Patient-centered hearing health care is about understanding the emotional and physical needs of the patient while developing a solution that addresses their daily lifestyle. Best practices for patient-centered care go well beyond excellence in diagnostic services. Understanding the attitudes, concerns, health literacy needs, and priorities of individuals with hearing loss are key to determining the right treatment options.
The Institute of Medicine defines patient-centered care as “providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient’s values guide all clinical decisions,” (IOM, 2001). The Picker Institute further divided patient-centered care into the eight categories in Figure 1.
These principles, when applied to hearing health care, can provide valuable insights to the areas where we can develop and enhance our current practice. Applying these principles to hearing health care can improve accountability and help gather information on how well we are serving the needs of our patients. The following article digs deeper into these eight principles as they apply to hearing health care.
1. Respect for the patient’s values, preferences, and expressed needs
Patients value health care providers who create a positive and supportive environment. Acceptance and adjustment to a diagnosis of hearing loss can only happen in an environment where a patient receives information in an empathetic manner. Interviews with patients about the adoption and use of hearing aids indicated that patients were more likely to pursue the use of hearing aids and overcome challenges in adapting to hearing aids when they perceived consideration, warmth, and empathy from their health care provider (Blazer et al., 2016). A review of first-time consultations with audiologists in Australia found that patients perceived a lack of demonstrated empathy and a gap between the patients’ needs and the goals of the audiologists. For example, when the audiologists delivered the diagnosis, two-thirds of them directly transitioned into a recommendation for hearing aids, without allowing the patient time to react or ask questions about the diagnosis and without discussing other available treatment options (e.g., hearing assistive technologies, communication programs, support groups) (Ekberg et al., 2014).
When the encounter with the professional creates a negative perception, the individual often delays taking action, resulting in putting off opportunities to improve quality of life and wellbeing (Clements, 2015).
Patient-centered care involves going beyond understanding the needs of the patients; it includes measuring if those needs were met. Requesting feedback from patients about whether they were treated respectfully, felt their values were taken into consideration, and whether they felt their needs were met during their encounter with the provider, provides information that can be used to improve upon existing clinical services. Patient satisfaction surveys sent to a patient after an appointment can help a practice hone its patient-centered care efforts. These surveys can be easily administered electronically with web-based survey tools.
2. Information and education
The first consultation with an audiologist or other hearing health care professional may have a long-term impact on decision-making and outcomes (Clements, 2015). In the hearing health care space discussion of different treatment options and opportunities for social and emotional support will lead to a comprehensive solution for patients. In addition to the hearing aid recommendations, written information about the following resources could prove to be very helpful for people with hearing loss.
ASSISTIVE LISTENING DEVICES
There are other options for treating hearing loss like assistive listening devices and other technologies that provide situation specific help for people with hearing loss. Technologies like captioned phones, amplified phones, amplified wireless headsets for television and other audio streaming can be part of an amplification strategy. Smart phone application also provide several options for amplification and captioning speech in real time.
Providers should consider including information on community-based education programs such as speechreading classes and aural rehab groups. Patient-centered care should also include providing information on support groups for people with hearing loss such as the Hearing Loss Association of America and hearing-impaired professionals groups that are available both locally and online. These groups not only provide additional support, they help develop a sense of acceptance and shared community.
ONGOING DEVICE SUPPORT
Health care providers need to provide regular updates on the use, operation, and maintenance of hearing aids and hearing assistive technologies at regular intervals after the initial fit. Links to videos and tutorials on care and maintenance of devices, along with a newsletter on what devices can do are a helpful reminder of how people with hearing loss can benefit from different technologies available in their devices. These additional avenues of support will help create an environment where hearing-impaired individuals are able to understand and accept their hearing abilities and use resources to achieve positive outcomes with amplification. This in turn will strengthen the provider-patient relationship.
3. Access to Care
Improving access to care involves providing easy access to the hearing health care provider and addressing the shortage of hearing health care providers nationally. With the expected increase in the aging population and market factors keeping the supply of audiologists fairly low, there is an expectation that new avenues need exploring to improve access to hearing health care (Marquardt et al., 2017). Clinics today have multiple technologies that reduce the need for in-person visits to see a hearing health care provider.
ONLINE TECHNOLOGIES/PATIENT MANAGEMENT PORTAL
Web-based technologies can make requesting appointments easy and allow patients to indicate their availability. The ability for patients to select the day and time of their appointment themselves; timely appointments; short waiting time in the office; and timely response to e-mails and telephone calls can be accomplished with the use of a customized patient management portal.
The global pandemic has forced practices to transition quickly to tele-audiology, which now enables remote appointments that increase efficiency and productivity for the provider. Every provider has had at least a few instances of a patient waiting in the clinic long after their appointment for a transportation pick up. Remote appointments also increase access for patients who cannot get to the office without transportation assistance.
Hearing health care does not reach all who need it. Residents of rural and low-income urban areas are at a particular disadvantage in accessing care. Tele-audiology holds the key to increasing access to providers for patients who also live several hundred miles away from their provider. Increasing the infrastructure to support a variety of tele-audiology appointments can go a long away towards alleviating the lack of providers in remote areas.
4. Emotional support to relieve fear and anxiety
Despite technological advances, psychosocial concerns of adults with hearing loss continue to have a large impact on their decision to seek help for their hearing loss and rehabilitation. Patient attitudes towards amplification are critical influential factors driving consultations for hearing device adoption (Meyer, 2014). Patients experience a variety of emotions when adjusting to a diagnosis of a hearing loss. These include sadness, disappointment, fear, and worry. Clinician response to patients during this time is an important aspect of patient-centered care. For a lot of patients, the recommendation of a hearing aid may trigger an unpleasant association. They may equate hearing aids with old age and lack of independence (Claesen & Pryce, 2012). When a patient raises these issues it is important that they feel that their concerns were heard during the interaction. A clinician’s interpersonal skills, along with active and empathetic listening, can facilitate more positive associations with hearing aids and foster a strong therapeutic relationship (Grennes et. al 2015). Setting aside time within the appointment to listen to the patient’s concerns and validate them is a critical step towards a strong patient-centered hearing health care model.
5. Involvement of family and friends
The National Quality Forum’s National Priorities Partnership characterizes patient-centered care as health care that “honors each individual patient and family, offering voice, control, choice, skills in self-care, and total transparency, and that can and does adapt readily to individual and family circumstances, and to differing cultures, languages, and social backgrounds” (NPP, 2010). For adults with hearing loss, families and other caregiver contributions can be divided into two categories:
A) Functional Assessment: They can add their perspective on how the hearing loss affects the everyday activities for the person with hearing loss, including their ability to communicate with those around them.
B) Treatment Efficacy: They are able to weigh in on the benefits or challenges associated with the different treatment options for the patient. This information can greatly assist the provider in making the most suitable recommendation for managing the hearing loss.
Patient-centered care is more than just agreeing to whatever the patient wants. It involves identifying issues that are meaningful in the patient’s life and tailoring a solution that will work with the patient’s values. It involves respect for their feelings and emotions along with buy-in from their family, caregivers, and loved ones. This provision of patient-centered care is complex and time-consuming, and requires broad involvement of the patient, the family, and the care team to consider all of the issues affecting the patient’s care.
6. Continuity and secure transition between health care settings and coordination of care
Often hearing health professionals are required to share information with other key health care providers and work as a part of a team to provide appropriate care for their patients. Timely sharing of health information, appropriate referral to specialists, and keeping the primary care physician informed of the care plan are all key components of patient-centered hearing health care.
Working with a HIPAA compliant electronic health record alongside secure transmission channels of health records is essential. Creating workflows within the administrative office that allow patients easy access to their test results and nimble coordination between different providers and insurance go a long way towards building patient confidence and trust in you as health care provider.
7. Physical comfort
In a hearing health care environment, care must be taken to ensure that the person is in a physical space that feels safe and secure and promotes participation. Suggestions to create this environment include:
- Room lighting to reduce glare
- Increased visual contrasts for walkways and doorways
- Having furniture that is solid and not prone to shifting when the person is sitting down or standing up
- Signage that is clear and easily understood
- Providing marketing materials that reflect and respect the patient’s cultural beliefs
- Making pocket talkers and amplifiers available for the patient to use during the appointment.
These techniques help create an office where the patients feel that their values are respected and that the care they receive is comprehensive, competent, and delivered by professionals who care about their well-being.
8. Support for HCP in patient-centered care environments
A comprehensive discussion of patient-centered care must include support for those who provide the care. For most practices, patient-centered care requires a significant investment of time and resources. Right now, many providers are overwhelmed by decreasing reimbursements and encroaching threats to their scope of practice. With a health care industry undergoing significant transformations, there is a need to identify mechanisms that will support the provider in reaching the goals of patient-centered care. Best practices in patient-centered care are those which also taken into account sustainability from a practice standpoint. Conversations around patient-centered care must include adequate reimbursement for the provider through appropriate billing codes and consideration of fee-for-service models.
Suggestions for practice modifications to increase patient-centered care vary with regards to cost in both time and financial investment. Providers need to consider the most realistic implementation plan that will fit their practice. Implementation of patient-centered care has very clear benefits for both the patient and the provider—better treatment outcomes, stronger therapeutic relationships, and improved financial outcomes for the practice.
Rupa Balachandran, Ph.D.
Department of Audiology
University of the Pacific
155 Fifth Street
San Francisco, CA 94103
1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Audiologists, on the Internet at https://www.bls.gov/ooh/health…
2. Claesen, E., & Pryce, H. (2012). An exploration of the perspectives of help-seekers prescribed hearing aids. Primary Health Care Research & Development, 13, 279–284. doi:10.1017/ S1463423611000570
3. Clements, C. (2015). Why do older adults delay in seeking help for hearing loss. Journal of Otolaryngology-ENT Research, 3(4), 00070.
4. Ekberg, Katie, Caitlin Grenness, and Louise Hickson. “Addressing patients’ psychosocial concerns regarding hearing aids within audiology appointments for older adults.” American Journal of Audiology 23.3 (2014): 337-350.
5. Gerteis, M. (1993). Through the patient’s eyes: understanding and promoting patient-centered care.
6. Blazer DG, Domnitz S, Liverman CT, editors. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Committee on Accessible and Affordable Hearing Health Care for Adults; Board on Health Sciences Policy; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Washington (DC): National Academies Press (US); 2016 Sep 6. 3, Hearing Health Care Services: Improving Access and Quality. Available from: https://www.ncbi.nlm.nih.gov/b…
7. Grenness, C., Hickson, L., Laplante-Lévesque, A., Meyer, C., & Davidson, B. (2015). The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. Journal of the American Academy of Audiology, 26(1), 36-50
8. Grenness, C., Hickson, L., Laplante-Lévesque, A., Meyer, C., & Davidson, B. (2015). Communication patterns in audiologic rehabilitation history-taking: Audiologists,
patients, and their companions. Ear and Hearing, 36(2), 191-204.
9. Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US).
10. Marquardt et al 2017 .-https://hearinghealthmatters.o…supply-demand-audiologists-us/
11. Meyer, C., Hickson, L., Lovelock, K., Lampert, M., & Khan, A. (2014). An investigation of factors that influence help-seeking for hearing impairment in older adults. International Journal of Audiology, 53, S3–S17. doi:10.3109/14992027.2013.83
12. NPP (National Priorities Partnership). Patient and family engagement. 2010. [February 18, 2011].
13. Picker Institute: Principles of patient-centered care.