Access to multiple sclerosis specialty care.
BACKGROUND
Health care providers recommend an annual visit to a multiple sclerosis specialty care provider.


OBJECTIVE
To examine potential barriers to the implementation of this recommendation in the Veterans Health Administration.


METHODS
Observational cohort study.


METHODS
Veterans Health Administration.


METHODS
Participants were drawn from the Veterans Affairs Multiple Sclerosis National Data Repository and were included if they had an outpatient visit in 2007 and were alive in 2008 (N = 14,723).


METHODS
Specialty care visit, receipt of medical services.


RESULTS
A total of 9643 (65.5%) participants had a specialty care visit in 2007. Veterans who were service connected, had greater medical comorbidity, and who lived in urban settings were more likely to have received a specialty care visit. Veterans who were older and had to travel greater distances to a center were less likely to have a specialty care visit.


CONCLUSIONS
Access to care in rural areas and areas at a greater distance from a major medical center represent notable barriers to rehabilitation and other multiple sclerosis-related care.
Department of Rehabilitation Medicine, Veterans Affairs Puget Sound Health Care System, S-117-RCS, 1660 S Columbian Way, Seattle, WA 98108; Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, WA; Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA(∗). Electronic address: Aaron.Turner@va.gov.
Aaron P
AP
Turner
Veterans Affairs Puget Sound Health Care System, Seattle, WA(†).
Michael K
MK
Chapko
Veterans Affairs Puget Sound Health Care System, Seattle, WA; Department of Biostatistics, University of Washington Seattle, WA(‡).
David
D
Yanez
Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, WA(§).
Steve L
SL
Leipertz
Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, WA(¶).
Alicia P
AP
Sloan
Multiple Sclerosis Center of Excellence West, Portland Veterans Affairs Medical Center, Portland, OR; Department of Neurology, Oregon Health & Science University, Portland, OR(‖).
Ruth H
RH
Whitham
Veterans Affairs Puget Sound Health Care System, Seattle, WA; Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, WA; Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA(∗∗).
Jodie K
JK
Haselkorn
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D009462:Neurology; D010810:Physical and Rehabilitation Medicine; D014481:United States; D058014:Veterans Health