title: Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?
abstract: OBJECTIVE
  In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings.
  
  
  METHODS
  The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols.
  
  
  RESULTS
  Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group.
  
  
  CONCLUSIONS
  These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.
authors.affiliation: The Department of Veterans Affairs Medical Center, Memphis, Tennessee, USA. robyncox@memphis.edu
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Cox
authors.forename: Genevieve C
authors.initials: GC
authors.lastname: Alexander
authors.forename: Ginger A
authors.initials: GA
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006310:Hearing Aids / Q000523:psychology*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011331:Private Practice; D011795:Surveys and Questionnaires; D014728:Veterans