Online Only

Articles/items published ahead of print or only online.

Wednesday, June 21, 2017

Moving Forward: Survey Gauges Reactions to PCAST and NASEM Recommendations

​​The Hearing Journal recently completed an online readership survey on the impact of two critical reports on hearing health care: the 2015 PCAST report and the 2016 NASEM report. Our July 2017 cover story breaks down the survey findings and explores the tapestry of insights into how these reports affect the future of audiology. Here, author Valerie Neff Newitt further​ explores ways for hearing professionals to acclimate to the PCAST and NASEM recommendations. ​ 

Since passage of the OTC Act, and adoption of at least some of PCAST's and NASEM's recommendations seem to pave the path to the future, how can hearing professionals best acclimate?

"We must try to turn a negative into a positive," said Kenneth Henry, PhD, associate professor and clinical program director, Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, DC. "The positive is we can decrease our focus on the commercial aspect of audiology–selling devices–and instead concentrate on rehabilitative aspects which are the foundation of audiology."

Cover story.jpgJackie L. Clark, PhD, president-elect of the American Academy of Audiology, also summed up a need for a greater public recognition of the totality of audiology's value. "As a dispensing audiologist serving exceedingly low-income hard of hearing individuals both in the U.S. and abroad, I am painfully sensitive to and aware of the lack of equity in access to hearing health care and assistance. It is unfortunate that policy makers believe there are easy and inexpensive hearing solutions for such disparities in access.  I firmly believe that OTCs provide the profession of audiology an opportunity to demonstrate to consumers the value of our professional services. We know that the auditory system is a complex mechanism and there is immeasurable value in clinical audiologists identifying, diagnosing and remediating a disordered human auditory system with professional finesse, commitment and technology through extensive experience, education and knowledge."

Research, too, offers a perspective on the role of audiology in an OTC environment. In March of this year the American Journal of Audiology published an article, "The Effects of Service-Delivery Model and Purchase Price on Hearing-Aid Outcomes in Older Adults: A Randomized Double-Blind Placebo-Controlled Clinical Trial" in which the authors determined efficacy of hearing aids in older adults using audiology best practices, to evaluate the efficacy of an alternative OTC intervention, and to examine the influence of purchase price on outcomes for both service-delivery models (Am J Audiol.2017;26[1]:53).

At the study's end investigators concluded that their "… single-site, double-blind, placebo-controlled, randomized clinical trial was the first to demonstrate that hearing aids are efficacious in older adults for an audiology-based best-practices (AB) service-delivery model. The efficacy of an alternative OTC approach [consumer directed (CD)] in which the consumer selected pre-programmed devices was also established. Overall, the consumer directed model of OTC service delivery yielded only slightly poorer outcomes than the AB model. Nonetheless, outcomes for CD participants improved significantly following a four-week AB-based follow-up trial. Purchase price, $600 versus $3,600 per pair of hearing aids, had no effect on outcomes, but a high percentage (85%) of those who rejected hearing aids paid the higher of the two prices for their devices…"

A survey respondent helped to sum up the way forward: "As audiologists, we should be treating our patients like any other medical specialist, making sure our patients understand that hearing loss will be a condition they have for the rest of their life. The loss will change over time, as will the condition of the devices themselves, which requires regular follow up -- just like monitoring blood pressure, blood sugar, etc." So while a piece of assistive hardware may soon be purchased through various retail outlets, the heart of true hearing healthcare will continue to beat within the collective body of hearing professionals.