The Patient Journey overview

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The Patient Journey - overview

• MHAS Training Team

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Patient journeys

• NEW PATIENT
• DR
• ENT
• REASSESSMENT (OLD) PATIENT
• REPAIRS

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DR Patient journey
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DR Patient journey
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Timings

• Timings are guide
• minimum, for straightforward patient,
• with PMS functioning
• and staff familiar with protocols
• Allow extra time while training

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Follow ups

• Follow-up 8-12 weeks
• Extra fine tune appointment required for some
  patients at 2-4 weeks

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Before Appt1

• Prioritise
• Patient demographics onto PMS
• Send info out
• Prepare patient for GHABP

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DR Appt1 - Assessment

• History
• TTSA
• Audiology
• PTA (AC/BC) Optional ULLs
• Lifestyle / holistic
• - GHABP Part 1
• - Attitude, Motivation Expectation
• -Counselling and Decisions

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History

• Standard form is on PMS
• TTSA criteria - does patient need referring for
  medical opinion?
• Review local protocol - ensure fast track into
  ENT for those who fail criteria

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Audiology

• PTA - AC/BC
• frequencies required by manuf
• BC not always taken into account by software
• ULLs optional

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Lifestyle

• GHABP - later talk
• Attitude Motivation Expectation
• IHR Family Benefit Profile

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• So what do my tests show then?
• But Im not deaf
• I can hear everything but I cant understand
• People mumble these days
• Ive been told a hearing aid wont help me
• Theyre big ugly things arent they?
• A digital aid will make me hear normally then?

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Attitude Motivation Expectation

• Attitude to hearing aids
• Motivation for coming to clinic
• Expectation of what aids will do
• AMEQ (as used in FirstWave) is optional - but it
  is in PMS

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Counselling - pre-fitting (Dillon 2000)

• Ensure patient understands nature of hearing
  loss, consequences, and treatment options
• Help patient acknowledge hearing loss, and
  working through any negative emotions that
  restrict enjoyment of life.
• Help patient overcome obstacles that discourage
  from engaging in rehabilitation

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Counselling-main elements

• Explanation of HL/ audiogram
• Assessment of attitude etc
• GHABP
• Counsel - discuss results, modify attitudes etc
• Agree that a hearing aid is appropriate
• FAQs on digital hearing aids

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Hearing loss audiogram

• Information about the hearing loss configuration,
  the influence that this has on speech
  discrimination, may be instrumental in people
  accepting that indeed they do have a hearing
  loss.

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Explanation of HL

• Location of loss, with reference to a suitable
  wall chart.
• Degree of loss, and configuration of loss, with
  reference to their audiogram, and prognosis.
• Disability - eg difficulty understanding speech
• Handicap - eg social withdrawal, family problems

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Putting it together

• Changing the attitude, motivation or expectation
  if these are negative, unrealistic, etc
• Using the information derived from tests and
  GHABP etc
• Discussion of the patients disability and
  handicap

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Between Appt 1 and Appt2

• Use GHABP to triage patients
• Identify difficult cases
• Referral to Hearing Therapy
• Earmould admin
• Immediately before appt,
• review GHABP
• ?program aids

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DR Appt2 - Fitting

• Fit earmoulds and aids, set up
• Verify using REM
• change aid settings if necessary
• Evaluate subjectively
• Instruct and Counsel
• Decision - need for earlier fine-tune/follow up?
• Admin on PMS

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Between Appt2 Appt3

• Refer to Volunteer/peer support service
• Graduated use programme

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DR Appt3 - Follow-up

• How are things going?
• Outcome measure - GHABP Part2
• Follow up on issues raised
• Use of different programs and T
• Fine tune / Counselling
• REM if necessary
• Plan/further appts?
• Admin on PMS

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Reassessment Patient journey
Appt1 - Re-assessment / fitting
Appt2 - Follow-up
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Reassessment Patient journey
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Before Appt1

• Patient demographics onto PMS
• New EMs (if necessary)
• Send/give info out
• Prepare patient for GHADiffP
• Immediately before appt,
• review GHABP (if available)
• program aids

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Reassessment Appt1 (1)

• History - new since last assessed
• Audiology
• Lifestyle
• Glasgow Hearing Aid Difference Profile Part1(old
  aids)

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Reassessment Appt1 (2)

• Fit set up aids
• Verify using REM
• Evaluate subjectively
• Instruct and Counsel

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GHADiffP

• Shorter and quicker for existing users
• Part 1 - Use and Residual Disability with current
  aids
• Part 2 - same with new aids, plus extra benefit
  and satisfaction with new aids compared to old.
• no unaided Disability or Handicap

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GHADiffP

• Use and Residual Disability for both old and new
  aids, but no absolute benefit and satisfaction
  (just relative).
• To get these absolute measures as a baseline
  assessment the GHABP could be done instead, or as
  well.

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Reassessment Appt2

• How are things going?
• Outcome measures -GHADiffP Part2 (new aids)
• Follow up on issues raised
• Fine tune / Counselling
• REM if necessary
• Plan/further appts?

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Repairs

• Aids need to be programmed for the individual,
  from PMS record
• Repairs take longer
• ?Are walk-in repair sessions feasible?
• ?special appointment sessions?

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Clinic changes

• Hearing aid patients coming via ENT require appt
  for assessment
• or booked slots with audiologist capacity on ENT

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Other stuff 1

• Encouraging attendance
• Discouraging requests for multiple repeat (fine
  tune) visits
• Beware PC as Significant Other Thing
• Use laminated guides

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