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95% Of Patients Could Benefit From Remote Care - An interview with Dr. De Wet Swanepoel

May 23, 2021
Blake Cadwell
Written by
Blake Cadwell
Blake Cadwell

Blake Cadwell is a hearing aid wearer and co-founder at Soundly. He regularly tests and reviews hearing technology to share his experience with Soundly’s readers. Blake's research and perspectives have been featured in the The New York Times, Washington Post, LA Times, AARP and FastCompany.

Soundly Staff
Reviewed by
Soundly Staff
Soundly Staff
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In 2020, telehealth went from an industry side project to an exploding category expected to grow from 3 billion dollars to 250 billion dollars. According to research from McKinsey, 76% of patients now say they want to continue to receive remote care. This seismic shift in behavior has already significantly impacted hearing healthcare.

Last week I interviewed Dr. Laurel Christensen, the Chief Audiologist at GN hearing (makers of ReSound and Beltone hearing aids). Today I’m continuing the series with Dr. De Wet Swanepoel of hearX Group and Lexie Hearing.

Dr. De Wet is a leading thinker in remote hearing care and is one of the key players behind the quickly growing Lexie Hearing brand. Read my full review of Lexie Hearing Aids here (spoiler: I was very impressed).

Dr. De Wet shares some great perspective and stats throughout the conversation and I found his focus on patient centered care particularly helpful.

Let’s get into it!

Q: Telehealth is the buzzword of the day. Do you think it has a long-term place within audiological care, or is this a trend that will fade post-pandemic?

Teleaudiology was largely a matter of convenience and personal preference (for patients and professionals) prior to COVID. During the pandemic it was rapidly escalated as a matter of safety first and foremost.

Advances in teleaudiology were evident in rapid deployment and upgrades to remote care apps for hearing aid fine-tuning, counselling and even in-situ audiometry. Changes like these became essential to continue some level of care for existing patients. At the same time developments to assess new patients using self test kits with tele-audiology functionality became available and incorporated into curb-side, counter-side and home-based models of care.

Also new ways to triage patients in these low- and no-touch models of care where bone-conduction testing may not be possible emerged relying simply on rapid air conduction assessments outside a booth. Furthermore, audiologists turned to online hearing screening to reach new patients with rapid, validated tools that are proven to generate referrals.

Adapting to consumer trends and innovating the way care is provided will be essential for hearing health care professionals preparing for the future.

Will it have a long term-place? Absolutely, But so will in person care. There is a need for value-based, cost-effective hybrid models combining face-to-face and online or remote care options across the patient journey.

Q: What are some of the upsides and drawbacks to remote audiological care?

Clear upsides include convenience and that patients can consult a professional from the comfort and safety of their own home, especially during COVID times. There is less time wasted stuck in traffic or sitting in waiting rooms, with the added benefit of associated cost savings.

However, the drawback is that remote care can never replace the personal interaction with a face-to-face session. In addition, there are still some limits to what remote test technologies can do; with particular gaps in bone conduction testing and real-ear measurements. The question however becomes, who needs which services?

Traditional audiological test-batteries have typically remained the same for adults over the past 70 years (Hall, 2021). We must reassess how we select diagnostic and treatment pathways based on patient profiles and needs.

Q: Do you see tech adoption holding back telehealth?

We recently demonstrated (Ratanjee-Vanmali, Swanepoel and Laplante-Lévesque, 2020) that digital proficiency is not necessarily a predictor for acquiring hearing services through a hybrid online and face-to-face hearing care model. These hybrid care models could allow hearing healthcare professionals to assist patients in using both face-to-face and online services tailored to meet individual needs, including convenience and personalized care.

In addition, people across the globe - regardless of age - have had to reassess the way they approach their health needs, shopping and lifestyle in general, as lockdowns and health risks have become part of our daily lives. Being forced to stay home has been forcing people to find alternative ways through technology to connect with the world and their loved ones.

The average customer of Audiologists is 72 years of age, and might not feel comfortable returning to face-to-face consultations as they did pre-COVID-19. As they’ve become familiar with using technology in other elements of their lives, they can use the same tools, such as Zoom or Google Meet video calling, for their hearing healthcare, from the comfort of their own home.

Q: The industry seems to embrace remote care for follow-up appointments, but many less mobile or rural patients have difficulty attending an initial in-person appointment. Is there a place for entirely remote care in the future?

Up to more than 95 percent of adults with hearing loss could be served using alternative low- or no-touch models of audiological care. Recent data from the Global Burden of Disease study (Lancet, 2021) suggest that for older adults more than 95% of losses are age related.

Sensorineural hearing loss due to age is the number one cause of hearing loss globally and does not necessarily require the infrastructure (e.g. sound booth facilities) and resources (advanced audiometric equipment) necessary to diagnose conductive hearing loss and ear disease.

A differentiated approach supported by reliable ways to triage patients, like with the hearX Self Test Kit, can ensure more directed care where large proportions could be served in low- and even no-touch models.

If a risk is detected for conductive hearing loss or ear disease, this small sub-group of patients can then be directed to high-touch audiology service. Technologies are increasingly enabling these types of differentiation in remote ways. More implementation science work on what the success factors are within varying contexts will be critical to move this forward.

Q: What are some of the challenges that completely remote care pose for patients and audiologists?

We’ve also mentioned in Swanepoel & Hall (2020), that the challenge in using remote care options is differentiating the small group of patients who require traditional clinic-based services ( such as suspected ear disease or conductive hearing loss cases), from those with sensorineural hearing loss who are likely candidates for hearing aids.

In addition, remote care cannot replace that human connection and relationship building that are usually established through face-to-face interaction between people. Integrated video call functionality to connect healthcare professionals and patients can potentially ensure a better human connection close to face-to-face experiences. If easily accessible through apps, this can be used seamlessly with products.

Q: How should audiologists and patients begin preparing for more remote care in the future?

We’ve also previously discussed (De Wet Swanepoel, Ph.D. in HHTM) the following practical pointers for hearing health professionals, considering these ongoing trends:

Harness the power of digital health solutions, like the examples mentioned above, to expand service-delivery options and reach. Make this an integrated part of your growth strategy.

Broaden your patient engagements to be more consumer-focused. This includes thinking about services outside of a conventional clinic setting. Consider diversifying and offering remote home-based concierge services or having hybrid online and face-to-face care options. This may also include supporting and offering OTC devices in the future.

Maximize the use of an online presence to reach consumers. For example, an online hearing test, like hearDigits, is validated to be accurate and to reach more patients. It is particularly helpful in providing access after-hours, when most people take online hearing tests, without needing to have the professional available. Digital marketing should be an essential part of any modern practice.

Probably most important. Make sure you differentiate your services by being person-centered in every aspect of your practice. There are excellent tools available by the Ida Institute to support professionals to provide comprehensive services that puts the consumer at the center of care to enable shared decision-making. This ensures that our professional services are truly personalized as a powerful differentiator directly linked to improved benefit in clients and higher rates of client retainment.

Q: If you imagine the world of hearing health in 5 years, how much has it shifted towards remote care?

I envision a significant shift. If you look at the estimated growth in the telehealth market overall (7-fold by 2025 with a market value estimated at $250 billion), hearing healthcare professionals would do well to capitalize on this trend. COVID has certainly kickstarted rapid changes but as the world comes to a new normal it would be important to continue adopting and forging ahead.

The likely scenario is for hybrid approaches that offer face-to-face and online options to become more common. Some may specialize in remote services and develop unique value propositions that fit this model and serve a specific group of patients.

Q: What role will hardware and tech improvements have on models of care. Will AI and more innovative hearing aids remove the need for as much hands-on care in the future?

AI certainly has exciting potential for future smart hearing aids but it is still early days. Whilst these types of tech improvements could benefit patients with potentially less adjustments the human factor, whether in-person or remotely, is still important in the person-centered approach to care.

Hearing aids are not like glasses, there is something about many persons with hearing loss wanting or needing a human connection to support and assist them through their acclimatization process.

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