Patterns of care for Multiple Sclerosis in a setting of universal care access: A cross-sectional study

Laura Barin; Marco Kaufmann; Anke Salmen; Christian P Kamm; Claudio Gobbi; Jens Kuhle; Caroline Pot; Andrew Chan; Adam Czaplinski; Vladeta Ajdacic-Gross; Stephanie Rodgers; Jürg Kesselring; Milo A Puhan; Viktor von Wyl; Swiss Multiple Sclerosis Registry

doi:10.1016/j.msard.2018.11.033

Patterns of care for Multiple Sclerosis in a setting of universal care access: A cross-sectional study

Mult Scler Relat Disord. 2019 Feb:28:17-25. doi: 10.1016/j.msard.2018.11.033. Epub 2018 Dec 2.

Authors

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].
² Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].
³ Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. Electronic address: [email protected].
⁴ Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: [email protected].
⁵ Neurocentre of Southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland. Electronic address: [email protected].
⁶ Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: [email protected].
⁷ Department of Clinical Neurosciences, Laboratories of Neuroimmunology, Division of Neurology and Neuroscience Research Centre, University Hospital of Lausanne, Lausanne, Switzerland. Electronic address: [email protected].
⁸ Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. Electronic address: [email protected].
⁹ Neurology, Neurocentrum Bellevue, Zurich, Switzerland. Electronic address: [email protected].
¹⁰ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].
¹¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].
¹² Department of Neurology & Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland. Electronic address: [email protected].
¹³ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].
¹⁴ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Electronic address: [email protected].

PMID: 30530118
DOI: 10.1016/j.msard.2018.11.033

Abstract

Background: Current guidelines recommend regular neurological MS care in persons diagnosed with MS, but little is known about implementation of this recommendation or potential access barriers. This study examined disease-specific and sociodemographic differences between MS patients in Neurological Care (NeC), General Practitioner Care (GPC), or no Physician Care (NoPC) to identify group differences and characteristics that may suggest care access barriers.

Methods: Patient-reported data were analyzed from 1038 Swiss Multiple Sclerosis Registry participants by means of multivariable regression to identify systematic differences across the three care groups. Assessments included comprehensive data on clinical, sociodemographic, and geographic factors.

Results: 89% reported being in regular care by a neurologist (56% in private practices, 44% in hospitals), 5% were in GPC, and 6% reported No Physician Care (NoPC). Compared with the NeC group, patients not seeing a neurologist included two subgroups, one consisting of persons with a primary progressive MS (PPMS) and/or an extended MS history. The second subgroup included persons with a recent MS diagnosis within the last 2 years. Within the NeC group, the patients seen in private practices were of older age and more frequently female compared to those at clinics, but no differences were detected with regard to disability status, MS type, or treatment patterns.

Conclusions: Access to neurological care is high in Switzerland. Given the emerging paradigm for early treatment and new drugs for progressive MS, regular neurology visits should be promoted among patient groups currently less in neurological care such as persons with PPMS or recently diagnosed.

Keywords: Access to Care; Disease-modifying treatment; Health care; Multiple Sclerosis; Switzerland.

MeSH terms

Adult
Aged
Cross-Sectional Studies
Delivery of Health Care*
Female
Humans
Male
Middle Aged
Multiple Sclerosis / epidemiology
Multiple Sclerosis / therapy*
Patient Acceptance of Health Care
Switzerland
Universal Health Insurance*