Referral rates and uptake of cochlear implantation in the global adult population are low. Five audiology centres across England and Wales retrospectively explored data over a six-month period in late 2019, post implementation of new National Institute for Health and Care Excellence (NICE) criteria. Geography and age are stated in this work as significant factors influencing clinical decision-making in regard to referral for cochlear implantation. Patient management systems were utilised to run Auditbase Crystal reports, identifying specific individuals that the software selects as presenting with audiometric results within referral criteria. Sites accessed patient journals, records, and assessment information to determine patient management outcomes. Outcomes were coded using specific parameters that explored where referral was offered, declined, or perhaps inappropriate considering other factors or contraindications. Thirty-six percent of identified appropriate cases documented no discussion at all of potential referral for cochlear implant assessment and the spread of discussions varied considerably between the five involved sites. Across each site, referral of older adults appeared significantly less likely for people over 80 years of age, although participants ranged from 18 to 105 years of age and there appeared no difference in age between patients who accepted referral and those who declined after discussion with their clinician. Perhaps unsurprisingly, centres attached to CI centres showed the highest rate of referral discussion whereas centres without this link were less likely to consider or discuss the option with their patients. The study was reliant on the reporting of documented discussions in the patient management system too. Thus, researchers were reliant on the clinician recording any conversation that had taken place regarding referral. Authors suggest the standardised reporting tool offers scope for a national measure to identify barriers and improve access to cochlear implantation.
Inequitable access to cochlear implantation across the UK
Reviewed by Charlotte Rogers
Cochlear implant referral patterns in the UK suggest a postcode lottery with inequitable access for older adults; results of a pilot audit in five Audiology sites.
CONTRIBUTOR
Charlotte Rogers
BSc Healthcare Science (Audiology), Allied Health Sciences, De Montfort University, Leicester.
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