8 Principles of Patient-Centered Care for Hearing Health

The key principles of patient-centered care for hearing health require  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 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 (IOM) 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 the principles of patient care into the eight categories in Figure 1.

These principles, when applied to hearing health care, provide valuable insights into the areas where hearing health providers can develop and enhance our current practices. Applying these principles to hearing health care improves accountability and helps gather information on how well we’re serving the needs of  patients.

In this article, I dig deeper into these eight person-centered principles of health care as they apply to hearing health.

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 only happens 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 empathy and a gap between their 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. For example, hearing assistive technologies, communication programs, and 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 well-being (Clements, 2015).

A patient-centered care model 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 on 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 can 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 lead to a comprehensive solution for patients.

In addition to a  recommendation for hearing aids, written information about the following resources can  help people with hearing loss.

Assistive Listening Devices

Other options for treating hearing loss  include assistive listening devices and technologies that give situation-specific help to 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 applications also provide options for amplification and captioning speech in real-time.

Community Support

Providers should include information on community-based education programs, such as speech-reading classes and aural rehab groups.

Patient-centered care can 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 people with hearing loss develop a sense of acceptance and shared community.

Ongoing Device Support

Health care providers need to offer patients regular updates on the use, operation, and maintenance of hearing aids and hearing assistive technologies 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 help create an environment where individuals with hearing loss can understand and accept their hearing abilities and achieve positive outcomes with amplification. This in turn strengthens 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 national shortage of hearing health care providers.

With the expected increase in the aging population and market factors keeping the supply of audiologists fairly low, there’s an expectation that new avenues need exploring to improve access to hearing health care (Marquardt et al., 2017). Clinicians today have access to multiple technologies that reduce the need for in-person visits.

Online Technologies and Patient Management Portals

Web-based technologies make requesting appointments easy for clinicians and patients. 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.

Tele-Audiology

The global pandemic  forced practices to transition quickly to tele-audiology, which enables remote appointments that increase efficiency and productivity for the patient and provider. Remote appointments also increase access for patients who can’t get to—or from—the office without transportation assistance. Every provider has had instances where a patient waited in the clinic long after their appointment for a transport to pick them up.

Hearing health care doesn’t reach everyone who needs 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 for patients who also live several hundred miles away from their provider. Increasing the infrastructure to support a variety of tele-audiology appointments goes a long way toward alleviating the lack of providers in remote areas.

4. Emotional Support to Relieve Fear and Anxiety

Despite technological advances, the psychosocial concerns of adults with hearing loss continue to have impact on the 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 triggers an unpleasant association. They may equate hearing aids with old age and lack of independence (Claesen & Pryce, 2012).

When a patient raises these issues with the provider, it’s important that they feel their concerns are heard. 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 Caregivers

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 family, friends,  and other caregivers of adults with hearing loss, their contributions fall into two categories:

1. Functional assessment: Family and caregivers 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.
2. Treatment efficacy: They can weigh in on the benefits or challenges associated with the different treatment options for the patient. This information helps the provider make 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 works 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  issues that affect 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 patient. 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 give 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 the 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. Ways create a safe and secure environment include:

• Room lighting that reduces glare
• Increasing visual contrast in walkways and doorways
• Having furniture that’s solid and not prone to shifting when the person sits down or stands up
• Signage that’s clear and easily understood
• Providing marketing materials that reflect and respect the patient’s cultural beliefs
• Making pocket talkers and amplifiers available for patients to use during appointments

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 needs to include support for those who provide the care. For most practices, patient-centered care requires a significant investment of time and resources.

Many providers are overwhelmed by decreasing reimbursements and encroaching threats to their scope of practice. With a health care industry undergoing significant transformations, there’s a need to identify mechanisms that support the provider in reaching the goals of patient-centered care.

Best practices in patient-centered care are those that also take 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.

Conclusion

Implementation of patient-centered care has very clear benefits for both the patient and the provider—better treatment outcomes, better health outcomes, stronger therapeutic relationships, and improved financial outcomes for the practice.

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