The Power of Analogs: A Case Study with Hearing Loss and Alcohol Use Disorder

I often recommend to my clients that we investigate analogs when developing patient and physician engagement strategies. A healthcare analog is a disease state that on the surface seems completely different than a company’s current focus, yet faces similar (e.g. analogous!) difficulties. Analogs are especially useful when addressing longstanding barriers to engagement.

Investigating analogs can be for some executives like attending an away game in baseball. With unpredictable weather, the unknown stadium, and the unruly fans, none of the surroundings seem familiar. Yet the power of analogs is that they provide a fresh perspective on entrenched challenges, whether ensuring that patients obtain needed treatment or educating physicians on the treatment benefits.

As a case example, alcohol use disorder serves as a useful analog to hearing loss and deafness. Comparing barriers to treatment for the two offers insight for companies addressing these conditions. These two conditions correspond in three important ways.

1. Stigma contributes to low patient engagement

For hearing loss and deafness as well as alcohol use disorder, patients encounter significant societal stigma.

People with hearing loss fear being labeled with reductive stereotypes that they are “disabled” or “cognitively declined,” according to Auditory Insight research.

Similarly, people suffering from alcohol use disorder dread stereotypes that they lack self-control or a moral compass, that at worse that they are “worthless,” “dangerous,” or “criminals,” based on this study.

To be labeled in this manner threatens people with the risk of social ostracism, losing their place at home and work. These punitive stereotypes chip away at people’s willingness to seek treatment, contributing to low uptake rates.

Less than 10% percent of people with alcohol use disorder seek treatment, reports the National Institute of Health (NIH), while only 15% of people with hearing loss regularly wear hearing aids, according to Auditory Insight’s analysis of NIH data.

2. Primary Care Physician focus is uneven

The attention that primary care physicians (PCPs) devote identifying possible alcohol use disorder and hearing loss and deafness is inconsistent and often inadequate, creating challenges for diagnosis.

Well over half of adults 65-plus have hearing loss, yet the PCP screening guidelines for this cohort lack “clear consensus,” per StatPearls. The US Preventive Services Task Force (USPSTF) has ruled that there is insufficient evidence “to balance of benefits and harms of screening for hearing loss in older adults.” In contrast, the American Geriatrics Society recommends screening all adults in this cohort for hearing loss.

The upshot is that far fewer older adults are getting their hearing tested than would be expected from established prevalence rates. Only 21% of Baby Boomers, for example, had their hearing tested in the last five years, according to a recent study by the American Speech-Language-Hearing Association. In contrast, well over half of this cohort has a mild or moderate hearing loss.

Moreover, a recent study found that only 57% of primary care physicians (PCPs) and nurse practitioners (NPs) are aware of a standard definition of so-called normal hearing, compared to much greater familiarity for measures like blood glucose and vision.

In the arena of alcohol use disorder, PCPs also do not consistently recommend treatment, although for different reasons.

The USPSTF recommends (with a Grade B) that PCPs screen adults for unhealthy alcohol use, providing those “engaged in risky or hazardous drinking with brief behavioral counseling interventions.”

PCPs perform somewhat well on screening, with almost three-quarters of surveyed office-based PCPs reporting that they do so. However, less than 40% of those PCPs report that they always follow up when indicated with the brief intervention recommended by the USPSTF, according to this study.

On net, patients who suffer from hearing loss and alcohol use disorder do not consistently receive screening and treatment recommendations from their primary care doctors.

3. The patient journey never ends

The final parallel between hearing loss and deafness and alcohol use disorder is that they are essentially chronic conditions.

Although people with hearing loss derive strong benefits from hearing aids, and in more severe cases, cochlear implants, there are no approved cures for hearing loss. Even gene therapies and drug therapies under development often demonstrate partial improvement, with some pitches better restored than others. Many patients undergoing these therapies may still need to rely on hearing aids.

As a result, people who wear devices need to focus on incorporating hearing aids and cochlear implants into their personal and professional daily lives. At Auditory Insight, we call this last phase of the patient journey Integration. It’s an ongoing phase, that basically never ends.

Similarly, many clinicians expert in treating alcohol use disorder view it as a chronic brain disease (although not everyone in the field agrees). Even people who successfully stop drinking run the risk of relapsing. Two-thirds of people treated for AUD relapse within the first six months, per this study.

Treatment for alcohol use disorder includes behavioral therapies addressing stress that could catalyze drinking and medications that can deter drinking during high risk times, according to the National Institute on Alcohol Abuse and Alcoholism.

As in the case of hearing loss, people diagnosed with alcohol use disorder need to make adjustments in their personal and professional lives to minimize the chance of returning to excessive drinking.

Analogs in action

Hearing loss and deafness and alcohol use disorder share three powerful similarities: stigma deters people from seeking treatment, PCPs show uneven rates of screening for the conditions, and these conditions are essentially chronic, with no available cures.

How might executives charged with bringing new treatments to market for hearing loss and alcohol use disorder benefit from identifying these commonalities? The two treatment ecosystems can learn from each other’s academic research, commercial pilots, and commercial initiatives, both successful and not.

These insights may be used to develop stakeholder engagement strategies, for both patients and physicians.

Case example with improving PCP engagement using peer networks

Consider as a case example how to improve PCP engagement by providing them support in the form of helping them tap into peer-to-peer support networks. PCPs may be more likely to recommend a patient with suspected hearing loss visit an audiologist or to conduct the brief behavioral counseling intervention with patients who do not pass alcohol use disorder screening if they have resources backing them up.

In the case of alcohol use disorder, some forward-thinking primary care clinics maintain lists of local people in recovery willing to provide peer support. “That may include taking the patient to a self-help meeting or to an addiction treatment facility intake appointment,” explains an editorial in American Family Physician. The self-help meeting might be hosted by Alcoholics Anonymous, one of the most widespread peer-to-peer networks in modern medicine.

In contrast, hearing healthcare’s peer-to-peer networks are far removed from the PCP. The Hearing Loss Association of America (HLAA), an advocacy organization, holds local chapter meetings, but not many primary care practices maintain an active connection with them.

For cochlear implants, global implant manufacturers sponsor peer-to-peer networks to assist people considering and then acclimating to these devices. MED-EL’s Hearpeers program, for example, connects patients with a mentor and also offers opportunities to connect with the broader community of cochlear implant wearers. However, patients must be indicated for cochlear implants—requiring passing through a PCP, a general audiologist, and a cochlear implant audiologist—before those peer networks become available.

Hearing healthcare could gain from fostering closer ties between PCPs and peer support networks, including HLAA. In addition, advocacy organizations like HLAA would benefit from considering how to emulate AA’s discretion and privacy, crucial for stigmatized conditions.

On the flip side, the cochlear implant manufacturers’ sponsorship of peer networks in hearing healthcare offer a potentially useful model for alcohol use disorder. Although sponsored by manufacturers, these peer networks have strong credibility with patients. Treatment providers in alcohol use disorder with a national footprint would be well served by considering how to import these successful design of these networks into their PCP engagement strategies.

The Power of Analogs

Enhancing peer networks to support PCP engagement provides just one example of how companies treating hearing loss and alcohol use disorder can benefit from the similarities in their care model. Healthcare analogs offer powerful tools for companies seeking to break logjams in patient and physician engagement.

Image: Photo by Adam Wilson on Unsplash