Landmark study shows telemedicine improves hearing health disparity

Mobile health school screening and telemedicine referral to improve access to specialty care in rural Alaska: a cluster-randomized controlled trial

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00184-X/fulltext

It’s still a bit amazing that even after audiology equipment has become more mobile and teleaudiology platforms exist, audiologists still resist leaving the comfort of their offices. I realize in some cases, it’s necessary to stay put. Working in an ENT office would not be of great benefit to be mobile. It is, however, a great way to meet patients where they are for those audiologists working in schools and/or in private practice. But, adoption has been slow. This study shows that children living in remote parts of Alaska who were referred to specialists via telemedicine received quicker access to follow-up care than referring them to primary care providers. 

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A recently published Hearing Norton Sound study found that children who were referred to specialists via telemedicine received quicker access to follow-up care than referring them to primary care providers.  Fifteen rural Alaskan communities participated in a randomized controlled trial from 2017-2020 and demonstrates that telemedicine can reduce a key rural health disparity in access to care.

Susan D. Emmett, M.D., MPH, one of the study leaders, said the study has implications for rural areas across the globe, including Arkansas, and for improving access to specialists for other preventable health conditions.

Emmitt, an associate professor in the UAMS College of Medicine Department of Otolaryngology-Head and Neck Surgery and the Fay W. Boozman College of Public Health Department of Epidemiology, specializes in hearing loss disparities and ways to improve access to care for people in underserved areas.

“Even if children are identified with hearing loss at school, they often never receive the care that they need. This loss to follow-up from school screening programs, as well as a dearth of specialists in rural areas, exacerbate barriers to care for rural children,” Emmet said. “The purpose of this study was to test whether telemedicine can address this challenge, providing a way for rural children to promptly enter the health care system to receive the specialty care they need.”

Alaska Native children have higher incidence of hearing loss (up to 31%) compared to a suspected 1.7-5% in the general U.S. population. In this randomized trial comparing referral methods, children referred to telemedicine versus traditional primary care received follow-up 41.5 days whereas the traditional referral method took 92.0 days.

This study has implications for improving access to specialty care in low-resource settings globally. Rural schools represent an essential access point for preventative services for children worldwide, yet loss to follow-up from school screening programs and scarcity of specialists and resources exacerbate barriers to care in rural communities.