Newborn Hearing Screening
The Quebec government has set up the Quebec Newborn Hearing Screening Program (PQDSN) in November 2013. On May 11, 2021, in the National Assembly, the government committed, through a motion adopted unanimously, to having it implemented throughout Quebec within the year. By April 2024, 93% of newborns would benefit from it.
Presbycusis
There is no national presbycusis screening program in Quebec. Its implementation is being considered, but the priority issue of the Ordre des audioprothésistes (OAQ) is to encourage the government to improve the coverage program of the Régie de l’assurance maladie du Québec (RAMQ). Indeed, this step is a prerequisite to a screening campaign.
Patient pathways and healthcare professional involved
Three hearing care professionals are involved in the Quebec care pathway. Hearing aid specialists (audioprothesist) whose reserved activities consist of selling, fitting, adjusting or replacing hearing aids. Then, audiologists and speech therapists whose reserved activities consist in particular of, on the one hand, assessing hearing disorders in order to determine the audiological treatment and intervention plan and, on the other hand, adjusting a hearing aid as part of an audiological intervention. Finally, ENT doctors.
According to the latest annual report, there are 483 audiologists, 532 hearing aid specialists and approximately 200 ENT specialists. Hearing aids must always be obtained after a certificate has been issued by an audiologist, speech therapist or physician attesting to the need for a hearing aid. Audiologists can conduct an assessment and determine the treatment and intervention plan that may or may not include the use of hearing aids.
The hearing aid specialist can conduct a hearing assessment for hearing aid purposes. When hearing aids are recommended, it is the hearing aid specialist who selects the hearing aids with the patient, adjusts them and ensures follow-up, all in compliance with the hearing aid specialist Act (“Loi sur les audioprothésistes”) and the OAQ regulations. Members are also required to comply with the Standards of practice for hearing aids in Quebec, guidelines and policies.
Funding
About one third of hearing aids are 100% covered by the RAMQ. However, for unemployed or retired adults, the program only offers one hearing aid provided that the person has an PTA (pure tone average = (loss on 500 Hz + loss on 1000 Hz + loss on 2000 Hz) / 3) of 35 dB or more in the better ear. In other words, we must tell patients to wait until they have sufficient loss in both ears to be able to rehabilitate only one. They must pay between CAN$1,500 and CAN$2,000 (€1,326) to acquire the second hearing aid. To fit patients who are covered by this program, the hearing aid professional is required to use hearing aids listed by the RAMQ. It is not possible for the patient to pay the difference for more efficient devices. One third of the hearing aids are covered by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), which compensates workers who suffer from occupational deafness. In the case of bilateral deafness, the CNESST provides binaural hearing aids. One third of the hearing aids are at the patients’ expense and may be partially covered by private insurance.
Children, visually impaired patients and workers may benefit from coverage for a second hearing aid.
The following elements are not part of the eligibility criteria for the RAMQ program for adults: intelligibility threshold in silence; deterioration of intelligibility in the presence of noise; hearing loss in high frequencies; auditory neuropathies; central disorders. Given the advances in science in this area, the Order considers that it would also be interesting to assess the risk factors for cognitive decline in order to provide earlier access to hearing aids. As for cochlear implants, they are covered by the State.
Healthcare offer
According to the latest statistics, each hearing aid professional fits approximately 140 hearing aids per year. According to this data, the OAQ considers that hearing aid professionals have the time to properly meet their professional obligations and provide excellent follow-up to patients who wear hearing aids. In our opinion, the adoption rate for hearing aids was 25% in 2022.
We do not have official data on access to audiologists and ENT specialists. However, the OAQ considers that access to quality hearing correction that meets the needs of individuals should be improved and actions across the entire patient journey must be taken to achieve this. We want to achieve an adoption rate of 50%.
Teleaudiology
The Order is interested in the issue and the implication of telepractice in hearing aid services, including its potential benefits and limitations, and is studying the possibility of drafting a Guide that would be distributed to members.
