The landscape of hearing health care is changing. Today's consumer has more options when it comes to amplification, and this is causing some concern among providers who feel, now more than ever, that they must differentiate themselves from the increasing competition. One way to accomplish this is by providing auditory rehabilitation (AR) beyond amplification. According to MarkeTrak VIII, only nine percent of experienced hearing aid users and 18 percent of new users received AR beyond the hearing aids, and less than five percent received any kind of auditory training (Hear Rev. 2010;17(4):12). These statistics demonstrate the ample opportunity to implement this underutilized service.
auditory clinic, audiology
Of course, differentiation isn't the only reason audiologists should provide auditory rehabilitation. Comprehensive AR includes sensory management, education, counseling, and auditory perceptual training (Trends Amp. 2007;11(2):63). Amplification alone cannot address cognitive factors related to working memory and speed of processing in older listeners (Int Jour Aud. 2003;42:11). Hearing aids can't fix communication with partners who mumble or speak from the other side of the house or in noisy environments where it's difficult to hear even for those with perfect hearing. The education, counseling, and auditory training components of aural rehabilitation are critical to patient acceptance of and long-term success with amplification. Aural rehabilitation should therefore be a part of our standard treatment protocol.
Why then is comprehensive AR being offered only by a few hearing care providers? The most commonly heard reasons include lack of time, lack of confidence (“we are not visited by the ‘AR rep’ for free training and support”), lack of reimbursement, and lack of patient compliance. As an audiologist in a busy ENT practice, I've faced these challenges and devoted the last decade to developing strategies and tools to overcome them. My recent acquisition of the audiology side of the practice has given me an additional opportunity to test and revise these strategies in a hectic private practice setting. In my opinion, comprehensive AR is a moving target; there is no one-size-fits-all solution. However, given a simple framework, some readily available tools, and encouragement, even the busiest clinical practice can provide comprehensive AR.
1. It all starts with the assessment. We need to shift our assessment focus from hearing concerns to communication concerns. This change should be reflected in the questionnaires we use and even in the way we refer to the initial consultation. The term “hearing aid evaluation” puts all emphasis on technology and does nothing to differentiate us from the commodity options. Let's follow the recommendation of Robert W. Sweetow, PhD, from more than a decade ago and modify the name to reflect a broader treatment plan (Hearing Journal. 2007;60(9):26). Functional Communication Assessment and Communication Needs are a couple of options (SIG 7 Perspectives. 2015;22:15). Many assessment tools are available for communication needs. My favorite is the Patient Assessment of Communication Abilities (Hear Rev. 2016;23(3):20). I have the patient and the communication partner complete this simple, closed-set questionnaire pre- and post-treatment to make sure we're meeting the goals of all involved parties.
2. K.I.S.S. Keep it super simple! This strategy cannot be over-stated. Clinicians are busy and our patient visits are consumed by instructions related to technology, leaving little time for counseling on communication and coping strategies. Patients are also busy and don't want to be burdened with time-intensive activities once they leave our office. They are also often overwhelmed by all the new technology and may not remember the verbal education received during clinic visits. We must keep our education, counseling, and training simple to increase both clinician and patient compliance with aural rehabilitation.
3. Have a written plan. Create a document that lists your clinical procedures, from the initial visit through the end of the trial period. Include procedures related to patient intake, diagnostics, treatment, patient education, auditory training, and follow-up. List these procedures by visit. For example:
Visit 1: Communication Needs Assessment
The written plan can be as basic or as detailed as you choose to make it. The goal of the written plan is to keep providers accountable for following best practices. In the craziness of our daily lives in the clinic, it can be easy to skip an important step, especially those procedures related to patient education. The written plan should be posted in the front of the patient's chart so that each step can be checked off as the clinician performs it. A written plan can be easily converted into an electronic document, such as a fill-able PDF, and stored in the patient's electronic chart for clinics using electronic medical records.
4. Know your tools and use your resources. When it comes to hearing aids, most hearing care providers feel confident about the products and wireless accessories they recommend to their patients. We receive excellent training from the manufacturer reps on products and software, and we get useful support materials such as brochures, colorful placemats, and displays. However, the story is much different when it comes to patient education, counseling, and auditory training. Tools for critical AR components are available, but they are not dropped on our laps as readily as the hearing aid tools. Hearing care professionals need to do a little digging to find them, and this is where that “lack of time” excuse comes into play. Allow me to do some of that dirty work for you. Please note that the following tools do not constitute an exhaustive list. They are simply the tools that I'm most familiar with and can act as a starting point for you.
These tools are only a sampling of the many great AR resources available to clinicians. My hope is that the strategies and tools presented here will give providers the motivation and confidence to add at least one new resource to their treatment protocol. As hearing care providers, it is our responsibility to provide education, counseling, and training beyond amplification. I promise you, it is worth the effort. Clinicians who provide comprehensive AR are reimbursed through fewer returns, more repeat purchases, and increased patient referrals. The need is clear, the tools are available, and we are the professionals trained to provide this critical service.
Dusty Jessen, AuD
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Consider these tips and tools to provide auditory rehabilitation beyond ...
The influence of working memory on speech understanding appears to be negligible...
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