Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
BMC Health Serv Res. 2023 Aug 30;23(1):929. doi: 10.1186/s12913-023-09900-y.
Hearing loss can have a negative impact on individuals' health and engagement with social activities. Integrated approaches that tackle barriers and social outcomes could mitigate some of these effects for cochlear implants (CI) users. This review aims to synthesise the evidence of the impact of a CI on adults' health service utilisation and social outcomes.
Five databases (MEDLINE, Scopus, ERIC, CINAHL and PsychINFO) were searched from 1st January 2000 to 16 January 2023 and May 2023. Articles that reported on health service utilisation or social outcomes post-CI in adults aged ≥ 18 years were included. Health service utilisation includes hospital admissions, emergency department (ED) presentations, general practitioner (GP) visits, CI revision surgery and pharmaceutical use. Social outcomes include education, autonomy, social participation, training, disability, social housing, social welfare benefits, occupation, employment, income level, anxiety, depression, quality of life (QoL), communication and cognition. Searched articles were screened in two stages ̶̶̶ by going through the title and abstract then full text. Information extracted from the included studies was narratively synthesised.
There were 44 studies included in this review, with 20 (45.5%) cohort studies, 18 (40.9%) cross-sectional and six (13.6%) qualitative studies. Nine studies (20.5%) reported on health service utilisation and 35 (79.5%) on social outcomes. Five out of nine studies showed benefits of CI in improving adults' health service utilisation including reduced use of prescription medication, reduced number of surgical and audiological visits. Most of the studies 27 (77.1%) revealed improvements for at least one social outcome, such as work or employment 18 (85.7%), social participation 14 (93.3%), autonomy 8 (88.9%), education (all nine studies), perceived hearing disability (five out of six studies) and income (all three studies) post-CI. None of the included studies had a low risk of bias.
This review identified beneficial impacts of CI in improving adults' health service utilisation and social outcomes. Improvement in hearing enhanced social interactions and working lives. There is a need for large scale, well-designed epidemiological studies examining health and social outcomes post-CI.
听力损失会对个人的健康和参与社会活动产生负面影响。采用综合方法解决障碍和社会问题，可以减轻部分耳蜗植入（CI）使用者的这些影响。本综述旨在综合评估 CI 对成年人的健康服务利用和社会结果的影响。
从 2000 年 1 月 1 日至 2023 年 1 月 16 日和 2023 年 5 月，在 MEDLINE、Scopus、ERIC、CINAHL 和 PsychINFO 五个数据库中进行了检索。纳入了报道成年人 CI 后健康服务利用或社会结果的文章。健康服务利用包括住院、急诊（ED）就诊、全科医生（GP）就诊、CI 修正手术和药物使用。社会结果包括教育、自主、社会参与、培训、残疾、社会住房、社会福利、职业、就业、收入水平、焦虑、抑郁、生活质量（QoL）、沟通和认知。检索到的文章经过标题和摘要筛选以及全文筛选两个阶段进行筛选。从纳入的研究中提取信息并进行叙述性综合。
本综述共纳入 44 项研究，其中 20 项（45.5%）为队列研究，18 项（40.9%）为横断面研究，6 项（13.6%）为定性研究。9 项研究（20.5%）报告了健康服务利用情况，35 项研究（79.5%）报告了社会结果。9 项研究中有 5 项研究显示 CI 改善了成年人的健康服务利用，包括减少处方药物的使用和减少手术和听力学就诊次数。大多数研究（77.1%）显示至少有一个社会结果得到改善，如工作或就业 18 项（85.7%）、社会参与 14 项（93.3%）、自主 8 项（88.9%）、教育（9 项研究全部）、感知听力障碍（6 项研究中有 5 项）和收入（3 项研究全部）。纳入的研究均无低偏倚风险。
本综述确定了 CI 在改善成年人健康服务利用和社会结果方面的有益影响。听力改善增强了社会互动和工作生活。需要进行大规模、设计良好的流行病学研究，以评估 CI 后的健康和社会结果。
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