Integrating ear and hearing care in primary care: Stefan’s story

A few years ago, during a 3-week holiday, Dr Stefan Teughels had time to reflect on his demanding work as a general practitioner and chairperson of general practice organizations in Belgium. By the end of his break, he had decided to quit his job as a general practitioner. “On the Monday, I started my practice and within one hour of patient contact, I had changed my mind,” he recalls. “The close relationship with patients, even a personal connection with some… it’s such a unique privilege, I wouldn’t want to miss it.” 

A day in the life of a general practitioner in Flanders 

Stefan graduated as a general practitioner in 1996. He is currently working in a multidisciplinary primary care facility in Flanders where general practice, nursing, midwifery, occupational health, psychology, social work and physiotherapy professionals work closely together to provide holistic, people-centred care. The clinic is in a small town of about 30 000 people, with a historical centre and flanked by waterways and forests. Yet managing such a clinic is far from a walk in the park. 

Stefan paints the picture of an ageing population with increasingly prevalent noncommunicable diseases and mental health conditions, including stress and burnout. The current health care system does not always meet people’s health needs, especially as it is concentrated in large cities, with clinics in regional and rural areas like his being the exception. 

Multidisciplinary and integrated primary care, efficient triage and task-sharing, and health promotion and prevention are yet to become a reality in most general practices in Flanders. An optimist at heart, Stefan believes that general practitioners can rise to the significant challenges and deliver quality and cost-effective primary care, if policies give them the opportunity to do so.  

For him, this includes payment mechanisms as well as health information systems that favour integrated and holistic care, including the prevention, early detection and management of ear and hearing conditions. 

Addressing hearing loss in primary care 

Stefan dreams of a future where general practitioners have the means to proactively address ear and hearing conditions.  

He balances the reluctance of people to acknowledge hearing loss, given the stigma attached to the condition, with the importance of good hearing to avoid social isolation, and thereby to promote healthy ageing. He has a hearing screening device for when people suspect hearing issues and adds that a hearing check should be part of the package of tests when cognitive decline is being investigated.  

Furthermore, nurses at the clinic can easily flush out excessive wax in patients’ ears. “Most of the patients with hearing loss I see can hear me in my quiet office,” he explains. “To ensure good communication despite hearing loss, I will sometimes write or draw, or involve a family member.”  

He recalls a baby identified with hearing loss through universal newborn hearing screening. “The specialized care from the university hospital, including bilateral cochlear implantation and aftercare, has been excellent. As a general practitioner close to the family, my unique role has been to provide them with the psychosocial support they needed and the answers to the health-related questions they had as they went through this adjustment process.” 

Communication is at the heart of efficient and person-centred primary care. “I call it the triangle of communication; the patient, the general practitioner and the specialist must speak the same language for care to be truly efficient and holistic,” he says. 

WHO/Europe support 

Ear and hearing conditions are among the most common health problems. In the WHO European Region alone, approximately 190 million people have hearing loss or deafness. WHO/Europe continues to support countries as they integrate people-centred ear and hearing care within national health systems. 

Over 60% of ear and hearing conditions can be identified and addressed in primary care. Support provided by WHO/Europe includes the integration of ear and hearing care within primary health care and the implementation of the WHO “Primary ear and hearing care: training manual” and related resources. 

Successful integration of ear and hearing care requires a strong and resilient primary health-care sector, including its workforce. In the report “Health and care workforce in Europe: time to act”, WHO/Europe calls on Member States to implement 10 actions to strengthen the health workforce, including expanding the use of digital tools that support the workforce, developing strategies that attract and retain health workers in rural and remote areas, creating working conditions that promote a healthy work-life balance, protecting the health and mental well-being of the workforce, and optimizing the use of funds through innovative workforce policies.

 


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