There has been a great deal of buzz recently about evidence based practice: who creates it, who can police it, and why its important. Here is my two cents: Audiology would not exist, as a discipline or as a profession, without research and the evidence it produces. To date, no national association, credentialing or accrediting body has held audiologists accountable or required the attestation of evidence based care. Evidence yields professional and clinical standards and guidelines. It creates new procedure. It also provides the foundational support for new CPT and HCPCS codes as well as increased coverage of certain items and procedures. Research and evidence make a profession viable and, in turn, keeps it relevant.
Some of our current professional challenges can be correlated to our lack of consistent focus on evidence based practice. It is evidence based, patient centered practice that can differentiate an audiologist from disruptive delivery channels. This is the evaluation and care that cannot be delivered OTC or by the majority of other provider types.
The hallmarks of ethical practice are also evidence based. Most of our licensure laws hold each of us accountable to these types of ethical standards of practice. Every patient deserves to have the best possible care delivered to them at every visit. We should treat our patients as we would expect our healthcare providers to treat us. Do we want our physicians, dentist, optometrist, chiropractor, physical therapist, or nurse practitioner to cut corners because of time, resources, or lack of knowledge? Do we want our healthcare providers to stay on top of the latest research and clinical techniques? I know I do. I also know that the most successful practices, both professionally and financially, are those who put the patient at the forefront of her decision and action.
Audiologists cannot use research and evidence as a marketing tool (i.e. cognition, falls, depression, dementia, and co-morbidities) and then ignore the evidence in other aspects of daily practice. Its disingenuous and misleading. For example, I would assume that, if you discuss cognition in your marketing, that your practice screens for cognition, fits amplification with cognitive status in mind, and provides auditory rehabilitation to provide compensatory strategies for the cognitive limitations. Just like in tinnitus, amplification is only PART of the answer. Research supports a much larger evaluative and rehabilitative approach.
For example, there is significant evidence surrounding the value of the use of speech in noise testing, handicap and hearing aid inventories, real-ear measurement and auditory rehabilitation to patient performance, satisfaction and outcomes. There is also evidence surrounding using a Hallpike as the primary means of diagnosing BPPV and using recorded speech materials instead of monitored live voice. There is research supporting the value of entry level hearing aid technology, OTCS and PSAPS. We have a great of basic and translational research available to us that can greatly influence our day to day practice and, in turn, provide better patient outcomes, performance, and satisfaction. THIS is how we retain patients and grow our professional footprint in healthcare. We just have ask, acquire, appraise, apply, and ACT!
Let’s have 2020 be the year of increased adherence to clinical practice standards and guidelines, to consistently devoting time to reading the literature, to supporting state and national meetings and research symposiums through attendance, and through, every day, providing the highest degree of evidence based, patient centered care possible. This is how we win and outperform the competition! I promise it will be worth it!