In the chapter, the authors address the prescient need to update accepted care models of cochlear implant (CI) fitting and long-term maintenance to better utilize self-care and tele-medicine possibilities, thus shifting the focus of CI maintenance to the recipient. There is a strong evidence base that such a move will better meet the needs of CI users, giving them greater control of and involvement in their hearing progress. Simultaneously, such an approach can better meet present shortcomings in the market acceptance and delivery of the benefit of cochlear implants, particularly in the elderly segment of the population, where device penetration of the market remains low (c. 7%). Such initiatives make it viable to reach many more users, as the present models are prohibitively expensive for such expansion. A case study of pilot software for CI maintenance based on tele-audiology is described with the inclusion of data collected from initial studies.
TopIntroduction
Cochlear implants (CI) are improving hearing for people with a severe-to-profound bilateral hearing loss, with the personal health and community health-economic benefits being universally accepted after more than three decades of evidence (Vaerenberg et al., 2014). However, with the maturing of the technology beyond a niche specialist discipline to an accepted widespread intervention, it is evident that the delivery and care methods need to evolve to suit this much wider uptake. The case for a wider uptake will only be expanded following the recent adoption by the World Health Authority, in May 2017, of a resolution on the worldwide need to address hearing loss (World Health Organisation (WHO), 2017b). The traditional model of intensive management in specialist (mainly university-based) centres can no longer meet the needs and desires of this wider recipient base, nor is it viable economically for health services to support traditional care structures for so many more users. In addition, society’s demographics, expectations and competencies are changing rapidly. The average age of the population is increasing (and the prevalence of hearing loss is correlated with age), while simultaneously people are expecting greater empowerment and involvement in their healthcare decisions. Concurrently, the population as a whole is rapidly getting more literate in the use of ICT (Information and Communication Technology): this is no longer a specialist domain. Considering this combination of societal trends, it is apparent that the widespread increase in technological literacy, coupled with increased personal empowerment for own-healthcare provision, can be harnessed to meet the impending bottleneck in support for the delivery of CI performance monitoring and maintenance.
Since CI involves lifelong management of the technology, and has a large impact on CI users’ lives, it is essential that CI users become involved in their treatment and have proper self-care practices. In health-care outcomes, human behaviour is the largest source of variance (Schroeder, 2007). Literature from chronic health domains suggests that an individual’s motivation plays a significant role in treatment adherence (Vermeire, Hearnshaw, van Royen, and Denekens, 2001). The self-determination theory health belief framework (Ryan, Patrick, Deci, and Williams, 2008), which is central to the design of proposed model of CI care presented here, is elaborated further later.
In the following chapter, the authors will present a background and outline of the issues with current CI patient care models, consider some theoretical objectives for how this care can evolve along with societal and technological trends, and then present a case study of an implementation of pilot Remote-care and Self-Care CI maintenance software. Results from initial field trials of this software will also be presented.