Access to and utilization of neurologists by people with multiple sclerosis.
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 chi(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.
Minden
S L
SL
Brigham and Women's Hospital, Boston, MA, USA. sarah_minden@abtassoc.com
Hoaglin
D C
DC
Hadden
L
L
Frankel
D
D
Robbins
T
T
Perloff
J
J
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards* / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000534:rehabilitation / Q000628:therapy*; D009462:Neurology / Q000706:statistics & numerical data*; D012008:Recurrence; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors