Check-up from the neck-up in primary care

Case Study: Check-up from the Neck-up at the Kingsway Health Centre

Case Study, Hearing Services

Dr. Alykhan Abdulla is the Medical Director at the Kingsway Health Centre, a multidisciplinary team of family practitioners providing primary care — from pregnancy to palliative — in Manotick, Ontario. Theirs is a clinic offering a host of comprehensive services, including,

  • family medicine
  • sports medicine
  • internal medicine/endocrinology
  • cosmetic services
  • travel and vaccination clinic
  • in-office surgeries
  • foot care
  • counseling services, and more

They also partner with a number of other regional practices. Together, they can offer the most well-rounded, efficient care possible for all their patients any day, any time.

In addition, Dr. Abdulla serves as a medical advisor for the Champlain LHIN Health Professionals’ Advisory Committee. Their mandate is to ensure that health services are well-organized, appropriately funded, and meet the health needs of the 1.3 million residents who live within the region. In his capacity as medical advisor, Dr. Abdulla works with the leadership team and a committee of champions to review policies and programs to manage healthcare access and efficiency parameters.

A large number of Dr. Abdulla’s patients at the Kingsway Health Centre are older adults. He estimates that 30% of his almost 2,000 patients are 65 and over. He has spent years devising a series of care policies and testing options intended to best serve this specific population of patients. Working with his registered nurse, Ms. Dorothy Thomson, they had come to realize that there were a series of much-needed medical tests that simply weren’t being provided during annual physical exams.

“We do standardized testing for your general health like mammograms, prostate testing, colon cancer checking, etc., but we rarely check mental function, hearing testing, and mood tracking. These ‘neck-up’ screening tests improve healthcare quality.”

Dr. Abdulla includes a series of “neck up” tests for all his patients over the age of 65. This allows him to establish an early baseline that he can then compare against during later annual exams. This helps him to identify and address early cognitive declines that often happen over time.

The Kingsway Health Centre books only older adult patients on Friday. They meet with Dorothy, who performs the following tests:

Montreal Cognitive Assessment (MoCA)
This test is a quick screening instrument for mild cognitive dysfunction. It assesses things like,

  • attention and concentration
  • executive functions
  • memory
  • language
  • conceptual thinking
  • calculations
  • orientation

Champlain LHIN Fall risk test
Designed to assess a patient’s risk of a fall, this test is comprised of a combination self-assessment questionnaire and a review of things such as,

  • current medications
  • gait
  • balance
  • mobility and muscle strength
  • feet and footwear
  • environmental hazards
  • even depression

PHQ9 and GAD7
This fast and reliable screening tool is the first step in depression/anxiety assessment.

Hearing test with SHOEBOX
It is a well-documented fact that 1 in 3 adults over the age of 65 will experience hearing loss. This sensory deficit can have a significant impact on one’s quality of life. Losing the ability to comprehend and exchange information may cause loneliness, isolation, dependence, and frustration. There is even research that indicates a correlation between the onset and severity of dementia and one’s ability to hear.

It is so important to regularly test the hearing of our older adult patients. Often they get misdiagnosed with having a memory or cognitive deficit or depression when what they actually are struggling with is undiagnosed hearing loss.

Hearing Health Testing

Of all the ‘neck up’ tests that Kingsway Health Centre offers their older adult patients, the hearing test is the only one that uses new technology. Dr. Abdulla and Ms. Thomson began testing their patients with SHOEBOX in the summer of 2017.

SHOEBOX is a tablet-based audiometer that has been clinically validated by peer-reviewed research to function as well as traditional audiometers. Optimized for use outside of a sound booth, making it an ideal device in clinics like Kingsway Health. The system offers two testing modes – automated and manual.


In manual mode, SHOEBOX functions like a traditional audiometer. It gives the tester complete control over settings and how to administer the test. This is generally the testing mode used by audiologists and other hearing health professionals.


But in automated mode, the patient self-administers the test by running through a series of exercises themselves. They click an image on the screen, then drag it in one of two directions depending on whether or not they hear a sound presented at various frequencies. This automated game-like test makes it simple and easy for almost anyone to administer a clinically valid hearing test.


Since Ms. Thomson and Dr. Abdullah began administering their specific series of older adult tests, they have conducted approximately 450 hearing tests. For those who presented with some hearing loss, Dr. Abdulla refers them to the Hearing Solutions Clinic in his neighborhood. They have an arrangement where he provides a copy of the audiogram results generated by SHOEBOX Audiometry. With this, the Hearing Solutions Clinic has a good idea of the patient’s general hearing level and, therefore, can be more efficient in deciding which tests to administer to complete the evaluation. In return, the Hearing Solutions Clinic sends a follow-up report back to Dr. Abdulla for his clinic files.

Whether the patient visits the Hearing Solutions Clinic or another hearing services center – or even their ENT specialists – having that initial test performed using SHOEBOX Audiometry during their annual exam saves time and ensures they get the referral when they need it. Having the hearing test results prior to scheduling follow-up can even help with more timely and more appropriate referrals.


Having these annual tests grouped together is beneficial not only to the patient but to the clinic too. By creating this bundle, Dr. Abdulla receives his reimbursements more efficiently and effectively.

Each province/state has their own individual billing codes and regulations. It’s important that you reference your region’s separate schedule of benefits to maximize reimbursement. If you, too, are here in Ontario, Canada, you can consult the Physician Services Under the Health Insurance Act for billing codes and regulations. If you’re still unsure of the process, feel free to email Dr. Abdulla at

Patient Feedback

When asked about how patients have been responding to this battery of tests, both Dr. Abdulla and Ms. Thomson – RN, agree, the consensus is generally positive. Patients appreciate the convenience of having all the tests performed in one location, the quick nature of the tests, and that they are all covered under their provincial insurance plans.

Of note, some geriatric patients can feel uneasy about the tests, worrying about the repercussions of a “failed” test. Dr. Abdulla deals with this apprehension by creating the understanding that these tests are a standardized protocol used to provide optimal annual care for those that meet the criteria.

Dr. Abdulla and his team at the Kingsway Health Centre have devised a unique approach to delivering the “neck up” tests their older adult patients could benefit. They pride themselves on being an innovative medical team motivated to look after the whole person and the whole family.

Would you like to share your comments with Dr. Abdulla? You can reach him at

If you’re a general practitioner and would like to offer hearing testing services to your patients at your clinic, you can contact us and let us tell you how you can get started.