Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Gerontologist. 2024 Oct 1;64(10). doi: 10.1093/geront/gnae107.
Hearing loss frequently goes undiagnosed and untreated, with serious sequelae. Hearing screening facilitates diagnosis and treatment but is not routinely conducted in primary care. This study addresses the attitudes and insights of patients and primary care clinic personnel relative to the routinization of hearing screening in primary care for older adults.
Data presented are from the qualitative portion of a larger study. The main study compared screening completion for 3 approaches to coordinating telephone-based hearing screening with primary care-1 offering hearing screening within the primary care encounter and 2 providing information for at-home screening ( 1 with and 1 without provider encouragement). Focus groups/interviews were conducted with personnel (n = 38) at the 6 participating clinics, patients who completed screening and were referred for diagnosis (n = 14), and patients who did not complete screening (n = 10). Analysis used the general inductive approach.
Most patients had unaddressed hearing concerns prior to the study. Negative attitudes toward hearing loss/treatment were common, and experiences of family and friends influenced attitudes, but lack of urgency was the primary barrier to screening completion. Respondents favored routine primary care-based hearing screening for older adults, but clinic personnel noted challenges of time, space, workflow, and reimbursement.
Findings favor greater routinization of hearing screening in primary care. Routinization will be enhanced by improved reimbursement for screening and follow-up; specialist engagement with primary care and the public (including leveraging older adults' social networks); and further research on specific integration options.
听力损失常常未经诊断和治疗，会带来严重后果。听力筛查有助于诊断和治疗，但在初级保健中并未常规进行。本研究探讨了患者和初级保健诊所人员对将老年人的听力筛查常规化的态度和看法。
本研究呈现的数据来自一项更大规模研究的定性部分。主要研究比较了 3 种方法在协调基于电话的听力筛查与初级保健方面的完成情况，这 3 种方法分别为：1. 在初级保健就诊期间提供听力筛查；2. 提供家庭听力筛查信息（1 种提供，1 种不提供提供者鼓励）。对参与的 6 家诊所的人员（n=38）、完成筛查并转介进行诊断的患者（n=14）和未完成筛查的患者（n=10）进行了焦点小组/访谈。分析采用一般归纳方法。
大多数患者在研究之前都有未解决的听力问题。对听力损失/治疗的负面态度很常见，并且亲友的经历会影响态度，但缺乏紧迫感是筛查完成的主要障碍。受访者赞成为老年人在初级保健中常规进行听力筛查，但诊所人员指出时间、空间、工作流程和报销方面存在挑战。
研究结果支持在初级保健中更常规地进行听力筛查。通过改善对筛查和随访的报销、专家与初级保健和公众的参与（包括利用老年人的社交网络）以及对特定整合方案的进一步研究，可以更好地实现常规化。
