Factors affecting the implementation of evidence-based Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers

Abstract

Purpose Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers. Method We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents’ facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites. Results Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans’ preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice. Conclusion Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans’ need for and interest in PTM, including delivery by telehealth modalities.

History of Tinnitus Research at the VA National Center for Rehabilitative Auditory Research (NCRAR), 1997–2021: Studies and Key Findings

“…Results of a survey targeting audiology and behavioral health leaders at the majority of VA medical centers suggested "wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training" (p. 2). 69 Considering the existing scientific literature covering tinnitus research, it is reasonable to conjecture that these same conclusions would apply in non-VA settings.…”

“…66,67 Clinical implementation of PTM across the VA was assessed using an anonymous, webbased survey targeting audiology and behavioral health leaders at 144 major VA hospitals. 68,69 The study addressed a gap in knowledge of PTM clinical implementation, focusing on factors that facilitated or hindered its implementation, and whether sites using PTM had developed adaptations to the methodology.…”

“…The goal of the quantitative analysis was to estimate levels of PTM program implementation in VA audiology and behavioral health clinics. 69 Survey responses were received from 87 audiologists and 66 behavioral health clinicians. Data analysis revealed that the majority (44 audiologists and 60 behavioral health clinicians) did not offer PTM (categorized as "no PTM") or they offered "partial PTM" (17 audiologists and one behavioral health clinician).…”

“…In addition to the noted wide variation in tinnitus clinical services, results revealed the need for behavioral health providers to be more engaged in tinnitus care, and a clear interest by both audiologists and behavioral health providers in receiving tinnitusrelated training. 69 Future research should address these barriers to PTM implementation in VA clinics.…”

Investigating tinnitus subgroups based on hearing‐related difficulties

“…It highlights that individuals with tinnitus require tailored interventions, such as progressive tinnitus management (PTM), which triages patients according to tinnitus distress. 45,46 These findings may aid with this triaging process and hence aid planning more effective tinnitus management pathways. Effective service provision is becoming increasingly important with current trends suggesting that the prevalence of tinnitus is on the rise.…”