Examining the Impact of Physician Influence on Hearing Aid User Satisfaction and Retention

Description of study design This study seeks to determine if additional patient benefit is derived from involving the referring physician in the hearing aid fitting process using the Client Oriented Scale of Improvement (COSI) process. The COSI process is a well-known methodology that consists of two consecutive phases: Phase I is completed by the client with the Audiologist either at the time of initial hearing aid fitting or within 21 days thereafter. The patient is asked to list any specific listening environment/situations in which he/she would like to improve his/her hearing with the assistance of wearing hearing aids; Phase II occurs within days 22 to 76 from the day the hearing aid device is fitted and is also normally completed by the patient and the Audiologist. In this phase, the patient indicates any degree of change in the specific listening environment/situations he/she had previously listed (wearing the hearing aid).

Two methods will be used for study purposes to assess patient satisfaction with hearing aid use 77 to 90 days post fitting: (1) the validated SADL questionnaire described previously will be completed by the patient and (2) the number of hearing aids returned up to 90 days post initial fitting will be recorded.

The study will consist of two groups: a control group and a test group. Both groups will undergo Phase I of the COSI process with the fitting Audiologist. Patients in the control group will undergo Phase II of the COSI process as part of their follow up with the audiologist, whereas those in the test group will complete Phase II of the COSI process in a scheduled visit with their referring physician before further follow-up with the audiologist. Participants will be recruited from the investigating audiologists' clinics in Vancouver. The study involvement time for each participant will extend over a period of 90 days.

Routine Clinical Practice A complete hearing aid fitting takes place over the course of several clinic visits each on average 30-45 minutes in duration. These include the initial hearing test and consultation, actual fitting, and any subsequent post-fitting adjustments. During hearing evaluation and post-fitting follow-up sessions, a COSI questionnaire is used by audiologists as part of routine clinical practice to guide optimal hearing aid adjustment to meet the patient's listening needs.

Time schedule The time taken to fit a hearing aid varies depending on the needs of the patient. Very often clients over the age of 55 have problems with dexterity, memory and other health impairments that extend the length of individual consultations. Some patients require more clinic consultations than others. Anecdotally it is estimated that the maximal number of visits required to complete the hearing aid fitting process is 10 visits over 90 days. These visits on average will be of 30 minutes in duration except for the initial and final visits which lasts for 45 minutes. A patient will spend a maximum of 330 minutes to complete the hearing aid fitting process of which 25 minutes will be related to study specific procedures.