Audiological Service Delivery for the Paediatric Population: A National Survey

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Audiological Service Delivery for the Paediatric
Population A National Survey

• Tirusha Naidoo
• Heila Jordaan
• Speech Pathology and Audiology
• University of the Witwatersrand

2
Purpose

• To conduct a national audit of audiology services
  for the paediatric population in S.A.
• To explore factors impacting on service delivery
  in the public and private sectors

3
Method

• Survey design
• 141 respondents registered with the HPCSA and
  practising as audiologists participated
• 70 were employed in private sector and 71 in
  public sector
• Private sector respondents worked primarily in
  autonomous private practice
• Public sector respondents worked primarily in
  state hospitals.
• Graduates from all South African Universities
  participated

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Highest qualification in Audiology
5
Primary Employment
6
Employment by Province and Sector
7
Basic Test Battery
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Basic Test Battery

• 95 provide this service
• No equipment only reason for not conducting
  basic tests
• Tympanometry identifies middle ear pathology
  should be available in all settings
• Cerumen management often not conducted due to
  lack of training (controversial)

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Diagnostic Audiology
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Diagnostic Audiology

• ABR not performed by most due to lack of
  equipment but is useful for infants and difficult
  to test children
• ASSR relatively new- not used routinely but can
  obtain frequency specific thresholds for infants
  referred from new born screening
• AEP tests NB for neonatal screening and early
  detection of hearing loss- need to ensure that
  service is available

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Paediatric Audiology
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Paediatric Audiology

• BOA used routinely but is subjective and should
  be supplemented by electrophysiological measures
• VRA not done due to lack of equipment but is NB
• Battery of tests and cross check principle NB
  for paediatric population
• Results confirm the need for a co-ordinated
  programme of EHDI

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Hearing aid servicesSelection and Fitting
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Hearing Aid services Verification and Validation
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Hearing aid verification

• Verification using objective measures is critical
  to achieving best calculated fit and should be
  performed with every fitting.

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Hearing Aid services
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Hearing aid verification

• Most do not use real ear measures
• Provide a direct measure of sound levels that
  instrument will deliver to infants ear across
  frequencies.
• More analogue technology in public sector
  therefore more manual trimming.
• Providing hearing aids is not enough if equipment
  to support fitting is lacking

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Newborn screening
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Reasons for not providing

• No case load
• No equipment
• Time constraints
• Many challenges in South Africa(de Wet, 2005)
• Should become one of the goals of health care by
  2010.

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(RE)HABILITATION
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Rehabilitation

• Encouraging that most in public sector provide
  these services
• Private practitioners not as involved
  concerning
• Inadequate training impacts on provision of sign
  language
• Team approach audiologists, early
  interventionists, deaf educationalists

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Service Delivery Issues Public Sector (n70)

• Delayed referrals 77
• Lack of Knowledge 79
• Lack of Testing Facilities 70
• Lack of staff 70
• Poor promotion prospects 73
• Funding 93

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Service Delivery IssuesPrivate Sector (n70)

• Delayed referrals 68
• Limitations on autonomous decision making re
  protocols 67
• Lack of knowledge (other profs) 83
• Limited med aid coverage 89
• Advertising rules
  76
• Limited availability of devices 80

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Conclusion

• There is work to do..
• Presently the field of audiology.because of its
  relative youth as a profession, lacks the impetus
  for achieving autonomy. This does not mean that
  this goal is unattainable. It will require a
  unified effort from all that is applied to the
  common good (White, 2002)