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General neurologist and subspecialist care for multiple sclerosis

Patients’ perceptions

From the Department of Neurology (Drs. Vickrey, Ellison, and Myers, and Z.V. Edmonds), UCLA School of Medicine, Los Angeles, CA; Center for Health Care Policy and Evaluation (Dr. Shatin), United HealthGroup, Minneapolis, MN; Department of Medicine (Dr. Shapiro), UCLA School of Medicine, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences (S. Delrahim and Dr. Belin), UCLA School of Medicine and UCLA Neuropsychiatric Institute, Los Angeles, CA; and Department of Biostatistics (Dr. Belin), UCLA School of Public Health, Los Angeles, CA.

Address correspondence and reprint requests to Dr. Barbara G. Vickrey, UCLA Department of Neurology, C-128 RNRC, Box 951769, Los Angeles, CA 90095-1769.

OBJECTIVE: To compare general neurologists and MS specialists on patients’ clinical characteristics and MS care as perceived by patients with MS.

METHODS: We sampled all adult patients with MS having physician visits over a 2-year period from a Midwestern managed-care organization and from the fee-for-service portion of 23 randomly selected California neurologists’ practices. In mid-1996, 694 subjects were mailed questionnaires; 532 (77%) responded. Sociodemographic/clinical characteristics, recent utilization of services/treatments, unmet needs, symptom care, and research participation were measured. Of 502 subjects (94%) who indicated their usual physician providing MS care was a neurologist, 217 (43%) reported having a general neurologist and 285 (57%) reported having an MS specialist. Comparisons between these two groups were adjusted for comorbidity and disease severity.

RESULTS: General neurologist and MS specialist patient groups did not differ on any sociodemographic or clinical characteristic except age (p < 0.05). Although health care utilization generally was similar, higher proportions of the MS specialist group were aware of or had discussed interferon beta-1b (IFNß-1b) with their physician (p < 0.05) and were currently taking it (p < 0.05); a smaller proportion of the MS specialist group reported stopping it because of side effects (p < 0.01). Overall, levels of unmet need and care for recent symptoms were similar, but the MS specialist group reported more confidence in their physician/carefulness in listening (p < 0.05). Twice as many MS specialist subjects had participated in nondrug research (p < 0.05); drug study participation was similar.

CONCLUSIONS: Patients’ perceptions of their care were similar in most ways for those who designated their main MS provider as a general neurologist compared to an MS specialist; however, care differed in potentially important areas. Prospective, longitudinal studies are needed to measure and relate neurologists’ training, experience, knowledge, and MS patient volume with both process and outcome measures of quality of MS care.

Key words: MS care—MS specialty care—Patient perceptions.

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