pain" (n = 15, 5%). No patient demographic factors, SES factors, or referral diagnosis correlated significantly with swallow therapy attendance. Overall, swallow therapy attendance was poor. In this group, socioeconomic and demographic factors did not significantly impact swallow therapy attendance. Future research should focus on identifying barriers to swallow care and strategies to improve attendance.