Benefits from Hearing Aid Services - What, Who, When, and How Do We Know? Stuart Gatehouse Recent years have seen significant advances in the technological content and flexibility of amplification devices and these developments pose new challenges for clinical practice. Matching technical solutions to the needs of hearing impaired listeners requires an understanding of the many dimensions of candidature, including impaired psychoacoustic function, listening demands of different auditory lifestyles, and non-auditory aspects such as expectation, motivation, psychology and cognitive function. As the available options expand, an increasing emphasis is evident on measures of outcome with proof of validity, reliability and clinical utility. This presentation documents the ways in which the technological content and rehabilitative context of services for hearing impaired people can be used to substantially alleviate disability and handicap. Where resources are not sufficiently elastic to allow unfettered access to unlimited technology and rehabilitation, a targeted candidature regime is advocated (as an alternative to simple rationing or universal low cost, low effectiveness provision). This presentation takes examples from the current status of resources (hardware and rehabilitative) within the United Kingdom National Health Service and demonstrates, at individual and group levels, the ways in which a set of routinely available outcome measures can be used to assess the clinical effectiveness and cost effectiveness of protocols to match management options to the needs of listeners, and to optimise those protocols. It is argued that the set of general principles of using outcome measures to maximise clinical effectiveness and cost effectiveness are of general applicability. |