Hearing referrals squeezed by limited consult times

A lack of consultation time and the cost of hearing interventions are key factors in the low rate of GP referrals to audiologists, new research suggests.
 
In the study published this week in the Australian Journal of Primary Health, researchers asked more than 100 GPs about the ‘enablers and barriers’ for audiology referrals among older adults.
 
‘Despite the proven efficacy of hearing interventions such as hearing aids’, hearing loss is ‘under diagnosed and under treated’ in older adults, the authors write.
 
They cite research indicating almost one in three adults who have noticed difficulty hearing have not consulted a clinician about the issue, while 28% of them have not had any kind of hearing test.
 
Limited time is a key factor almost half of the GPs surveyed suggest, with 48.5% disagreeing with a statement that there is enough time to discuss hearing during a standard clinical appointment.
 
For Associate Professor Caroline Johnson, a GP and academic specialist at the University of Melbourne’s Department of General Practice and Primary Care, the finding raises a familiar concern.
 
‘It certainly aligns with the college’s calls for better funding for longer consultations, which was a big part of the conversation recently around bulk-billing incentives,’ she told newsGP.
 
‘To raise something that a person might not necessarily have planned to talk about when you’re in a time-limited situation and you’re being paid to be efficient and have high throughput is probably going to be a challenge.’
 
She also said that without a mandated need for a referral to see an audiologist, GPs could still be recommending audiology without specifically writing a referral.
 
The authors, who cite historical research suggesting 0.3% of GP consultations with adults aged 50 and over involve managing a hearing condition, found cost was also frequently raised as an issue.
 
‘Hearing aids are very expensive for people, so often I feel what difference will it make if they cannot afford aids,’ one GP respondent said.
 
Associate Professor Johnson believes some GPs may find more information about identifying the best place for referrals useful.
 
‘The audiology space is a very confusing space, because there are a lot of commercial interests happening there,’ she said.
 
‘We all hear stories from our patients about having spent 1000s and 1000s of dollars on something without it really seeming to have helped, and that makes us cautious about sending other people down that path.
 
‘Because I’ve been lucky enough to be in one area for a long time, I have some audiologists that I know well and trust, who won’t sell my patients stuff that they don’t actually need.’
 
More than 80% of GPs who participated in the study agreed older patients had concerns about the stigma of hearing loss and hearing aids, while a significant minority (41%) said most patients would initiate a discussion if they had concerns about their hearing.
 
The study also found less than one-third of respondents had used a screening tool for hearing loss to shape their referral decisions.
 
Associate Professor Johnson, however, points out that the preventive healthcare guidelines in the RACGP’s Red Book do not recommend screening for hearing loss in asymptomatic older adults.
 
In recent years, hearing impairment has been listed among the potentially modifiable risk factors cited by The Lancet for dementia – although the Red Book currently states there is ‘insufficient evidence’ to recommend hearing aids for cutting dementia risk.
 
But for Associate Professor Johnson, there is value in highlighting hearing impairment as a risk factor to patients.
 
‘Hearing is one of those ones that’s not as well known in the general public,’ she said.
 
‘People know that you should avoid alcohol and control your cardiovascular risk factors. I think people could be made more aware of the benefits of good hearing as well.’
 
Authors of the study say their questionnaire covered 25 themes relating to GP audiology referrals, with eight not previously reported in the existing body of literature.
 
They write that it ‘lays the groundwork for further intervention-focused research aimed at increasing the number of referrals from general practice to audiology’.

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