How Are We Recommending Hearing Aids to Patients - Do We Need to Rethink Our Approach?

Hearing aids come from manufacturers in many technology levels.

Often, manufacturers and professionals will divide the levels into three or four segments titled along the lines of:

Premium, Active, Value, Entry.

Platinum, Gold, Silver, Bronze.

Good, Better, Best.

A recent study* (2015) by William Demant's Oticon A/S sought to "gain insight into the decision making criteria utilized by professionals when recommending hearing instrument (HI) technology levels to hearing-impaired patients." as "no known studies define any audiometric or nonaudiometric parameters as being significant as as prefitting indicators determining patient outcome or satisfaction as a function of HI technology levels."

Receiving responses from 733 professionals across 4 countries (USA, Germany, France & Italy), the results demonstrated that recommendations were not being made based on objective criteria of performance but was predominantly being driven by the professional's perception of the patient's lifestyle (followed by speech discrimination).

"An active patient with poor speech discrimination had a 17% chance of being recommended the highest technology level. For a very active patient with good speech discrimination, the probability increased to 68%."

In an increasingly competitive landscape with big box retailers, manufacturer owned stores, Personal Sound Amplifiers (PSAPs) and an increasingly internet savvy baby-boomer patient population, simply recommending technology based on one's perception and possibly implicit bias of the patient (as well as the HI technology) may not be generating the best possible outcome for the patient and ultimately the professional.

So the question becomes, do we need to adjust our approach to presenting products to patients? Multiple objective tests, as well as subjective patient questionnaires exist that can be used to not just fit, but also validate performance of different technology levels. There is even technology available to professionals, such as Unitron's Flex, that can help demonstrate (and evaluate) different levels of technology to help determine the best solution for the patient through a singular Behind-the-Ear (BTE) device.

If a patient achieves a similar score on an objective measure, i.e. the QuickSIN and a subjective validation questionnaire, i.e. APHAB or COSI when demoing HI technology of different levels (i.e. Premium vs. Value), wouldn't that information be useful to both the professional and the patient?

Would it not also instill a sense of confidence in the patient, that the product they are getting is effective, as well as the best value, before they leave the office?

But does it sound time consuming?

It wouldn't take as long as one may think, and in the current dispensing model where comparative evaluations are not being conducted, how much time is being spent on trying to solve patient concerns after the fact? Whether, it is with a lower end technology that isn't meeting the demands of the patient, or the reverse, a buyer's remorse that has set in with the patient worried they overspent and didn't need the premium technology to maximize their performance.

If a patient has either one of those experiences, could it possibly cause doubt as to whether their experience in your office was the right one for them? Even if the patient decided to keep the devices despite that doubt, could that then cause them to not come back for the next pair? To not recommend a friend to your clinic?

According to the authors, This "recommendation paradigm" - "is deeply anchored in the mindset of the professional. The professional does not have an adequate evidence base on which to make the decision in the recommendation. This calls for a shift in the professional's technology level recommendation practice, from non-evidence based to a proven practice capable of maximizing patient outcome."

So, should we consider rethinking our approach to HI recommendations? It is not enough that we may need to be objectively programming, i.e. Real-Ear-Measures (REM) the technology for the patient, but also objectively comparing and subjectively validating different technology levels as well.

The authors leave us with this final thought:

"The psychological bias effect in decision making will always be at work in the human mind. But being aware of the existing schema in the meeting with the patient will impose for a new recommendation that is not based on psychological bias effects but on more objective data."

Our patients today are savvy consumers, and they are going to want service and technology on their own terms, not on terms imposed on them. How can we differentiate ourselves and demonstrate value? By showing our patients that we can objectively program, demonstrate, compare and validate the products available to them - and not just give a suggestive recommendation that is not based on evidence.

*Source: Case Factors Affecting Hearing Aid Recommendations by Hearing Care Professionals - Journal of the American Academy of Audiology/Volume 26, Number 3, 2015