Consider this: More than 37.5 million people in the United States (15% of the adult population) have some degree of hearing loss, and only about 11,200 full-time audiologists are available to provide hearing health care services (Vital Health Stat 10. 2014 Feb;(260):1; J Am Acad Audiol. 2013 May;24(5):407). In this adult patient population, those aged 65 years and older have the highest adoption rate of hearing aids (40%), while those between 35 and 64 years old have the lowest adoption rate (20%; Hear Rev. 2015;22(6):16). Less than half of those in any age group who could benefit from amplification actually use hearing aids. Additionally, the audiology profession recently faced issues of accessibility and affordability of hearing aids for those with hearing loss. Enter over-the-counter (OTC) hearing aids and audiology assistants.
OPPORTUNITIES IN OTC DEVICES
Barriers to accessibility and affordability, such as federal regulations on hearing aid dispensing and the high cost of hearing aids, have been attributed to low market penetration of hearing aids. These issues became the focus of the President's Council of Advisors on Science and Technology (PCAST) report in 2015 and that of the National Academies of Sciences, Engineering, and Medicine (NASEM) report in 2016 (see Hearing Journal. 2017;70(7):26 http://bit.ly/2I68zUO). While both reports outlined the need for hearing aids to be more accessible and affordable, the PCAST report focused mainly on the product, whereas the NASEM report described recommendations related to products, services, and consumer awareness.
One of NASEM's recommendations that the Food and Drug Administration (FDA) create an OTC hearing device category will become a reality with the approval of the FDA Reauthorization Act in August 2017. Section 709 of this Act states that the new category, along with a set of guidelines for its regulation, must be created by August 2020—a timeline that marks the coming of OTC hearing devices in the near future. This disruptive change provoked varying reactions from the audiology community from acceptance to avoidance and others in between. Interestingly, this same range of reactions has been seen in response to the integeration of audiology assistants in audiology practices, even though assistants have been employed by early adopters for decades at this time.
BENEFITS OF HAVING AUDIOLOGY ASSISTANTS
While acceptance of audiology assistants has increased over the years, the use of their services remains an anathema to some (Audiology Today. 2017;29(4):48). For those who had the opportunity to work with a well-trained, knowledgeable, and personable assistant, it is difficult to imagine operating a practice without one or more assistants. Audiology assistants improve practice productivity, profitability, and patient satisfaction—all key elements for a successful practice (Hearing Journal. 2012;65(1):22). Other health care fields routinely utilize the services of assistants, e.g., physical therapy assistants, so why should audiology be any different?
Not having enough audiologists, especially in rural areas, to meet the demand of people with hearing impairment adds to the problem of limited hearing health care access. Audiology assistants could help bridge this gap. However, one obstacle that hinders the widespread employ of audiology assistant services stems from state regulations (or lack thereof) and varying requirements in education and training. Among the states with regulations, some either certify, register, or license assistants. The education and training requirements also vary by state: Some states require a high school diploma (ASHA, 2017 http://bit.ly/2GujXIF). As of 2016, it appears as though the following states regulate assistants: Arizona, Colorado, Idaho, Illinois, Louisiana, Massachusetts, Maryland, New Mexico, Ohio, South Carolina, South Dakota, Texas (via licensure), Arkansas, Alabama, Arkansas, California, Delaware, Indiana, Kansas, Maine, Missouri, Mississippi, Montana, Nebraska, Pennsylvania, Rhode Island, Utah, West Virginia, Wyoming (via registration), and Florida, New Hampshire and North Carolina (via certification; Semin Hear. 2016 Nov; 37(4): 348).
It is important to review your state's laws and regulations prior to employing an audiology assistant, not only to ensure compliance, but to establish the range of services assistants can provide (even if the description of these services are brief or vague). Keeping state regulations and laws in mind, the supervising audiologist can determine the assistant's tasks. Tasks such as completing daily equipment calibrations, checking newly-arrived hearing aids, and explaining the routine care and cleaning of hearing aids to patients are among the many tasks that are usually delegated to assistants (Audiology Today. 2017). The question then becomes: What about adding the task of discussing OTC device options for patients whom these may be appropriate?
WHERE AUDIOLOGY ASSISTANTS MEET OTCs
Audiology assistants and OTC hearing aids, among other changes, are at the doorstep of hearing care. How can we utilize our resources to provide the best patient-centered, evidence-based care possible when confronted with issues like time constraints, declining reimbursements, and shortage of audiologists? While change can be intimidating, change can also be good. Assistants can guide patients for whom OTC hearing devices are their entry to hearing health care. OTC instruments will not be the ultimate solution for many patients who try these devices, and a trained assistant can counsel them on the limitations of OTC devices and the additional advantages of prescribed hearing technology. This may lower the barriers to adoption of advanced technology as hearing care relationships are established.
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