Equity and person-centeredness in provision of tinnitus services in UK National Health Service audiology departments

Abstract

Rationale, aim and objective: Chronic tinnitus is a prevalent condition broadly managed using individualised sound-based interventions, individualised or group education, counselling, or cognitive therapies. In the UK, therapy is largely delivered by audiologists or hearing therapists and, where available, clinical psychologists and physicians. Changes in the structure of the health service necessitate ongoing evaluation to monitor equity and person-centeredness of care. The purpose of the current evaluation was to describe provision and explore diversities in the services provided for tinnitus patients across the four countries of the UK and consider these relative to current commissioning and clinical practice guidelines. Method: A 37 item questionnaire was devised and distributed via email and social media to reach audiology departments in the UK and 147 valid responses were acquired during the 3 month period of the evaluation. Results: The structure and provision of tinnitus services varies widely across the four countries of the United Kingdom in terms of which clinicians provide the services. Outside of England there was no report of clinical psychology or audiovestibular physician involvement in services. There is also variability in access to psychological therapy or support (little training in CBT in Scotland and none in Northern Ireland), self-help groups (little involvement but interest from clinicians) and devices (e.g., one quarter of departments do not currently offer combination hearing aid devices for tinnitus). Clinicians are increasingly using validated questionnaires to evaluate the effectiveness of tinnitus management in their departments. Conclusions: Training in and the provision of psychological support for tinnitus patients by audiologists is particularly a concern for Scotland and Northern Ireland and has implications for the person-centeredness of audiology services. Capacity and need for research in paediatric tinnitus, combination devices, non-ear level sound devices and audiologist-delivered psychological therapy, are noted.

A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology

“…In a survey of English National Health Service audiology departments, 65% of clinicians indicated that they were not able to refer outside of their service to a clinical psychologist or other health professional qualified in providing psychological therapy (Gander et al, 2011). In a more recent evaluation of audiology services in the four countries of the UK, only services in England reported ever having a clinical psychologist in their team (7%) and access to a member of staff trained in CBT (48%), with a third of all services offering CBT as part of standard care (37%; Hoare et al, 2015). Self-help interventions can provide a way of improving access to psychological services for tinnitus.…”

Internet-Based Intervention for Tinnitus: Outcome of a Single-Group Open Trial

“…A further concern regarding tinnitus management in the United Kingdom is that many who experience tinnitus remain without access to tinnitus treatment, as they are not always referred for treatment by their general practitioner (El-Shunnar et al, 2011). For those who are referred, both the structure and provision of tinnitus services throughout the United Kingdom is variable, leading to inequality in tinnitus care (Hoare et al, 2015). Cognitive behavioral therapy (CBT), a psychological intervention aimed at altering maladaptive responses to tinnitus through behavioral modifications, has the most evidence of effectiveness at reducing tinnitus distress (Hesser et al, 2011).…”

Pre-market version of a commercially available hearing instrument with a tinnitus sound generator: feasibility of evaluation in a clinical trial

“…Although a recent British Tinnitus Association tinnitus service evaluation showed that 74% of UK audiology clinics can offer combination hearing aids (Hoare et al, 2015), the challenges that we faced in recruiting existing combination device users suggests that the numbers of wearers are small. Recruitment into a UK clinical trial would need to enrol either existing conventional hearing aid (amplification only) users or those who do not use any devices to manage their hearing loss and tinnitus.…”