Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.

Speech and/or swallowing impairment occurs in a high percentage of patients with Parkinson's disease. Mutch et al. (1986) report that in a study of 249 Parkinson's disease patients, 65% had speech difficulty and 18.5% of 265 Parkinson's disease patients surveyed reported swallowing impairment. The benefits of speech and language therapy for these patients have been recognised. Clearly, these patients can only benefit if they can access a speech and language therapy service. This pilot interdisciplinary project, between a speech and language therapy service and a general practice unit, set out to audit access to and awareness of the speech and language therapy service for patients with Parkinson's disease in a primary care setting. All the Parkinson's disease patients in one general practice unit were identified and invited to a speech and language therapy assessment. A survey of these patients and their carers was completed by interview investigating their awareness of their communication/swallowing difficulties and perceived need for speech and language therapy. A postal survey of all general practitioners in the Trust area was carried, out examining attitudes and past practice of general practitioners concerning referral of adult patients to the speech and language therapy service. Past referrals of Parkinson's disease patients to the service were analysed to establish historic access routes to the service. Speech and language therapy assessment and patient interviews were completed for 13 Parksinson's disease patients. Interviews were carried out with 10 carers. Questionnaires were sent to 69 general practitioners and 37 responses (54%) were received. Results of the general practitioner survey indicated poor awareness of the role of speech and language therapy for this client group. Patient and carer survey findings highlighted accurate perceptions regarding patient dysarthria symptoms. Speech and language assessment identified four of 13 patients requiring direct therapy and a further eight patients who could benefit from advice and information. Only one patient had no dysarthria symptoms. Referral analysis indicated that of 18 patients referred with Parkinson's disease to speech and language therapy, one had been referred by a general practitioner. The findings highlight the need for increased awareness among patients, carers and members of the primary healthcare team about the role of speech and language therapy with this client group, in order to ensure timely and appropriate referral. The outcome of this interdisciplinary audit project indicates benefits for patients, carers and general practitioners through improved identification of need and mutual education. The aims, process and issues involved in interdisciplinary audit of this kind are described, along with guidelines for the selection of suitable interdisciplinary audit topics.

This audit project was undertaken by members of a voice specific interest group (SIG) in order to examine current practice in the management of selected voice patients. The study focused on patients referred to speech and language therapy with a diagnosis of vocal nodule(s) (VN) and/or Reinke's oedema (RO). The findings of the audit will be used to inform discussions between SIG members and members of the Regional Medical Audit Group (ENT), with a view to collaborative standard setting and future inter‐disciplinary audit activity. Across four health boards, all therapists accepting voice referrals were invited to randomly select and retrospectively review the case notes of 10 patients discharged from their clinic (5 VN and 5 RO) and complete a questionnaire for each patient, giving specific information in respect of referral, assessment, therapy and outcome measures. Eleven therapists from 10 Trusts/District Management Units (DMUs) participated in the audit. Data was submitted on 86 cases: 42 VN; 41 RO and three both VN and RO. Data analysis indicates that therapists receive most referrals directly from ENT (92%), that the majority of patients (87%) have normal or improved voice post‐therapy without surgical intervention and that the voice outcome following therapy is better for VN patients (91% normal or improved) than for RO patients (83% normal or improved). Most patients referred for therapy post‐laryngeal surgery did not achieve normal voice. Improved vocal cord status was reported post‐therapy for 64% RO patients and 72% VN patients. Overall, 75% of patients completed therapy within six months. The findings support the view that vocal nodules and Reinke's oedema can be managed effectively with voice therapy.