title: High rates of physician services utilization at least five years before multiple sclerosis diagnosis.
abstract: BACKGROUND
  Multiple sclerosis (MS) management has changed over time, but changes in health care utilization by MS patients remain understudied. We estimated physician services utilization in the five-year periods before and after MS diagnosis, and over the period 1984-2008.
  
  
  METHODS
  Using administrative data we identified 4092 persons with MS and a matched general population (GPOP) cohort of 21,446 persons. Using general linear models we compared physician visits between the MS and GPOPs for the period 1984-2008, the year of MS diagnosis, and for the five-year periods pre- and post-diagnosis.
  
  
  RESULTS
  From 1984 to 2008, 98% of the MS population averaged ≥1 physician visits/year versus 87% of the GPOP. In 2008, the MS population had 12.9 physician visits/person-year while the GPOP had 8.4 (rate ratio (RR) 1.53; 95% confidence interval (CI): 1.52-1.55). Five years pre-MS diagnosis, the MS population had more physician visits than the GPOP (RR 1.15; 95% CI; 1.10-1.21). The number of visits peaked the year of MS diagnosis (19.0), decreasing thereafter, but remaining elevated versus the pre-diagnosis period.
  
  
  CONCLUSIONS
  The MS population uses more physician services than the GPOP, starting at least five years pre-MS diagnosis. A better understanding of the reasons for these higher utilization rates may ultimately improve outcomes in MS.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada. rmarrie@hsc.mb.ca
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.forename: Nancy
authors.initials: N
authors.lastname: Yu
authors.forename: Yichuan
authors.initials: Y
authors.lastname: Wei
authors.forename: Lawrence
authors.initials: L
authors.lastname: Elliott
authors.forename: James
authors.initials: J
authors.lastname: Blanchard
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis; D009819:Office Visits / Q000706:statistics & numerical data*; D010820:Physicians; D013997:Time Factors; D014600:Utilization Review