The Importance of Interprofessional Practice in Audiology

Interprofessional practice (IPP) occurs in those “ … occasions when two or more professionals learn with, from and about each other to improve collaboration and quality of care.”

— The Centre for the Advancement of Interprofessional Education (caipe.org) ¹

One exemplary interprofessional collegial engagement between widely varying types of medical practitioners is demonstrated in Pharmacy, Podiatry, Optometry, and Dentistry (PPOD). This interprofessional group comprised of four unique medical disciplines works together to optimally provide best patient care in treating people with diabetes (or potentially prevent type 2 diabetes). ² Their mission in collaborative, integrated, and comprehensive engagement is to maintain consistent messaging when advising and educating patients about diabetes control and prevention aims to accomplish, as well as ensuring the patients are being monitored on a regular basis by the entire PPOD. The PPOD message emphasizes the importance that all PPOD health providers obtain uniform educational components and support the patient’s practice of self-management, while also consistently directing the patient to the other PPOD health professionals for treatment.

Interprofessional collegial engagement is not a new concept in audiology. There are several insightful visionaries, like Raymond Carhart, who propelled the profession into establishing validated audiological clinical assessment practices to serve the hearing needs across multiple populations in the late 1930s through 1940s. However, clinical audiology as a profession began over a century ago in 1920 when Cordia C. Bunch graduated and was immediately appointed as an -associate professor of Audiology within the Otolaryngology Department at (his alma mater) the University of Iowa. ³ In fact, the family lineage of audiology has multiple lengthy and frequent intersections with otolaryngology over the past century. Since the genesis of audiology, interprofessional collegial engagements with otolaryngology have primarily focused on audiological identification of hearing loss secondary to etiology in both pediatric and/or adult patient populations. ⁴

Since post World War II, the profession of audiology has identified opportunities for engagement with many other medical specialists who would also serve varied clinical populations presenting with basic diagnoses, tinnitus, balance, auditory processing differences, rehabilitation, and hearing conservation. Consequently, within the context of serving and enhancing best practices through a broader base of -patients while engaging with many medically based professionals in addition to otolaryngologists. Those non-auditory/ear-based medical practitioners could include neurologists, general practitioners, pulmonologists, neonatologists, pediatricians, ophthalmologists/ optometrists, and/or rehabilitationists (physical and occupational therapy or speech-language pathology).

Within the formative period of professional maturation, the profession of audiology identified great value in partnering with speech-language pathologists to serve those veterans as well as civilian communities suffering from hearing and speech-language challenges. Even to date, the fruits of interprofessional collegiality between audiology and speech-language pathologists remain strong when complex patients emerge and present with hearing loss secondary to (though not an exhaustive list): idiopathic sudden onset, cerebral vascular accidents, aging (natural or idiopathic), failed newborn or school-aged hearing screening, etc. The logical clinical partnership between audiology and speech-language has ensured continuity in patient care for those with significant communication disorders.

The aim of this specific collection of articles is to highlight a variety of opportunities audiologists may identify and strengthen for fruitful interprofessional engagement. It goes without saying that every circumstance is formed contextually dependent upon unique mission, infrastructure, and available resources (e.g., personnel, materials, etc.); for instance, the earlier example of PPOD focuses on promotion of optimal diabetes care across multiple disciplines. As detailed previously, audiology practice provides multiple opportunities to engage with a variety of health practitioners that serve the same populations as audiologists. Though the offerings within this special collection are not exhaustive, consider the collection of articles as the “food for fodder” and consideration. This collection of articles could be considered a baseline of multiple opportunities for professional socialization across a variety of vectors.

The first informative article provided by Dr. Angela Shoup, et al. describes an influential interprofessional organized group. It is likely that many audiologists are not aware of the interprofessional group, the National Academies of Practice (NAP), that was founded over 40 years ago with a mission to serve the public and multiple health disciplines by advancing education, policy, practice, and research. NAP’s goal is to foster and enhance collaborating and learning across disciplines while promoting to preserve health and well-being for society. NAP publishes a quarterly online-only peer-reviewed Journal of Interprofessional Education & Practice. An added benefit of immersing oneself within the breadth of collaborations can be found through the capability of various professionals aptly providing an informed, as well as unified, voice to advise governmental bodies about the values of supporting affordable, accessible, and coordinated quality health care.

Our next article, written by Dr. Karin Joubert, reveals that even in South Africa there are unique interprofessional collaborations. South Africa has a population of nearly 70 million (i.e. equivalent to 0.87% of the world population) with a birth rate that is considered more than double the national death rate. ⁵ The needs are painfully great within the context of exceedingly limited health care resources across the nation, but even more so in the rural areas. However, interprofessional engagement with nutritionists and pharmacists is not only a necessity, but it can and does exist throughout South Africa. There are specific examples of maximizing patient care while also maintaining best patient care practices.

Dr. De Wet Swanepoel’s article in this collection demonstrates impactful ways of establishing unique interprofessional partnership models within South Africa. As mentioned in the article, the South Africa Rural Health Conference has gained acceptance across a variety of health practitioners. But, now with a fast forward, we can observe a laser focus between hearing and pharmacology and optometry offices, which house creative teleaudiology hearing screening kiosks. Each kiosk is equipped with appropriate messaging immediately at the conclusion of the screening to connect with the servicing audiology practice. Such proof of concept for interprofessional collaborations demonstrates an assurance of engaging with a wider variety of allied health professionals and/or pharmacies.

The next article brings us to a guide with unique perspectives in hearing care for people with vision loss by Dr. Jenna Littlejohn and colleagues. There is a wealth of resources that include introducing audiologists to clinical terms and definitions pertaining to vision loss; common eye conditions with the potential functional impacts upon individuals’ vision clarity; and suggested adaptations with tips for audiologists to consider implementing when engaging with patients who have vision loss. Finally, the authors provide relevant information and implications about the functional impact on daily living as a result of age-related eye conditions as well as suggested adaptations for hearing care in clinical practice.

Dr. Gabrielle Saunders and colleagues provide fascinating insights from their investigation about the challenges experienced by individuals with hearing loss during their pharmacy encounters, in the next article. The study revealed that pharmacists recognize that they do not know how best to communicate with individuals who have hearing loss. Secondly, those pharmacists included in the study acknowledged their need for training to facilitate clear communication with individuals who have hearing loss. Lastly, those same pharmacists conceded that their clients should play an important role in disclosing their hearing needs to pharmacists. Studies, such as these continue to provide evidence about the importance of engaging in interprofessional collegial interactions. Our patients reap the reward of an improved experience and outcomes as we provide the best quality of care.

Finally, the article by Dr. Graham Naylor and colleagues provides provocative results from data over a two-year period regarding efficacy of hearing aid use to reduce the impact of dementia. This unique collegial global partnership between multiple professionals from auditory research scientists, rehabilitation specialists and the U.S. Department of Veteran Affairs. Their ultimate take-away message suggests that untreated hearing loss can increase the risk of dementia and that cognitive impairment can contribute to discontinued hearing aid use.

This unique collection of articles offers a peek into potential interprofessional collaborations that audiologists can easily pursue to enhance best patient care practices through multi-professional teamwork. It is my hope that readers will identify a variety of ways they can engage in interprofessional collegial partnerships to improve patient outcomes. Afterall, the benefit of improving outcomes will exceed the initial energy exerted to make those interprofessional collaborations.