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People with MS who see neurologists are more likely than those who see other providers to receive treatment with disease-modifying agents and to see rehabilitation specialists and urologists, according to a new article based on the Sonya Slifka Longitudinal MS Study funded by the National MS Society’sPromise: 2010research and care initiative. Sarah Minden, MD (Abt Associates) and colleagues published these findings in a special supplement ofNeurologydedicated to MS (2008;70:1141). The study suggests that the 28% who consult non-neurologists for their MS care – whether because of choice, lack of access, socioeconomic and other factors – may not be receiving the latest advice or widest spectrum of treatments that have been shown to improve outcomes. Although the study was not designed to determine quality of care among types of physicians treating MS, it highlights the need for broader dissemination, to non-specialist physicians and to patients and their families, of expert recommendations that can optimize care for people with MS.
While most people with MS receive their MS care from neurologists, others receive their MS care from non-neurologist physicians. A key area of the Society’s research mission is to improve quality of MS care by determining how people with MS utilize health care, and how this utilization may affect their life with MS.
One resource for researchers investigating socio-economic and quality of life questions about MS is the Sonya Slifka Longitudinal MS Study. This ongoing study, a targeted research initiative funded through the Society’s Promise: 2010 campaign, tracks a large, diverse sample of people with MS. Researchers interview thousands of people with MS via telephone every six months, asking about how MS influences their daily lives, how effective their treatments are, and how they utilize health care.
For this study, Dr. Minden and colleagues analyzed data on 2,156 Sonya Slifka Longitudinal MS Study participants, including demographics, disease characteristics, and use of neurologists, other specialists, and disease-modifying agents. A small proportion of the participants did not seek any usual care for their MS. This study focused on participants who saw a health care provider for their MS, comparing characteristics of people who used neurologists (MDs who specialize in disorders that impact the nervous system) with those who used other providers.
Neurologists were seen by 72.2% of participants for routine MS care. Most of the other providers were primary care physicians. People with MS who used neurologists were significantly more likely to take disease-modifying agents, attend an outpatient program, and see occupational therapists, urologists, or physical therapists.
The probability of seeing a neurologist was significantly lower in individuals who did not have health insurance, were poor, lived in rural areas, or were African American. Also, people who had had MS for more than 15 years, had difficulty walking but did not use an assistive device, required a wheelchair or scooter, or were confined to bed were less likely to see neurologists. Those who were significantly more likely to see a neurologist were women, or had reported one to two relapses during the previous year. Also, the percentage of participants who saw neurologists decreased steadily with increasing age.
The authors caution that this study was not designed to determine quality of care. They suggest, however, that the full range of treatments and rehabilitation interventions available to people with MS may not be as familiar to non-neurologic health care providers. These findings highlight the need for broader dissemination of expert recommendations that can optimize care for people with MS.
The National MS Society provides numerous resources to educate all health care professionals treating MS through itsProfessional Resource Center,including a Clinical Consultation, in which physicians are invited to consult via email with MS specialist colleagues who serve on the Society’s National Clinical Advisory Board.
The National MS Society is recruiting 2,500 additional people for the second phase of the Sonya Slifka Longitudinal MS Study.Find out whether you’re eligible to participate in this study.For this second phase, we are seeking people with MS who belong to one or more of these groups: recently diagnosed (within 12 months of the date of enrollment), African-American, Hispanic, 18-24 years old.
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