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The Three A's of Hearing Health Care

Weinstein, Barbara E. PhD

doi: 10.1097/01.HJ.0000499585.99944.f8
Golden Rules

Dr. Weinstein is professor of audiology and founding executive officer of Health Sciences Doctoral Programs at the Graduate Center, City University of New York, and coauthor of the Hearing Handicap Inventory for the Elderly/Adults.

In the groundbreaking report by the National Academies of Sciences, Engineering, and Medicine (the Academies), “Hearing Health Care for Adults http://bit.ly/2b2VlvY,” Blazer and colleagues articulated a set of 12 goals along with specific recommendations designed to better promote hearing health care and make it more accessible, affordable, and transparent. Some of the goals are more pressing than others, and audiologists must respond by being proactive rather than reactive.

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ACCESSIBILITY

The Agency for Healthcare Research and Quality recently published a checklist to evaluate practice readiness to embrace change. With that in mind, I suggest that audiologists select goals and recommendations that are important to them (Table 1). For an audiologist to be proactive, he or she must answer a very basic question: Is my practice ready to integrate new philosophies and methodologies into the workflow? Other questions are listed in Table 2.

If the answer to the majority of the questions in Table 2 is a resounding “YES,” then sustainable implementation and maximized patient-clinician encounter must be in the forefront of your plan. As you embark on this initiative to make hearing health care more affordable, accessible, and transparent, make sure to always ask the following (Langley. The Improvement Guide [2nd ed.]. San Francisco: Jossey-Bass, 2009):

(1) What are you trying to accomplish?

(2) How will you know what changes to make?

(3) Are the changes associated with measureable improvement and added value?

It seems to me that the goals and recommendation listed in Table 1 may be a good place to start. Consider broadening the hearing health assessment to focus on communication with physicians, health care providers, family, friends, and colleagues. This enables your patients to state the concerns most important to them, making clinical encounters more efficient and effective. Gauge patient readiness and motivation to change. Work with patients to formulate a realistic treatment plan (Fernald. Health Assessments in Primary Care. Rockville, MD: Agency for Healthcare Research and Quality, 2013). Relating hearing health care and the ability to communicate to overall well-being will typically be considered high value by your patients, especially if patients come to understand the impact of the intervention on critical encounters with health care professionals and family members. Patients appreciate when doctors relate their hearing and communication abilities to their overall well-being and describe the importance of hearing interventions on more critical encounters with health care professionals.

Regarding goal 6 on physician-patient interaction, patients will be pleasantly surprised to learn that quality of communication affects health, including adherence, trust, self-efficacy and self-care, and more distal outcomes tied to social support and engagement, which are so critical to mortality and morbidity (Street. Patient Educ Couns 2009;74[3]:295 http://bit.ly/2b3s1Wg). Prioritizing communication quality may earn you a reputation for emphasizing wellness and lifestyle improvements. Consequently, you may gain increased referrals from a variety of stakeholders.

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AFFORDABILITY

Regarding goal 9 on affordability of hearing health care and transparency, a number of new direct-to-consumer models of hearing aid delivery are emerging, challenging us to change the structure and content of our services. Self-fitting hearing aids (SFHA), trainable hearing aids, Internet-based delivery of hearing aids, and unbundling the cost of hearing services are disruptive innovations that are increasingly becoming a reality (Keidser. Trends Hear 2016;20:piii http://bit.ly/2b3rKmn). A recent study revealed that older respondents perceived Internet-based delivery of hearing aids as affordable, convenient, and accessible (Chandra. J Am Acad Audiol 2016;27[6]:441 http://bit.ly/2b3rLGC). However, a more traditional audiologist-based mode of delivery featured qualities considered paramount to good hearing health care experience: a trusting and empathic relationship, personal connection, ongoing hearing aid management and audiologist expertise. Based on emerging evidence and the recommendations of the Academies, perhaps returning to an “unbundling model” will in fact improve transparency of the fee-for-service paradigm by highlighting the expertise of the audiologist. Patient-centered care for the complex needs, such as psychosocial treatment, will return to the forefront of the care we are trained to deliver (Keidser, 2016). Unbundling of charges enables audiologists to accomplish several important ends. It allows us to place the emphasis on our professional knowledge and skills rather than on the product, helping to craft a service delivery model that meets patient needs more effectively with benefits outweighing costs. Additionally, market penetration may increase as people who purchase SFHA or hearing aids from a big box store seek out audiologists for their knowledge and skills required to optimize communication and well-being.

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AUDIOLOGISTS

In sum, all stakeholders are in agreement that hearing loss is a public health problem that must be addressed. It is likely that the Centers for Disease Control and Prevention, the FDA, and related agencies are exploring ways to implement many of the recommendations set forth in the Academies report. Audiologists should welcome the opportunity to improve patient well-being, considering the projected growth in the hearing impaired population, the emerging evidence of the health consequences of communication problems associated with untreated hearing loss, and the innovations in hearing aid delivery systems. Do not squander the opportunity to impact the lives of many hearing-impaired older adults who may benefit but do not use their hearing aids. Explore your readiness to embrace change and empower your patients to do the same.

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