Grutters Janneke P C, van der Horst Frans, Joore Manuela A, Verschuure Hans, Dreschler Wouter A, Anteunis Lucien J C
Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, AZ Maastricht, The Netherlands.
BMC Health Serv Res. 2007 Apr 19;7:57. doi: 10.1186/1472-6963-7-57.
Because of the increasing costs and anticipated shortage of Ear Nose and Throat (ENT) specialists in the care for hearing-impaired persons, an integrated care pathway that includes direct hearing aid provision was developed. While this direct pathway is still under investigation, in a survey we examined expectations and potential barriers and facilitators towards this direct pathway, of patients and professionals involved in the pathway.
Two study populations were assessed: members of the health professions involved in the care pathway for hearing-impaired persons (general practitioners (GPs), hearing aid dispensers, ENT-specialists and clinical audiologists) and persons with hearing complaints. We developed a comprehensive semi-structured questionnaire for the professionals, regarding expectations, barriers, facilitators and conditions for implementation. We developed two questionnaires for persons with hearing complaints, both regarding evaluations and preferences, and administered them after they had experienced two key elements of the direct pathway: the triage and the hearing aid fitting.
On average GPs and hearing aid dispensers had positive expectations towards the direct pathway, while ENT-specialists and clinical audiologists had negative expectations. Professionals stated both barriers and facilitators towards the direct pathway. Most professionals either supported implementation of the direct pathway, provided that a number of conditions were satisfied, or did not support implementation, unless roughly the same conditions were satisfied. Professionals generally agreed on which conditions need to be satisfied. Persons with hearing complaints evaluated the present referral pathway and the new direct pathway equally. Many, especially older, participants stated however that they would still visit the GP and ENT-specialist, even when this would not be necessary for reimbursement of the hearing aid, and found it important that the ENT-specialist or Audiological Centre evaluated their hearing aid.
This study identified professional concerns about the direct pathway for hearing-impaired persons. Gaps exist in expectations amongst professions. Also gaps exist between users of the pathway, especially between age groups and regions. Professionals are united in the conditions that need to be fulfilled for a successful implementation of the direct pathway. Implementation on a regional level is recommended to best satisfy these conditions.
由于护理听力受损者的耳鼻喉（ENT）专科医生成本不断增加且预计短缺，因此开发了一种包括直接提供助听器的综合护理途径。虽然这种直接途径仍在研究中，但在一项调查中，我们研究了参与该途径的患者和专业人员对这种直接途径的期望、潜在障碍和促进因素。
评估了两个研究群体：参与听力受损者护理途径的卫生专业人员（全科医生（GP）、助听器经销商、耳鼻喉专科医生和临床听力学家）以及有听力问题的人。我们针对专业人员制定了一份全面的半结构化问卷，内容涉及期望、障碍、促进因素和实施条件。我们为有听力问题的人制定了两份问卷，均涉及评估和偏好，并在他们体验了直接途径的两个关键环节：分诊和助听器验配之后进行发放。
平均而言，全科医生和助听器经销商对直接途径持积极期望，而耳鼻喉专科医生和临床听力学家持消极期望。专业人员指出了直接途径的障碍和促进因素。大多数专业人员要么支持直接途径的实施，前提是满足一些条件，要么不支持实施，除非满足大致相同的条件。专业人员普遍就需要满足哪些条件达成了一致。有听力问题的人对当前的转诊途径和新的直接途径评价相当。然而，许多人，尤其是老年人表示，即使助听器报销不需要，他们仍会去看全科医生和耳鼻喉专科医生，并且认为耳鼻喉专科医生或听力中心对他们的助听器进行评估很重要。
本研究确定了专业人员对听力受损者直接途径的担忧。不同专业之间在期望上存在差距。该途径的使用者之间也存在差距，尤其是年龄组和地区之间。专业人员在直接途径成功实施所需满足的条件上达成了一致。建议在区域层面实施以最好地满足这些条件。
