title: The impact of a multidisciplinary, holistic approach to management of patients diagnosed with multiple chemical sensitivity on health care utilization costs: an observational study.
abstract: OBJECTIVE
  The aim of this study was to look at the impact of a multidisciplinary approach to treatment of individuals with multiple chemical sensitivity (MCS) and to present preliminary results which compare health care utilization pre- and postmanagement of individuals with MCS.
  
  
  METHODS
  The design for this study was that for a cohort study.
  
  
  METHODS
  The setting for this study was the Nova Scotia Environmental Health Centre (NSEHC; Fall River, Nova Scotia, Canada).
  
  
  METHODS
  Following ethical approval, individuals who had filled a detailed-symptoms questionnaire and had agreed to participate in research activities were linked to their medical insurance records, using encrypted numbers and a blind procedure for confidentiality. Diagnosis by the NSEHC; physicians followed the consensus criteria for multiple chemical sensitivity (MCS). A total of 563 patients formed 3 cohorts (145 in 1998; 181 in 1999; and 237 in 2000).
  
  
  RESULTS
  Physicians' visits by general practitioner and by specialists, emergency and hospital separations, and associated costs showed a relative decrease in the years following the consultation at the NSEHC. The overall yearly decline in consultations between the years before the initial consultation until 2002, for each cohort, was: 9.1% for the 1998 cohort; 8% for the 1999 cohort; and 10.6% for the 2000 cohort; compared with 1.3% for the overall Nova Scotia population. Relative to the provincial utilization costs, the standardized average yearly decrease in utilization costs for the 3 cohorts combined was 8.7%, or a total savings of $77,440. The 1998 cohort showed a sustained decrease up to 2002, reaching a level similar to the overall Nova Scotia population. Those with high symptom scores had the highest reduction in mean physician visits (31% for the 1998 cohort) in the following years.
  
  
  CONCLUSIONS
  Presented in this paper are the preliminary results of the health care utilization costs in the management of individuals with MCS. Despite the limitations of our study design, the initial findings from this study are encouraging and warrant further exploration. These results indicate a possible impact on the long-term health care utilization from the NSEHC's management strategies, although a further controlled study, with a longer follow-up, may be necessary to confirm these findings.
authors: Nova Scotia Environmental Health Centre, Fall River, Nova Scotia, Canada. roy.fox@cdha.nshealth.ca
authors: Roy A
authors: RA
authors: Fox
authors: Michel R
authors: MR
authors: Joffres
authors: Tara
authors: T
authors: Sampalli
authors: Jill
authors: J
authors: Casey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000191:economics; D002648:Child; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D018777:Multiple Chemical Sensitivity / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D009674:Nova Scotia / Q000453:epidemiology; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000191:economics* / Q000706:statistics & numerical data