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Open Access Research article

Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff

Phillip E Gander12*, Derek J Hoare12, Luke Collins12, Sandra Smith12 and Deborah A Hall123

Author Affiliations

1 NIHR National Biomedical Research Unit in Hearing, 113 The Ropewalk, Nottingham, NG1 5DU, UK

2 School of Clinical Sciences, The University of Nottingham, Nottingham, NG7 2RD, UK

3 Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK

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BMC Health Services Research 2011, 11:162  doi:10.1186/1472-6963-11-162

Published: 6 July 2011

Abstract

Background

In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments.

Methods

We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service.

Results

The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service.

Conclusions

Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients.