**10. Four underserved patient categories**

*Advances in Rehabilitation of Hearing Loss*

4.Break the hearing aid check and other similar follow-up appointments into "knowing how" and "knowing when" buckets. "Knowing how" refers to physical, hands-on skills patients must acquire to be successful hearing aid users. "Knowing when" skills are more abstract and require clinicians teach patients more complex tasks that require higher level cognitive awareness and skill, such as knowing when to use a remote microphone, knowing when to recognize a challenging listening situation that requires some modification of listening behavior, or knowing when know how to be a more assertive, proactive listener. Tailor instructional materials to help patients identify when they

need to modify a behavior to be a more effective communicator.

and fosters their ability to be an independent communicator.

enabling them to be independent, self-managers of their communication.

some things we can do to add value to the follow-up process.

complication that requires a physician referral

○ Hearing loss self-management skills training

already own hearing devices:

with a hearing aid test box.

of the following services:

**9. Beneficiaries of self-directed care**

non-audiologist

5.Encourage patients to keep a diary of their initial listening experiences. This enables patients to keep more directly involved in their follow-up. Ask patients to spend a couple minutes at the end of the day to reflect on their listening experiences, how they feel about each of them and what they did in reaction to their feelings. By keeping a diary for the first month or so of hearing aid use facilitates activity involvement on the part of the patient as a problem solver

Beyond adjusting the acoustic parameters of hearing aids and assisting patients with the hands-on skills needed to use their hearing aids, there are an abundance of person-centered skills that are too often overlooked by clinicians, but desired by patients. The work of Bennett and her colleagues lays the groundwork for how knowledge, skills and tasks can be conveyed to patients in a meaningful way, thus

While clinical audiologists to shed light on new approaches to care, there are

• Diagnostic audiological assessment to identify possible underlying medical

• A quality control check of their devices to ensure they are meeting a validated standard, either in the ear with probe microphone measures or in the coupler

• Basic communication assessment to identify extent of problem followed by one

○ Device customization and/or device mastery training, possibly delivered by a

○ Customized treatment plan that focuses on "getting used to hearing aids"

Considering the low update of hearing aids, the advent of self-directed care and self-fitting hearing aids has the potential to expand the market for services. Below are four underserved segments of the hearing care market that could benefit from

In summary, the following types of services could be offered to help seekers who

**52**

There are at least four types of individuals, currently underserved by hearing aids that are candidates for these alternative devices. Three of the four categories are commonly encountered in the clinic, while the fourth category are in great abundance, but rarely find their way to a clinic for reasons we will discuss later. **Table 1** is a summary of these four underserved patient categories. Here are some added details on each one.


The three previously mentioned groups of patients are likely to seek the services of an audiologist for testing or guidance. The final category, because they often have normal or near-normal hearing aid and do not consider their hearing to be a "problem," are unlikely to seek help from an audiologist. Therefore, this group must be reached in other ways.

*Tech Savvy Overshoots*: There are many adults, often between the ages of 50 and 65, that experience occasional difficulty with their hearing, but do not think they have a problem that warrants a visit with an audiologist. Because they are younger,


#### **Table 1.**

*A summary of the four groups, possibly under-served in today's marketplace, who may be receptive to the use of non-custom devices.*

tech savvy individuals they might be open to a do-it-yourself approach to finding help in situations where hearing is a challenge. In the past, if these individuals were to find their way to an audiology clinic, they were offered a \$3000 solution for a problem they perceive to be worth fixing for less than \$500. By combining amplification with other features that they find useful in their busy lives, the middle aged, tech savvy individual could address their communication challenges with any number of high quality ear-level PSAPs. Because many of these individuals will not seek the services of the audiologist in a clinic, we can use tools like the internet or a well-designed website to reach them. Although traditional hearing aids would be appropriate choices from a prescriptive fitting target standpoint, the style or function of traditional hearing aids may negate the trial and use of amplification as a treatment option.

Considering less than 30% of adults with hearing loss use hearing aids, a primary challenge for a medical clinic is attracting individuals that need help with their hearing into your practice. One approach to broadening the market for audiology is to recommend high quality non-custom amplifiers to adults who are not viable candidates for traditional hearing aids. Although traditional hearing aids are likely to remain the gold standard for adults with benign cases of hearing loss, clinicians should embrace vetted non-custom amplifiers as a solution for the appropriate candidate.

#### **11. Overcoming the tyranny of free tests and unit margins**

Ultimately, the onus of addressing the unmet needs of those with hearing loss falls to the profession. It is incumbent upon all of us to find innovative approaches to service device provision that get more individuals coping with the ill-effects of untreated hearing loss involved in the process of improving their own hearing and communication. This, after all, is the essence of the chronic care model: To help these patients become better, more effective self-managers of their own condition.

**55**

*Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose…*

**Help seekers with hearing devices**

1. Gather objective information on

3. Conduct objective assessment of current hearing devices, using PMM

1. Conduct self-management

2. Target areas of improvement 3. Align goals and expectations with current treatment (or recommend

1. Align goals and expectations with treatment option (post-treatment) 2. Look for areas of improvement: device mastery and/or selfmanagement skills

current hearing devices 2. Collect audiological and nonaudiological information about patient

following ICF model

new treatment plan)

interview

**Help seekers without hearing** 

3. Collect audiological and nonaudiological information about patient following ICF model

1. Target areas of improvement

4. Align goals and expectations with treatment options (pre-treatment)

1. Align goals and expectations with treatment option (post-treatment) 2. Look for areas of improvement: device mastery and/or selfmanagement skills

3. One-year post fitting: conduct self-management interview

*A summary of various clinical procedures that could be offered to two different types of patients that* 

*ICF = international classification of functioning, PMM = probe microphone measures.*

*audiologists can expect to see once OTC and self-fitting products are widely available.*

1. Assess "importance to treat" (low

2. Determine potential to self-fit their

For decades, it was sustainable business practice to provide free hearing tests and dispense, on average, 15–20 hearing aids per month to be profitable. Even if you provide the very best patient care, the units based business model is unlikely to be sustainable over the long haul in a profession that will see shrinking margins resulting from the availability of OTC device, third-party insurance contracts and other

By focusing on the emotional, psychosocial and functional impact that hearing loss has on the person's ability to self-manage their condition, audiologists can provide a full range of counseling and customization services—beyond the traditional bundled approach to delivering audiologist-driven care. These new services could be appealing to a broader range of persons with hearing loss who choose to

A primary focus of this chapter was to provide some practical insight on how self-fitting hearing aids and other amplification devices purchased over the counter (OTC), might change the way patients interact or connect with audiologists in their clinic. Although no one can predict the future, it is safe to say the availability of self-fitting hearing aids as well as other OTC devices that allow people to self-direct their care will have an impact. It is likely individuals who have already purchased a hearing device over the counter will seek the services of an audiologist. Thus,

To summarize, three different clinical tasks used during the Communication Assessment are outlined in **Table 2**: information gathering & exploratory dialog, goal setting and treatment planning, and assessing outcomes and monitoring progress. Along with the three clinical tasks, **Table 2** summarizes the key work of audiologist for those three dimensions of care for two types of help seekers. As we move into a future sure to be filled with self-fitting hearing aids, automated hearing testing and other consumer-driven healthcare initiatives, audiologists will serve

self-direct their care and could complement current clinical practice.

audiologists must be prepared to offer them a service of value.

innovations that appeal to persons with hearing loss.

*DOI: http://dx.doi.org/10.5772/intechopen.88224*

Information gathering and exploratory dialog

Goal setting and treatment planning

Assessing outcomes and monitoring progress

**Table 2.**

**devices**

or high)

own hearing aids

2. Option talk 3. Choice talk

*Audiology's Third Pillar: Comprehensive Follow-Up Care and Counseling for Those Who Choose… DOI: http://dx.doi.org/10.5772/intechopen.88224*


#### **Table 2.**

*Advances in Rehabilitation of Hearing Loss*

Contemplator During interview blame

Cochlear distortion

Tech savvy middle agers

*non-custom devices.*

**Table 1.**

other people or the environment for their hearing problem

Poor word recognition score at PB max

Struggle in with their hearing in one or two challenging listening

situations

tech savvy individuals they might be open to a do-it-yourself approach to finding help in situations where hearing is a challenge. In the past, if these individuals were to find their way to an audiology clinic, they were offered a \$3000 solution for a problem they perceive to be worth fixing for less than \$500. By combining amplification with other features that they find useful in their busy lives, the middle aged, tech savvy individual could address their communication challenges with any number of high quality ear-level PSAPs. Because many of these individuals will not seek the services of the audiologist in a clinic, we can use tools like the internet or a well-designed website to reach them. Although traditional hearing aids would be appropriate choices from a prescriptive fitting target standpoint, the style or function of traditional hearing aids may negate the trial and use of amplification as

*ALD = assistive listening device, PSAP = personal sound amplification product, QSIN = quick speech in noise test.*

*A summary of the four groups, possibly under-served in today's marketplace, who may be receptive to the use of* 

**Group Red flag characteristics How to identify Non-custom solution** 

and haptic screen

No change in word recognition between 45 and 75 dB presentation levels, poor QSiN score

Self-assessment tools on a clinic-branded website

Older old Chronological age > 85 Poor scores on cognitive

**to consider**

amplifier

earbuds

or smartphoneenabled app + wired

Ear-level wireless, neck-band PSAP or traditional hearing aid

Ear-level wireless or neck-band PSAP with multi-tasking capability

During interview process Ear-level PSAP, ALD,

Ear-level neckband PSAP, ALD or non-custom headset

Considering less than 30% of adults with hearing loss use hearing aids, a primary challenge for a medical clinic is attracting individuals that need help with their hearing into your practice. One approach to broadening the market for audiology is to recommend high quality non-custom amplifiers to adults who are not viable candidates for traditional hearing aids. Although traditional hearing aids are likely to remain the gold standard for adults with benign cases of hearing loss, clinicians should embrace vetted non-custom amplifiers as a solution for the appropriate

Ultimately, the onus of addressing the unmet needs of those with hearing loss falls to the profession. It is incumbent upon all of us to find innovative approaches to service device provision that get more individuals coping with the ill-effects of untreated hearing loss involved in the process of improving their own hearing and communication. This, after all, is the essence of the chronic care model: To help these patients become better, more effective self-managers of their own condition.

**11. Overcoming the tyranny of free tests and unit margins**

**54**

a treatment option.

candidate.

*A summary of various clinical procedures that could be offered to two different types of patients that audiologists can expect to see once OTC and self-fitting products are widely available.*

For decades, it was sustainable business practice to provide free hearing tests and dispense, on average, 15–20 hearing aids per month to be profitable. Even if you provide the very best patient care, the units based business model is unlikely to be sustainable over the long haul in a profession that will see shrinking margins resulting from the availability of OTC device, third-party insurance contracts and other innovations that appeal to persons with hearing loss.

By focusing on the emotional, psychosocial and functional impact that hearing loss has on the person's ability to self-manage their condition, audiologists can provide a full range of counseling and customization services—beyond the traditional bundled approach to delivering audiologist-driven care. These new services could be appealing to a broader range of persons with hearing loss who choose to self-direct their care and could complement current clinical practice.

A primary focus of this chapter was to provide some practical insight on how self-fitting hearing aids and other amplification devices purchased over the counter (OTC), might change the way patients interact or connect with audiologists in their clinic. Although no one can predict the future, it is safe to say the availability of self-fitting hearing aids as well as other OTC devices that allow people to self-direct their care will have an impact. It is likely individuals who have already purchased a hearing device over the counter will seek the services of an audiologist. Thus, audiologists must be prepared to offer them a service of value.

To summarize, three different clinical tasks used during the Communication Assessment are outlined in **Table 2**: information gathering & exploratory dialog, goal setting and treatment planning, and assessing outcomes and monitoring progress. Along with the three clinical tasks, **Table 2** summarizes the key work of audiologist for those three dimensions of care for two types of help seekers. As we move into a future sure to be filled with self-fitting hearing aids, automated hearing testing and other consumer-driven healthcare initiatives, audiologists will serve

as advisors and consultants. When patients have questions or concerns, no matter where they purchased their hearing devices (or if they own them at all), they will seek the services of audiologists. Rather than limiting the role of audiology to selecting, fitting and tweaking hearing aids, **Table 2** demonstrates that in the emerging era of self-directed care, the potential value of audiology is evaluating the entire person and offering solutions, many of which are not device-related, that help patients become better, more effective self-managers of their condition.

Audiologists must anticipate a future filled with several options that allow patients to self-direct their care. From the point of view the massive numbers of people with untreated hearing loss, the provision of new direct to consumer choices is a positive development. Rather than scoff at this change, audiologist would be wise to embrace it and identify ways they can add value for those who opt to selfdirect their care and then find they need some additional support or guidance from an expert. The objective of this chapter was to spur thinking on novel approaches to service and review some of these approaches that can be implemented in a clinic today. Now is the time for audiologists to create the future—a future less dependent on the sale of a device.
