Effectiveness of group versus individual hearing aid visits.

INTRODUCTION Nearly 414,000 veterans had a service-related disability through the Department of Veterans Affairs (VA) for defective hearing in 2005, making hearing impairment the most common disability in veterans [1]. The Veterans' Health Care Eligibility Reform Act of 1996 (Public Law 104-262) and the Veterans Health Administration Directive 96-069 greatly expanded the number of veterans eligible for VA-issued hearing aids. More eligible veterans combined with the aging veteran population have increased the demand for hearing aid services in the VA by more than 300 percent from 1996 to 2005 [2]. Implementing approaches that provide more efficient treatment without compromising quality of care has become a focus of the VA through a program called "Advanced Clinical Access" (ACA) [3]. One of the components of ACA is to increase clinical capacity by offering group visits that allow more patients to be seen with the same amount of resources as traditional one-on-one encounters. Audiological rehabilitation visits aimed at teaching new hearing aid wearers how to use their hearing aids effectively may be appropriate for a group format because they contain standardized information and common discussion themes that are relevant to all new patients. However, before they could be recommended for routine care, showing that group visits do not lead to worse outcomes would be critical. National organizations such as the Hearing Loss Association of America (HLAA) recognize the potential value of group visits [4]. The HLAA recommends that all hearing aid wearers have the opportunity to participate in group hearing aid orientation classes because of the potential benefits from shared information and support with other hearing aid wearers. A number of VA audiology programs have started offering group hearing aid fitting and/or follow-up appointments. While a number of studies suggest that group aural rehabilitation visits can produce equivalent or better patient outcomes when offered as a supplement to standard care [5-19], only limited observational evidence suggests that group follow-up visits yield hearing aid patient outcomes (e.g., hearing handicap, satisfaction, adherence) that are at least as good as individual visits [20]. No studies have been published that compare group and individual hearing aid fitting visits. If evidence indicates that group hearing aid visits do not worsen outcomes, then group visits might reduce the strain on VA resources and waiting times while maintaining care for more veterans. This investigation gained more insight into whether group hearing aid fitting and follow-up visits yielded patient outcomes similar to or better than individual visits. We hypothesized that group visits would yield equivalent or improved patient outcomes when compared with individual visits. METHODS We conducted a retrospective chart review to compare hearing aid outcomes for new hearing aid patients who received group hearing aid fitting and follow-up visits with those who received individual fitting and follow-up visits at the VA Puget Sound Health Care System (VAPSHCS) between September 2004 and March 2005. We chose this time frame because group visits were being offered concurrently with individual visits, which permitted comparisons with a concurrent control group. The University of Washington Institutional Review Board and the Research and Development Review Committee at the VAPSHCS approved all procedures. Before the introduction of digital technology at the VAPSHCS, group hearing aid visits were routinely offered. Group visits were discontinued during the transition to digitally programmable technology in the late 1990s because of the increased complexity of hearing aid programming and varying wearer options (e.g., multimemories with or without memory button, directional microphone, remote control, and switchless telecoil). As audiologists learned the technology, fitting practices became more standardized, but wearer options varied more between patients than with former conventional circuits. …