Pediatric Hearing Healthcare in Kentucky’s Appalachian Primary Care Setting

Abstract

Objective Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention (EHDI) programs in an area of known hearing healthcare disparity. Study design Cross sectional questionnaire study Methods Appalachian PCP’s in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. Results 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5% versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p<0.001). Very rural practices (Beale code 7–9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4–6) (p<0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Conclusions Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children.

Healthcare disparities in pediatric otolaryngology: A systematic review

“…Disparities were most commonly reported in the realm of otology (33 of 61 [54.1%] studies). Examples of otologic disparities included decreased parental knowledge of failed newborn‐hearing screens and lower likelihood of audiology follow‐up testing for infant hearing‐loss patients in more rural compared to less rural areas . Several disparities related to acute otitis media (AOM), including a higher risk of AOM in low SES patients, longer wait times for AOM treatment for Medicaid versus private insurance patients, and lower likelihood of affording medications or seeing a specialist for frequent ear infections in black and Hispanic versus white patients .…”

“…Examples of otologic disparities included decreased parental knowledge of failed newborn-hearing screens and lower likelihood of audiology follow-up testing for infant hearingloss patients in more rural compared to less rural areas. 21,22 Several disparities related to acute otitis media (AOM), including a higher risk of AOM in low SES patients, longer wait times for AOM treatment for Medicaid versus private insurance patients, and lower likelihood of affording medications or seeing a specialist for frequent ear infections in black and Hispanic versus white patients. 16,[23][24][25] Of note, in one study controlling for type of insurance, children of color with recurrent ear infections still had a lower chance of seeing a specialist and a higher chance of having delayed care due to transportation difficulties compared to their white counterparts.…”

Rural Family Perspectives and Experiences with Early Infant Hearing Detection and Intervention: A Qualitative Study

“…Resources such as telemedicine could directly address some of the distance concerns for some of the participants [17]. Nearly all of the study participants welcomed the idea of telemedicine, and a few reported they already utilize it for other aspects of their child’s care.…”

Disparities in access to pediatric hearing health care

“…In a cross-sectional survey of 93 rural physicians, many providers reported that they do not receive newborn hearing screening results consistently and they lack confidence in counseling parents through the EHDI process. 54 …”