Establishing eligibility criteria for the provision of hearing aids in the Hearing Services Program
Project Goals
When a person has difficulty hearing, a hearing provider must decide whether they will benefit from hearing aids. Often, this is done by measuring the softest sounds that they can hear. The louder that the person needs the sounds to be before they can hear them, the more hearing loss they are said to have. In the Australian Government’s Hearing Services Program, if the person has less than a threshold amount of hearing loss, they can not receive hearing aids through the Program.
However, how much hearing loss someone has is not a good predictor of how well they will do with hearing aids. This project used a variety of methods to develop a new way of deciding who is most likely to benefit from hearing aids.
The specific aims of this project were:
1. To talk to people delivering and receiving hearing care in Australia and understand problems that they may have with the threshold used in the Hearing Services Program.
2. To look at existing data to see what predicts people doing well with hearing aids.
3. To collect information from people who have had their hearing checked, including people receiving hearing aids, and use this information to develop new criteria to identify who will do the best with hearing aids.
4. To assess whether this new way is likely to be cost-effective.
Results
Clinicians, managers of hearing services, and advocates for people with hearing difficulty joined us for interviews, a survey, and an online workshop. Many of them said that having clear ways of deciding who should get hearing aids was a good thing, but that they were worried about how these considerations might change the ways that clinicians think and act. They had mixed feelings about the threshold currently used, but most believed that it did not help Australians with hearing difficulty get positive hearing outcomes. They also told us about a range of different things that might be used in the future to better identify people who would benefit from hearing aids.
Three existing data sets were collected from hearing clinics in Australia and the United Kingdom and from a large Australian hearing research study. The kinds of information that was in these data sets could not predict whether people did well with hearing aids. This suggests that hearing clinics and researchers are not collecting the right kinds of data to predict whether patients are likely to be helped by hearing aids. The current criteria of hearing sensitivity for assessing who should be fit with hearing aids is a poor predictor of hearing aid use and benefit, therefore the audiogram alone is unlikely to be the best measure to identify who should get hearing aids in terms of patient benefit. Instead, eligibility criteria that include other measures such as self-reported hearing disability, readiness to wear hearing aids, expectations, and individual needs has the potential to better identify those who would benefit from and use hearing aids in the HSP, and thereby improve hearing outcomes from the program.
More than 1900 people, including more than 850 people receiving hearing aids, answered a series of questionnaires about their hearing and their lives in general. Things that helped predict the benefit of hearing aid fitting included how isolated people felt from their friends and family as a result of their hearing difficulty, the number of different kinds of listening situations that they found themselves in, how tired listening made them feel, and how much difficulty they felt they had hearing in their everyday lives.
Furthering impact
The results of this study were used to develop new criteria, which much better-identified people who were likely to benefit from receiving hearing aids and were likely to cost less than the current threshold. Further work aimed to develop a robust, evidence-based, and clinically practicable method of determining which older adults should be fit with hearing aids.
