Patient-Centered Care Flashcards
Is the prevalence of ear disease and/or hearing loss highest in the adult population?
Yes
Middle ear disease is most prevalent b/w ages 0-6
Presbycusis, NIHL, SNHL is most prevalent at ages 70+
As more sophisticated technology was developed, did patient satisfaction and the percentage of people wearing amplification increase?
No
Is cost the only reason that people are not getting hearing aids?
No
Adoption rates of hearing aids are still far below 100% even in countries that do not charge for amplification
Do people with hearing loss tend to wait a few years before discussing it with their PCP?
Yes
What are some client related barriers as to why a person is not moving forward with amplification?
Self-image (vanity, pride, denial)
Underestimated importance of hearing health (linked with cognitive decline, communication problems, increased risk of falling, social isolation, depression, and anxiety)
Financial limitations (3rd largest material purchase behind a house and car)
Limited access to healthcare which delays treatment
Unrealistic expectations and lack of knowledge on how to achieve success
Motivation
Are there social barriers at play?
Yes
Including attitudes of immediate family members (individualism vs collectivism)
Attitudes of friends
Cultural norms, practices, and ideologies (familism - obligation, the family’s needs are more important than mine; stigmatism - reflects negatively on me as a person)
Are low adoption rates due to barriers created by medical professionals?
Yes
Physicians place a barrier because they don’t always refer them on
Say “you seem fine to me”
Do audiologists create barriers for patients?
Clinical setting barriers (parking, office convenience, appearance of office)
Quality of experience (ease of making appointment, staff knowledge, wait time, perceived priorities of the staff)
Communication mismatch between patient and audiologist (offers informational counseling when personal adjustment counseling is needed, investigate activity limitations and participation restrictions)
Technocentric barriers (offers only product-based solutions)
Focus on high-end tech options and ignores more affordable options
Does not offer easy to use or non-amplification options
What do audiologists tend to lack awareness of?
The negative synergies associated with dual sensory loss (combination of these losses show an exacerbated impact on their lives)
The impact of comorbidities on loss
The increase of falls risk in the hearing-impaired populations
What are barriers related to cultural responsiveness?
Providers lack cultural competence (they learn about cultural differences only after the patient arrives)
Relies on family and friends to interpret rather than hiring a professional
Provider doesn’t recognize that most communication is managed differently outside of the US (family or community decision making, whatsapp)
Provider marketing material images aren’t culturally representative (older adults playing dominoes instead of cards)
Provider doesn’t minimize healthcare disparity by offering a variety of affordable options
Does research show that patients prefer a person-centered communication style?
Yes, 69% do
Rather than a direct, biomedical style
Do many audiologists make excuses for their lack of adherence to best practices?
Yes
Patient-centered care requires us to let go of what we think is patient-centered care
To change our behavior, we need to spend time learning patient’s perspectives
What are elements of patient-centered care?
Listen to & respect patient’s perspective and values
Involve the family
Reinforce shared decisions
Prioritize free flow of information and dialogue
Demonstrate empathy and understanding of patient’s point of view
Does whole-person healthcare require multi-dimensional, multi-systemic, and collaborative care coordination?
Yes
Why do we need to partner with our patients?
Each person’s hearing-loss journey is unique (one-size-fits-all approaches don’t work)
Recommendations focusing on what’s important to the patient increases satisfaction and improve compliance
Investigate the patient’s hearing-loss journey to better understand what is most critical to their well-being
Allow patient to partner in creating the treatment plan to increase motivation & compliance
How do you make your office hearing loss friendlu?
Train staff to use best communication practices at check-in, at check-out, and over the phone
Plan for receptionist personally alert patient when it is time to be seen to reduce worrying that they won’t hear their name called
Keep pocket-talkers, speech to text apps, or other assistive-listening devices on hand
Provide a written summary of the visit to reduce follow-up calls for clarification and to help the patient’s family stay informed.
Create a well-lit and quiet office space to promote a better hearing environment
What are some things to provide for patients in the waiting room?
Share relevant literature and brochures for local hearing-loss support groups
Enable TV w/ captions, display caption telephones, HAT, working telecoil induction loop (and use it!)
Provide information on resources: HLAA publications and communication tips, Office of Vocational Rehabilitation resources, mental health support
What are some ways to practice differently?
Communication strategy training: Teach patients and their families beter communication methods
Promote self-advocacy skills so patients learn to ask for the assistance they need
Recommend audiologic rehab group support so they’ll meet others dealing with similar challenges
Recommend speech perception training to practice hearing in difficult listening environments & improve their speech recognition.
Start with HAT, or OTC options
Unbundling fees to help patients understand the value of our time (shifts from selling to solutions)
Demonstrate value by providing a broader scope of services (group AR, speech perception training, communication strategy training, and educate about accommodations and encourage their use)
How can you involve the family?
Invite families to attend and participate in the appointment
Set up the consultation room so families can fit comfortably
Let families know that you’ll be seeking input from them too
Engage the family and patient in shared decision-making during treatment plan development
Present options to support the goals of both the patient and family
Measure outcome effectiveness from both the patient and family’s perspective
What is involved in the patient-centered care model?
Conduct a Communication needs assessment (objective assessment (LDL, QuickSIN, ANL) and subjective assessment (self-report questionnaires, and use of COSI)
Individualized audiologic rehabilitation plan specifies:
Amplification & HAT
Perceptual training
Communication strategies
Communication behaviors
What is involved in the family-centered care model?
Communication partner (CP) self-report questionnaires (significant other assessment of communication, significant other scale of hearing disability, and significant other profile)
Inclusion in the AR plan:
Understanding of hearing loss impact
Opportunities to participate in goal development
Incorporating the CP’s needs into rehabilitation goals
Was personal adjustment counseling supposed to be an add on service?
No
Helping patients and families face their fears, doubts, and embarrassment
The audiologist’s scope of practice includes a direct exploration of personal needs to prepare them to accept solutions
What does ASHA define the scope of AR as?
Developing and implementing an AR plan of care in collaboration with the person receiving services as well as with family/significant others and other professionals (e.g., physicians, SLPs)
Providing information and training in the areas of listening skills and communication strategies; managing the listening environment; communication with significant others; strategies for addressing quality of life; hearing protection/noise hazards; and self-advocacy
Providing referrals to other appropriate professionals to ensure access to comprehensive services
Providing information about local and national consumer resources
Whenever there is anxiety, is there a lack of trust?
Yes
Start by finding out the problem and how to develop trust
This leads to a natural reduction in anxiety, distress, questions, etc.
What is a decision aid?
An organizational tool designed to systematically review a set of treatment options
The tool reviews all options facilitating conversations with the patient to help them decide on which treatment options they will begin
