Title: Hearing health information from primary care data: how to capture hearing aid uptake
Funder: Department of Health and Social Care

Abstract: BACKGROUND: To improve outcomes and reduce health inequalities, we propose a unique and comprehensive NHS telehealth program grant to evaluate case finding of adult hearing loss in primary care via online assessment with remotely delivered intervention. Our application embraces the NHS long-term plan by using: digital solutions, innovations, technology supported self-management, and remote care to better support people with long-term conditions. To conduct the planned evaluation of this intervention, a reliable measure of hearing aid (HA) uptake is required that can be used at primary care level. Although primary care data can index treatment uptake for many health conditions, coding of hearing loss and hearing loss treatments is variable. NHS HA services communicate with referring GPs and Clinical Commissioning Groups (CCG) through letters or bills of service, respectively, but no communication or coding standards exist. AIM: To identify and evaluate candidate measures of HA uptake in an adult primary care population, based on routine clinical data, to inform development of an efficient and inexpensive long-term outcome measure for clinical trials. OBJECTIVES: Audit recording of HA provision in primary care against NHS HA service records to characterise how HA uptake is communicated, coded, and billed. Determine sensitivity of primary care records and CCG billing at identifying first HA provision. Identify what information is required by GPs, what HA services can provide, and barriers/facilitators to communication between HA services and primary care. Develop, implement, and evaluate a primary care coding scheme for first-time HA provision. METHODS: We will audit primary care coding and CCG billing data to identify first time adult HA recipients across NHS HA services (NHS Trusts and Any Qualified Provider) and trace these cases to the relevant primary care provider in order to characterise communication of HA provision (objective 1&2). We will interview audiologists and GPs to determine: (i) what information GPs want from HA services; (ii) what constraints/facilitators there are for coding information; (iii) what information HA services can provide; and (iv) what constraints/facilitators there are on providing that information to GPs (objective 3). This work will inform development of a communication strategy from HA services to primary care and a coding scheme for HA fittings. We will implement the coding scheme and evaluate the degree to which first-time HA fittings are captured in GP records over 3-months post-implementation in a sample of 6 practices in two geographic areas (North West and London), varying in size and deprivation. Implementation and access to routine data will be facilitated by tools developed by PRIMIS (primary care health informatics: https://www.nottingham.ac.uk/primis/) (objective 4). TIMELINES: Audit and interviews will run concurrently in the first 6 months of the project; development and implementation of the coding scheme in the final 6 months. IMPACT AND DISSEMINATION: Developing reliable communication and overcoming barriers to coding of HA uptake information in primary care will: i) facilitate indices for future trials to improve hearing health and, ii) promote good communication and record keeping between primary care and HA services, enabling better clinical outcomes for people with hearing loss.

Lay abstract: Aims To ensure GP medical records can be used reliably to identify people who are prescribed NHS hearing aids. Background Hearing aids have a positive effect on everyday life for people with hearing loss. People often wait 10 years before requesting hearing aids and most people who could benefit don t request them. We want to promote uptake of hearing aids and encourage people to request them earlier in life. To do this, we wish to develop an on-line hearing check and provide easier ways for people to access hearing aids. In order to test if the hearing check increases the uptake of hearing aids, we need a reliable way of recording who is prescribed hearing aids using data from patients medical records. An extra benefit of improving how hearing aid prescriptions are recorded is that it will promote better communication between local doctors and audiology services, and improve their record keeping related to hearing aids. Development work plan We will check what information GPs (and those responsible for funding NHS health care) currently hold on who is prescribed hearing aids and compare this to the records kept by NHS hearing aid providers. This will help us decide how best to record hearing aid uptake in patients medical records. We will speak to GPs and NHS hearing aid providers and find the best way to improve communication and record keeping between them. We will develop a reliable method of recording hearing aid provision in GP patient medical records, and test that this is a good way to measure uptake of new hearing aid fittings by comparing the results with hearing aid clinic records. Patient and public involvement Patient/public representatives from Action on Hearing Loss (the largest UK hearing loss charity) and a service user are co-applicants on this development project and part of the project management group, giving oversight of project management, analyses and reporting. Dissemination and anticipated outcomes Finding a reliable measure of hearing aid uptake and, if necessary, improving record keeping by GPs and NHS hearing aid providers will help scientists carry out research aiming to improve mental, physical and social health for people with hearing loss. It will also enable better clinical care by making sure that information about hearing aid fitting is communicated reliably between NHS hearing aid providers and GPs. Our professional links will enable us easily to pass information about outcomes through the Royal College of GPs and the British Academy of Audiology s educational materials and literature. In a future project, we will use the measures of hearing aid uptake developed in this project to measure the impact of an on-line hearing check on the numbers of people getting help for hearing loss.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: EAR