Even though the FDA’s OTC legislation seems to generate many of the industry headlines these days, there are still a lot of notable news items that could have a direct impact on how audiology is practiced over the next generation, so before you settle on your Halloween costume for this year’s big bash, spend a few minutes catching up on some items worthy of a few minutes of your undivided attention.
The New Age of Patient Autonomy
That was the headline in an October 15 JAMA report published online. Because patients are better informed by social media and the internet, they are less dependent of their medical professional for access to healthcare information and resources. This change in the patient-provider relationship is driving a moment away from medical paternalism and toward patient centric care. Creators of patient centered care service delivery models recognized more than 30 years ago that one critical component of patient centered care is shared decision making.
Shared decision making involves the patient and their medical professional working in close partnership to make decisions that in agreement with the patient’s preferences and values. In theory, this has been an effective model in which to provide care, but until recently the medical professional held most of the power because that person had sole access to knowledge and other resources needed for the patient to decide on the course of care.
Now, using the web, patients can thoroughly research and “pre-diagnose” conditions affecting them. To compound the challenge, patients can use their smartphone and any number of apps to gather personal data about themselves, sometimes even conducting tests, ordinarily conducted at a clinic.
Given the rapidly evolving direct-to-consumer testing and product markets, physicians and other medical professionals are beginning to re-examine their role in this age of increased patient autonomy.
The authors of the recent JAMA report, who hail from the University of Pennsylvania Medical School, suggest that physicians (and other autonomous providers of medical care gatekeepers) need to focus on three burgeoning roles in the changing healthcare system:
- Gatekeepers to follow-up services – work with patients that may have conducted some type self-test that lead to a “pre-diagnosis” and ensure that patient gets the appropriate follow up care with another medical specialty.
- Continue to perform diagnostic and therapeutic procedures that cannot be conducted by the patient and continue to make judgments about the appropriateness of carrying out procedures requested by patients.
- Serve as consultants and advisors for patients who first choose to self-direct their care and then opt to see a medical professional when they are confused or uncertain about something.
The October 15 JAMA report, although it did not mention hearing-related care, has several important insights on how medical professionals can better manage the needs and expectations of patients who decide to self-direct their care.
The entire article can be found here.
ICF Model to Optimize Patient Centered Care is Garnering Attention
Most audiologists are aware that the routine case history and standard audiological assessment may fail to capture the complete functional limitations of hearing loss experienced by many patients. That is, personal factors such as cognitive ability and self-confidence, or environmental factors such as background noise levels can be significant factors to success, but often are not formally evaluated by the clinician. Additionally, an emerging trend in healthcare is the application of patient-centered care, which in simple terms means managing the communication needs of the whole person, not just measuring their hearing loss and fitting hearing aids. One promising tool that researchers are evaluating and planning to operationalize to provide more effective patient centered care is the International Classification of Functioning.
The International Classification of Functioning, Disability, and Health (ICF) is part of a family of international classifications developed by the World Health Organization (WHO). The ICF classification system focuses on human functioning and provides a unified, standard language and framework that captures how people with a health condition function in their daily life rather than focusing on their diagnosis or the presence or absence of disease. Slowly, over the past few years, the ICF model is attracting the attention of research audiologists who are investigating ways to more effectively target the needs of adults with hearing loss.
Clinical application of the ICF model might be particularly helpful in an age when patients can self-direct their care and buy self-fitting hearing aids without the input of a licensed professional.
The ICF Core Sets for Hearing Loss (CSHL) consists of several short lists of categories from the much larger ICF classification system that are most relevant for describing the functional capabilities of persons with hearing loss. Effective adaption of the ICF framework could lead to a clinical in-take tool that gathers information on an entire range of factors contributing to a person’s ability to function in daily living with their hearing loss. Further, an ICF-based tool could lead to a fully tailored treatment plan, along with robust outcome metrics, that matches the patient’s needs.
A retrospective study published-ahead-of-print by Ear and Hearing used patient records from 169 patients collected by otolaryngologists (ENT) and audiologists at Mayo Clinic Jacksonville to see how they linked to the pre-defined ICF Core Sets for Hearing Loss. Razan Alfafir and colleagues determined that the multidisciplinary (ENT and Audiology) intake documents overlapped the ICF Core Sets for Hearing Loss was 100% for the brief version and 50% for the comprehensive version. When audiology and ENT- specific intake documents were evaluated they matched the brief ICF Core Sets for Hearing Loss at 70%. Results of the study show some of the limitations of current in-take procedures used by audiologists and ENTs in comparison to the breadth of factors included in the ICF Core Sets for Hearing Loss.
Given the extensive range of factors that impact individuals with hearing and ear problems, many of which are not typically assessment with during routine evaluations today, the use of the ICF Core Sets for Hearing Loss to develop more comprehensive in-take and outcome tools that capture the full range of functional limitations and underlying contributors would be a valuable addition to the profession.
As Alfafir et al suggest, when hearing-related services are limited to the sale of hearing aids, the comprehensive audiological assessment can devolve into a screening exercise to identify candidates for that treatment, rather than a careful exploration into the nature and context of a person’s unique hearing difficulties and needs. As consumer-driven healthcare gains traction, clinicians should be hopeful this vein of research provides a working framework for how audiologists can deliver true patient centered care that goes beyond the provision of hearing aids.
The entire article can be found at this gated site: https://journals.lww.com/ear-hearing/Abstract/publishahead/Comparing_the_International_Classification_of.98868.aspx
Another similar article by the lead author can be found here at this un-gated site: https://docs.wixstatic.com/ugd/caf823_02d10eb722984effaacab58358655992.pdf
Technology Won’t Make Your Job Obsolete, Just Different
With all the chatter about self-fitting hearing aids and automated AI-driven screening procedures like CEDRA, it’s normal to think your job might be eventually replaced. A recent blog at Scientific American, however, provides value perspective.
More than 300 years ago doctors were concerned the thermometer – yes, that object that every parent has in their purse or medicine cabinet – was going to replace the well-placed hand of an experienced clinician on the forehead of a sick child. In turns out, of course, that the thermometer didn’t replace doctors, and neither did blood tests, x-rays or the microscope- several other innovations of the 19th century that we take for granted today.
It turns out quantitative measures, even those that are faster, cheaper and more accurate than ever before, are complemented quite effectively by the qualitative competence of steadfast physicians.
To learn how pediatricians in Philadelphia are embracing their role in the era of AI-based diagnostic algorithms, read this article from Scientific American.
Audiologists in the near future will be challenged by some of the same things mentioned in this article. The profession will need to figure out how to incorporate AI-based tools that lead to more precise diagnosis while simultaneously using their humanistic skills to provide a high quality of personalized care.
FuturEar Celebrates 1 Year
Dave Kemp of Oaktree Products has an informative blog that offers some valuable insights on the convergence of hearing aids and consumer audio.
Read his recent musings on biometric sensors and exotropic hearing aid features here: https://futurear.co/category/hearables/
Longitudinal Study Shows Relationship Between Cognition, Untreated Hearing Loss and Social Isolation
Readers may recall a July 2017 Lancet study which estimated 35% of the risk factors associated with dementia was modifiable, and that the most prominent modifiable risk factor was hearing loss, which contributed 9% toward the acceleration or possible onset of dementia. A study, published in JAMA Otolaryngology last week, builds on this eye-opening data.
Using a sample size of more than 7000 adults over the age of 50, British researchers investigated the link between age-related hearing loss, cognitive decline, specifically looking at untreated hearing loss and social isolation as potential contributors of the link between cognition and hearing.
Their results showed that hearing loss had a negative association with cognitive ability for participants with a moderate to severe hearing loss, but this association was only seen in those participants who did not use hearing aids. Their results suggest a key driver of the association between hearing loss and cognitive decline is untreated hearing loss. Further, the investigators found that those with hearing loss has higher odds of being socially isolated.
Like others similar studies that have received considerable attention in the industry press (e.g., Baltimore Longitudinal Study of Aging), this study shows hearing loss is linked to cognitive decline, with the association being greater as the degree of hearing loss increases. This current study, however, contributes one new finding: the association between hearing loss and cognitive decline was seen only in individuals who did not use hearing aids, and for the participants who wore hearing aids there was no evidence of an association between hearing loss and cognitive decline.
Another finding of interest in this study is that social isolation significantly reduces cognitive ability. Those participants with hearing loss that did not use hearing tended to be more prone to the ill-effects of social isolation.
According to the investigators, their findings are an indication that adults over the age of 50 ought to be routinely screened for hearing loss and cognitive decline in primary care settings. Additionally, they recommend, based on the results of this study, that more prominent public health campaigns are needed to increase the awareness that cognitive decline associated with age-related hearing loss might be preventable with opportunistic hearing screening, along with early rehabilitation.
The full text can be found at this gated site: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2698895?resultClick=1
*featured image courtesy healthcareinamerica