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Access to and utilization of neurologists by people with multiple sclerosis

From Brigham and Women's Hospital (S.L.M.), Boston, MA; Abt Associates Inc. (D.C.H., L.H., T.R.), Cambridge, MA; National Multiple Sclerosis Society (D.F.), New York, NY; and Heller School (J.P.), Brandeis University, Waltham, MA.

Address correspondence and reprint requests to Dr. Sarah L. Minden, Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 02138 sarah_minden{at}abtassoc.com

Objective: This study examined access to and use of neurologists among a broad, national sample of people with multiple sclerosis (MS); identified demographic, economic, and clinical factors associated with access and use; and examined differences in treatment and management of MS.

Methods: We used computer-assisted telephone interviews to collect data from 2,156 people with MS on demographics, disease characteristics, and use of neurologists, other specialists, and disease-modifying agents (DMAs). We used ² tests and logistic regressions to compare patients of neurologists and other providers and identify predictor variables and treatment factors associated with seeing neurologists.

Results: For their usual MS care, 72.2% of participants saw a neurologist. The probability of seeing a neurologist was significantly lower for people who lacked health insurance, were poor, lived in rural areas, or were African American; had been ill for more than 15 years; had difficulty walking but did not use an assistive device; or required a wheelchair/scooter or were confined to bed. People who reported one to two relapses in the preceding year and women were significantly more likely to see neurologists. Patients of neurologists were significantly more likely to take a DMA, attend an outpatient rehabilitation program, or see an occupational therapist, urologist, or physical therapist.

Conclusions: People with multiple sclerosis who see neurologists are more likely than people who see other providers to receive treatment with disease-modifying agents and see rehabilitation specialists and urologists. While some people may choose other providers, economic, insurance, racial, and geographic factors appear to limit access to neurologists.

GLOSSARY: AMA = American Medical Association; DMA = disease-modifying agent; MEPS = Medical Expenditure Panel Survey; MS = multiple sclerosis; NHIS = National Health Interview Survey; NMSS = National Multiple Sclerosis Society.

Supplemental data at www.neurology.org

Supported by the National Multiple Sclerosis Society. Dr. Minden's preparation of the report was supported by the Lily Center for Women's Health Fellowship, one of the 50th Anniversary Scholars in Medicine Fellowships of Harvard Medical School.

Disclosure: The authors report no conflicts of interest.

Received July 18, 2006. Accepted in final form August 14, 2007.