Would a hearing aid consultation conducted via teleaudiology be as effective as an in-person consultation? A recent study published in the International Journal of Audiology suggests it would be (Int J Audiol. 2020 Sep 23;1-12). The study compared the quality and effectiveness of hearing aid follow-up services via standard face-to-face consultations, teleaudiology, and blended services (a combination of face-to-face and remote sessions), and concluded that teleaudiology follow-up consultations “were of similar effectiveness” and quality as face-to-face sessions. It also found that a blended approach to follow-ups “can provide an effective, high-quality service irrespective of the mode or order of delivery of the consultation.”
The study was designed as a single-blinded crossover randomized controlled trial. Fifty-six adult participants were recruited from hearing aid fitting bookings, then randomly divided into two groups. The first group had one face-to-face follow-up consultation in an audiology clinic, followed by one teleaudiology consultation at participants’ homes or workplaces. This order was reversed for the second group. All consultations were with an audiologist, although the teleaudiology sessions were assisted by a facilitator who was physically with each participant to act as the clinician's ‘hands’. After the consultations, all participants attended a final in-person outcome assessment to examine their experience in the earlier sessions.
One challenge that researchers faced was measuring the outcomes as there was an “absence of published tools for assessing teleaudiology, and even to a degree [standard] audiology services.” To overcome this, they used a combination of validated and new tools for outcome assessment, including the International Outcome Inventory for Hearing Aids (IOI-HA), the Client Oriented Scale of Improvement (COSI), and the Hearing Aid Services Satisfaction of Patients (HASS-P).
TELEAUDIOLOGY FARED SIMILARLY, BUT STILL NOT PREFERRED
“Outcomes from face-to-face and remote consultations [were] similar for the participants’ communication, fitting, and service satisfaction and improvement of quality of life,” the study found. “There was also a significant longitudinal improvement in all these measures with blended services.”
Interestingly, the study noted that while participants were similarly satisfied with both face-to-face and telehealth sessions, none of them reported preferring teleaudiology over face-to-face consultations.
“Many factors could account for this preference, especially those related to the interaction between patient and clinician and facilitator,” explained lead researcher Karina F. M. Tao, AuD, citing the following examples:
Experience during the consultation with internet connectivity between the computers in the remote and clinic sites as interruptions in communication can jeopardize the quality of the service provided;
Familiarity with online meetings, which usually requires the interaction to happen using a small screen (e.g., laptop or mobile phone), which may be challenging for those with hearing loss who have to rely on visual cues; and
Difficulty in replicating face-to-face patient-clinician interaction equally through telehealth even though a facilitator can be with the patient to assist in the consultation, as the facilitator cannot replace the clinician in the decision-making.
Tao added, “In our study, the need for telehealth services and previous familiarity with online meetings were not criteria for inclusion of participants. Future studies should investigate the aspects mentioned above.”
Could blended hearing aid services provide a happy middle ground for patient satisfaction? The study notes that this approach can also be effective, but that patient satisfaction “can be negatively impacted by technical or human-related issues.”
Poor internet connection is a significant technical issue, Tao explains. “It is possible that signal strength was less than optimal inside the testing location, or that the signal strength or available bandwidth was poor in the area. Ideally, network connectivity and quality of service should be tested beforehand to ensure that it can cope with a video conference consultation.”
Human factors also affect patient satisfaction. “A human-related issue can involve either the patient, clinician, or facilitator/staff involved in the delivery of clinical care,” said Tao, giving these sample scenarios:
Patients who are not yet satisfied with their hearing outcomes may find it difficult to report what they feel or what they would like in terms of their hearing aids.
Facilitators may require more training to help clinicians and patients. For instance, facilitators have to use their own judgment on the size of the dome based on ear canal inspection.
Clinicians may require more training on the unique elements of telehealth consultations, such as breaking the distance barrier for positive interaction with the patient.
A BRIDGE DURING THE PANDEMIC
Although in-person consultations appeared to be preferred by patients, the increased use of teleaudiology amid the COVID-19 pandemic may lead to further patient acceptance.
“The enforcement of social isolation during the COVID-19 pandemic, especially for people in the at-risk groups, increased the need of delivering of a variety of services at distance,” said Tao. “This includes hearing aid services in which follow-up consultations are an ongoing part of the hearing rehabilitation program. Policies around teleaudiology have thus started to be changed to allow routine use of teleaudiology; the findings of our study support this for follow-up services.”
Tao, however, emphasizes that a facilitator plays a role in physically assisting patients during teleaudiology sessions.
“Considering that the majority of hearing aid users are usually above 50 years of age, having a facilitator visiting their homes may help to reduce the number of older adults transiting from one place to another and consequently reduce their exposure to the virus,” she noted. “Our findings are an important contribution to the growing body of evidence of the effectiveness of teleaudiology, and encourage policymakers to support innovations in clinical practice.”