Purpose: Hearing loss, deafness, and other hearing-related conditions can significantly impact quality of life; numerous qualitative studies have sought to describe these impacts. Synthesis of these findings may provide additional or more robust insights. Methods: A qualitative systematic review of studies reporting qualitative data relating to the impact of hearing problems on adults’ health-related quality of life. A subset of studies was included in the review and subsequently analysed using a thematic approach. Results: The literature search yielded 129 studies, of which 22 met our inclusion criteria and were included for analysis. The included studies, primarily from Australia, the UK, and the USA, involved approximately 450 participants with various hearing conditions. Semi-structured interviews and focus groups were the most common data collection methods, with thematic analysis being the predominant analytical approach. Three overarching categories of descriptive themes were identified: Physical, Mental, and Social. Physical encompassed sound localization, sound clarity, speech, and physical fatigue. Social included relationships, isolation, communication, independence, work function, social stigma, and confidence. Mental encompassed depression, anxiety, listening effort, mental fatigue, fear, and identity. The identified themes shed light on the diverse domains of health-related quality of life affected by hearing conditions. Conclusion: Differences in hearing function impact upon people’s health-related quality of life in a variety of ways relating to physical, mental, and social aspects of health, and these themes are clearly demonstrated across qualitative studies. These results will inform the development of hearing-specific questionnaire items for with the EQ-5D descriptive system, a commonly used patient-reported outcome measure.

Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status. To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice. Case–control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years. Compared to NAs, FAs were more likely to report a lower quality of life ( P < 0.001), be unmarried ( P = 0.03) and have no educational qualifications ( P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety ( P < 0.001), morbid obesity ( P = 0.02), pain ( P < 0.001) and long-term pathological and ill-defined physical conditions ( P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001). Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity.

There is growing interest in cost-effectiveness thresholds as a tool to inform resource allocation decisions in health care. Studies from several countries have sought to estimate health system opportunity costs, which supply-side cost-effectiveness thresholds are intended to represent. In this paper, we consider the role of empirical estimates of supply-side thresholds in policy-making. Recent studies estimate the cost per unit of health based on average displacement or outcome elasticity. We distinguish the types of point estimates reported in empirical work, including marginal productivity, average displacement, and outcome elasticity. Using this classification, we summarise the limitations of current approaches to threshold estimation in terms of theory, methods, and data. We highlight the questions that arise from alternative interpretations of thresholds and provide recommendations to policymakers seeking to use a supply-side threshold where the evidence base is emerging or incomplete. We recommend that: (1) policymakers must clearly define the scope of the application of a threshold, and the theoretical basis for empirical estimates should be consistent with that scope; (2) a process for the assessment of new evidence and for determining changes in the threshold to be applied in policy-making should be created; (3) decision-making processes should retain flexibility in the application of a threshold; and (4) policymakers should provide support for decision-makers relating to the use of thresholds and the implementation of decisions stemming from their application.

Evidence regarding the effectiveness of health technologies can be distorted via numerous mechanisms, including publication bias, methodological errors, over- interpretation of findings and fraud. In recent years, popular science writers have brought these issues to the fore, resulting in popular movements to improve the credibility of science. One particularly effective campaign has been that of the AllTrials movement, which focuses on the pre-registration and reporting of all clinical trials [1]. Many of the concerns that led to this campaign can be observed in the context of decision modelling.\ud In 2010, researchers called for the creation of a collaborative organisation to oversee a registry of decision models [2]. The concept was not realised. In recent years, the landscape of academic publishing and collaboration has changed dramatically. In this editorial, we restate the call for a model registry and recommend actionable steps for its introduction