White Paper Reference Number Date 2020
HELP SEEKING ADULTS RECEPTIVE TO TELEHEALTH AS COMPLEMENT TO IN-PERSON CARE Author: Lise Henningsen, Head of Audiology
Since the outbreak of the COVID-19 pandemic in the US, telehealth has emerged as an important component of the fight to slow the spread of the virus. Telehealth services, available for several years but largely underutilized, have helped to ease the burden on traditional healthcare systems by encouraging patients with mild or moderate ailments, including hearing loss, to seek help via virtual web-based applications. Due to the COVID-19 pandemic, the US telehealth market is expected to witness over 80% YOY growth in 2020.1 In response to the pandemic, health service providers around the US have ramped up telehealth services to connect healthcare providers and patients remotely. In March, when state governments began implementing social distancing and shelter-in-place measures to contain the pandemic, telehealth services became an effective tool for healthcare management. Early on, because telehealth services were not popular among most patients, healthcare professionals were unsure how patients would receive these virtual services. Now, several months after the first social distancing and shelter-in-place guidelines went into place, healthcare professionals are finding that many Americans have utilized telehealth services, and most appear to like it. A recent nationwide survey of 2,000 adults found that 42% WSA.COM
have used telehealth services since the beginning of the pandemic. A remarkable 82% of survey respondents reported they like using telehealth services. Of those respondents who like using telehealth services, 65% said they like it because the visits are more convenient than meeting their healthcare provider in an office, while 63% said they like not having to worry about exposure to other potentially sick patients. Further, 38% said they liked the streamlined nature of follow-up appointments and other communication with their healthcare provider, while 51% said that if they were to use telehealth services post COVID-19, convenience would be most important reason why they would continue to use it. 2 Other reports suggest patients believe telehealth services are easy to use, convenient and helpful.3,4,5 Although these survey responses and anecdotal reports indicate many Americans like telehealth services once they become familiar with them, the generalizability of these results to adults with hearing loss is uncertain. Given an average age of first-time hearing aid use of 67 years6, adults with hearing loss tend to represent an older cohort than the previously cited reports. Because adults with hearing loss tend to skew older, it is possible some are reluctant to use telehealth services, or some could be less likely to own smartphones or laptop computers, essential components to the WS Audiology White Paper
White Paper use of any telehealth platform. Additionally, adults with hearing loss might be different than other groups that have recently begun using telehealth services and view telehealth as a stopgap in nature until normal activity resumes. A final important consideration related to persons with hearing loss who tend to be older is they represent a segment of the population most vulnerable to the effects of COVID-19. Thus, many persons with hearing loss are likely to rely on telehealth services for a longer timeframe, even after social distancing guidelines are ended. To better understand the opinions of adults with hearing loss and how they view telehealth services, WS Audiology conducted a survey. The survey was emailed at random to a database of current and prospective hearing aid wearers. A total of 800 individuals (432 male and 133 female) with a median age of 73 years completed the survey, with 798 individuals responding to all questions on the survey. The survey was conducted from May 11 to May 20, 2020, 79% of respondents reported they were full time hearing aid wearers. Results Based on an analysis of the responses from 798 individuals who completed all the survey questions, the following trends are gleaned from the results. Most have stayed home 75% report that they have sheltered in place or stayed at home during the pandemic. Use of face masks and social distancing negatively effects communication 87% report some difficulty with communication as a result of social distancing measures, with 44% of
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respondents saying they are ‘significantly impacted’ by them. Sound quality is clearly the most important hearing aid feature… Of the 79% of respondents who reported they were full time hearing aid wearers, a solid majority of this group (61%) said that sound quality was the most important feature on their hearing aids. A distant second was wireless connectivity (21%), followed by rechargeability (7%), physical comfort (6%) and appearance (1%). …And biggest challenge Full time hearing aids wearers also reported sound quality was the biggest challenge associated with hearing aid use, as 48% reported it to their main issue. Physical comfort (16%), ease of use (10%) and cosmetics (1%) also received votes. Interestingly, 22% of hearing aid wearers reported no challenges associated with hearing aid use. Fitting and fine-tuning skills of HCP are most valued The survey asked respondents to list the most beneficial reasons for working with an HCP. The highest-ranking response was fitting and fine-tuning (40%), followed closely by assurances that their HCP is an expert (30%). Professional care (13%) and clear explanations of hearing loss and hearing needs (11%) rounded out the list. Considering sound quality is the most important feature and biggest challenge associated with use for most respondents, the fitting and fine-tuning skills of the HCP as the highest ranked attribute of the HCP is not unexpected. Consistent with MarkeTrak 10 findings,6 hearing aid owners rely on their HCP to serve as the expert responsible for optimizing performance and use of their devices.
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White Paper Majority still have no experience with telehealth services, but numbers appear to be growing To date, 53% of respondents have no experience with any type of telehealth services, but 27% have used telehealth services for the first time within the past three months, following the onset of Covid-19. Prior to the pandemic, about 1 in 6 respondents (17%) had experience with telehealth or remote services. Note that a previously cited national survey reported 42% of adults had utilized telehealth services following the onset of Covid-19, while 27% in this survey reported they began using telehealth services at that time. This disparity may reflect the older cohort of respondents in this survey, as older individuals tend to rely less on remote and virtual technology relative to the general population. However, given that 17% reported using telehealth services prior to the onset of the Covid-19 pandemic and 27% reported using telehealth service for the first time since its onset, this represents a substantial uptick in the numbers of individuals using telehealth services within a narrow timeframe. Further, this increase in telehealth usage, especially among older adults who are most vulnerable is likely to continue to increase until a proven therapeutic or suitable vaccine is found. People are receptive about, and inclined to use, telehealth services Fifty-three percent of respondents said that were very likely to use telehealth services, while 32% were unsure and just 15% were unlikely to access telehealth services. A majority of respondents (53%) saying they were very likely to use telehealth services suggests that a growing number of older adults are resolved to embracing telehealth services because of the long-term effects associated with Covid-19.
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If you build it, they will come The survey suggests that many individuals use telehealth service because their provider offers it as an option. When asked what best describes their preference for remote care services, 19% said telehealth was their preferred method of interaction with their provider, 41% report that even though telehealth is not their preferred method of interaction, they use because their provider offers it and 40% say they have no preference on how they interact with their provider. The latter percentage hints that a relatively large number of individuals seeking the services of an HCP are open-minded about how they interact with their provider, and would probably utilize telehealth if it was available, and they could become familiar with how to use it. Reasons for telehealth use varies; many are likely to continue to use it after pandemic While 27% of respondents said they use telehealth services to reduce the risk of COVID-19 infection, there are a range of reasons patients will likely use it following the pandemic. Ten percent indicate telehealth saves time, 16% say it’s convenient and 21% report that telehealth is an added way to stay in close contact with their provider. Two-thirds are ‘very likely’ to return for in-person visits Results of the survey show that 68% of respondents are very likely to return for in-person visits, once social distancing restrictions in their area are lifted, with just 7% saying they are unlikely to return for in-person appointments. Interestingly, one-third of the respondents reported that they were very likely to continue with remote care appointments after restrictions were lifted, one third were unlikely to continue with any remote care appointments and another third of
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White Paper respondents were undecided on the continued use of telehealth appointments after all restrictions have been lifted. Few Plan to Buy Hearing Aids Online When asked if they would prefer to purchase hearing aids directly from an online website, just 16% of respondents said they would consider buying their next hearing aids in this manner. However, 60% of respondents reported they would consider buying hearing aids that used telehealth services as a partial or blended approach to care. Summary Given the majority of people who benefit from hearing care services are over the age of 60, which is also the age for individuals with the highest risk of COVID19 related illnesses, telehealth services are likely to remain an essential component of how hearing-related services are delivered now and into the future. And since audiology services have, historically, been delivered across several in-person appointments, the rise of COVID-19 presents an opportunity for hearing care professionals to temporarily replace and permanently supplement inperson care with remote services.
Survey results indicate that sound quality is the most important feature and biggest
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challenge associated with wearing hearing aids. These findings suggest HCPs could rely on telehealth services to provide additional touchpoints that result in higher levels of overall patient satisfaction, especially during initial use of hearing devices. As HCPs know, the first 30 to 60 days of a patient’s experience with hearing aids are critical to long-term success. As patients become acclimated to their new devices, it is critical for them to stay in close contact with their hearing care professional when they need adjustments to their hearing aids. According to previous survey data, however, there is a strong positive relationship between hearing aid success and fewer visits to the clinic for routine adjustment appointments.7 Remote telehealth services can provide, in a timeefficient manner, additional touchpoints for these critical adjustments when they are needed. Like other similar surveys outside of hearing care, the WS Audiology survey indicates that a cohort of primarily older adults are receptive to using remote telehealth services, find them to be helpful when they do use them and will rely on remote telehealth services in the future to enhance (not replace) the quality face-to-face care they currently receive from hearing care professionals.
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White Paper REFERENCES:
1. US Telehealth Market Sees an Increase in Demand for Telehealth Services Due to COVID-19 Pandemic. Business Wire. Published April 27, 2020 2. Survey: Telehealth on the rise, popular with patients. Medical Economics. Published May 21, 2020. 3. Telehealth gaining popularity during coronavirus pandemic. MSMV News Nashville, TN. Published May 21, 2020 4. COVID-19 may permanently alter the telehealth landscape, from reimbursement to utilization. Healthcare Finance. Published April 21, 2020 5. 5 Reasons Why Telehealth Is Here to Stay (COVID-19 And Beyond). Forbes. Published May 4, 2020. 6. MarkeTrak 10. Seminars in Hearing 2020 7. Kochkin (2010) MarkeTrak VIII: The Impact of the Hearing Healthcare Professional on Hearing Aid User Success Hearing Review April 2010
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