社区康复干预对听力障碍老年人生命质量的影响及成本效果评价

Hearing loss is a leading cause of disability among older adults and will become a more challenged concern to address with an accelerated ageing in China. However, the government, society and hearing-impaired families are not clearly aware of all the consequences of the hearing loss due to its slow onset, reduced ability to detect and individual deficiency of hearing-related knowledge. Aural rehabilitation is the main strategy to improve the quality of life (QoL) among older adults with hearing loss, but current clinical-based interventions have multiple barriers and inequalities. Therefore, it is of great importance to conduct a community-based intervention study on this topic. So far, a very limited number of randomized controlled trials (RCT) regarding the impact of aural rehabilitation on QoL for this population were mainly conducted in developed countries, and studies on this issue in China did not exist. Our previous community-based epidemiology study showed that only 6.5% of older adults with hearing loss acquired a hearing aid. Based on this community survey, we will design and conduct a RCT with a combined intervention package, including hearing aid fitting, perceptual training and counseling, for rehabilitation providers, patients and their families, as well as investigate the best interventions through feasibility and cost-effectiveness analyses. This study will be beneficial for improving well-being for older adults and giving implications to achieve healthy ageing in China.

我国老年人群听力障碍患病率在六类残疾中排名首位，随着老龄化加剧将更难应对。但是由于其徐缓发病、难以感知等疾病特点，以及个人听力健康知识缺乏，尚未引起应有重视。康复服务是提高听力障碍人群生命质量的主要策略，但目前临床干预存在障碍和不公平，需要开展社区干预。国际上康复服务对老年听力障碍生命质量影响的随机对照实验较少，我国尚未开展此类研究。本课题组前期社区听力流行病调查发现，听力障碍老年人康复利用率仅6.5%。本课题将在此项调查基础上，设计针对基层卫生机构、患者及家庭的助听器佩戴和听觉训练与咨询相结合的社区康复干预方案，开展随机对照研究，论证社区康复对听力障碍老年人生命质量的影响，比较不同干预方案的可行性、成本与效果，探索最优社区干预方案。此项研究在科学层面上有很好可行性，在现实层面上有利于增进老年社会福祉和实现人民群众对美好生活的向往，在政策层面上为制定老年福利政策和实现健康老龄化提供建议。

项目背景：听力障碍是中老年人最常见的感觉功能障碍，也是全球普遍的健康和公共卫生问题。我国是世界上听力障碍患者最多的国家，听力障碍也是危害我国中老年人健康的重大致残因素。随着我国人口老龄化的加剧，听力障碍和听力残疾患病率迅速提高，中老年人患病率大幅高于其他人群。听力障碍广泛降低了患者的健康水平，带来沉重的社会经济负担。虽然听力障碍的危害性大，其对健康和经济社会的影响尚未引起个人和社会应有的重视。作为主要的康复干预手段，助听器有助于改善听力障碍人群的健康与社会福祉，但其利用仍面临多种障碍。.研究内容：在山东省临沂市沂水县和费县进行的以助听器适配为主的随机对照试验（RCT），设计以社区为基础的听力障碍老年人助听器康复干预方案。通过双重差分法评估助听器康复干预对中老年人健康和医疗服务利用的效果；对助听器康复干预进行成本效果分析，计算每获得一单位质量调整生命年所增加的成本；最后进行预算影响分析，测算在不同助听器报销比例下的医保预算费用变动。.结果与数据：助听器康复干预显著减轻了抑郁症状（β=−0.15，p=0.032），提高了听力相关生命质量（β=−2.46，p=0.015），以及情景方面的生命质量（β=−1.47，p=0.004）。在医疗卫生服务利用方面，助听器干预显著降低了自我治疗的费用（β=−0.91，p=0.015）及自我治疗自付费用（β=−0.93，p=0.009）；显著降低了总医疗费用（β=−1.48，p = 0.020）及总医疗自付费用（β=−1.52，p= 0.013）。若助听器的平均使用年限大于2.20年，则干预非常具有成本效果。假定医疗保险系统对助听器报销比例从10%到100%变化，相应的助听器报销政策覆盖人群的比例从12.2%到100%变化，医保预算支出也随之变动，最多约需3.25年医保预算即可持平。.科学意义：本研究在实践层面上有助于促进中老年人听力障碍的助听器康复干预，增进中老年社会福祉和实现人民群众对美好生活的向往，在政策层面上为制定老年福利政策和实现健康老龄化提供基于实证的建议。