Routine Hearing Screening for Older Adults in Primary Care: Insights of Patients and Clinic Personnel.

ABSTRACT

BACKGROUND AND OBJECTIVES: 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 attitudes and insights of patients and primary care clinic personnel relative to routinization of hearing screening in primary care for older adults. RESEARCH DESIGN AND METHODS: Data presented are from the qualitative portion of a larger study. The main study compared screening completion for three approaches to coordinating telephone-based hearing screening with primary care - one offering hearing screening within the primary care encounter and two providing information for at-home screening (one with and one without provider encouragement). Focus groups/interviews were conducted with personnel (n=38) at the six 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. RESULTS: Most patients had unaddressed hearing concerns prior to the study. Negative attitudes towards 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. DISCUSSION AND IMPLICATIONS 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.