One Step May Improve Auditory Screening Among Older Adults

Jennifer Garcia, DVM

November 11, 2020

An electronic alert may help doctors identify older adults with hearing loss sooner and increase referrals to an audiologist, according to a study published online November 9 in the Annals of Family Medicine.

"Our findings demonstrate that using an electronic alert to prompt primary care clinicians to ask the single question, "Do you have difficulty with your hearing?" to identify and refer appropriate at-risk patients for hearing testing is feasible and improves outcomes," write Philip Zazove, MD, professor and chair, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, and colleagues.

Although hearing loss is known to be associated with an increased risk for a variety of health conditions, including hypertension, diabetes, dementia, and depression, the US Preventive Services Task Force has concluded that there are insufficient data to evaluate the value of widespread screening.

To address that gap, Zazove and colleagues designed the Early Auditory Referral-Primary Care study. As part of the study, researchers added a hearing loss alert to the electronic medical record (EMR) systems of 10 family medicine clinics within two large healthcare systems, the University of Michigan (UM) and Beaumont Health (BH). Clinicians were educated on how to perform hearing loss screenings and the alerts were triggered to appear when clinicians evaluated patients 55 years of age or older who were being seen for nonhearing-related issues.

Between July 2016 and February 2019, 14,877 patients were enrolled in the study resulting in 36,701 encounters.

The researchers found that clinicians addressed the alert for 10,567 patients, resulting in an increase in referral rates from 3.2% at baseline to 14.4% in the UM system and from 0.7% to 4.7% in the BH system. For 26.2% of patients, the alert was not addressed at any encounter with the family clinician.

At the time of enrollment, patients were asked to complete a Hearing Handicap Index for the Elderly (HHI) questionnaire that was used to identify patients at risk for hearing loss. These results were blinded to clinicians. From the HHI data, available from 5893 patients, the researchers found that 25.2% of patients had scores suggestive of hearing loss and that these patients had greater overall referral rates during the study period compared to patients with lower scores (28% vs 9.2% [P < .001], respectively).

Addressing hearing loss/communication challenges can improve healthcare utilization and improve quality of life for older patients, noted coauthor Michael McKee, MD, MPH, in an interview with Medscape Medical News.

"This includes their relationships with significant others, better adherence to treatment plans, and possibly reducing their risk for cognitive decline," McKee said.

While acknowledging that this type of alert should be relatively easy to implement in most EMR systems, "the issue of electronic medical record alert fatigue must be considered," said Angela Shoup, PhD, FAAA, FNAP, president of the American Academy of Audiology and executive director of the University of Texas Callier Center for Communication Disorders in Dallas.

"Healthcare providers and information technology advisers are increasingly sensitive to the need to carefully curate alerts to ensure providers do not become so inundated that they miss important clinical decision support tools," Shoup told Medscape Medical News.

"Tailoring the alert to specifically trigger only for the specified population, as noted in this article, is one technique recommended to help reduce EMR alert fatigue," she noted.

The addition of this prompt for family clinicians "should increase the chances that hearing loss patients, who suffer substantial morbidity when untreated, will get better and earlier hearing healthcare with potentially fewer hospitalizations and improved quality of life," Zazove and colleagues conclude.

Funding for this study was provided through a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD). The authors and Shoup have reported no relevant financial relationships.

Ann Fam Med. 2020;18:520-527. Full text

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