title: Disability and treatment patterns of multiple sclerosis patients in United States: a comparison of veterans and nonveterans.
abstract: The Veterans Health Administration (VHA) is the largest integrated healthcare system in the world and provides care to approximately 20,000 multiple sclerosis (MS) patients. Here, we report that these MS patients are disproportionately more likely to be older, male, unemployed, and disabled with lower levels of education and financial resources when compared to veterans not receiving care within the VHA or to nonveteran MS patients. When comparing the VHA MS patients to a cohort of nonveteran MS patients matched for age, sex, and disability, we found that veterans receiving care within the VHA were equally likely to have received care from a neurologist and more likely to have received care from rehabilitation specialists and primary care physicians than nonveterans. Similarly, veterans in the VHA were more likely to receive therapy with certain symptomatic medications but were less likely to be treated with disease-modifying agents for MS (DMAMS) than nonveterans. When treated with DMAMS, they are more likely to be treated with Avonex and significantly less likely to receive treatment with Copaxone or Novantrone.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA. timothy.vollmer@yale.edu
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Vollmer
authors.forename: Olympia
authors.initials: O
authors.lastname: Hadjimichael
authors.forename: Jana
authors.initials: J
authors.lastname: Preiningerova
authors.forename: Weijia
authors.initials: W
authors.lastname: Ni
authors.forename: Joan
authors.initials: J
authors.lastname: Buenconsejo
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D011336:Probability; D012042:Registries; D012680:Sensitivity and Specificity; D014481:United States; D014728:Veterans