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

Barin, L.; Kaufmann, M.; Salmen, Anke; Kamm, Christian P.; Gobbi, C.; Kuhle, J.; Pot, C.; Chan, Andrew; Czaplinski, A.; Ajdacic-Gross, V.; Rodgers, S.; Kesselring, J.; Puhan, M. A.; von Wyl, V. (2019). Patterns of care for Multiple Sclerosis in a setting of universal care access: A cross-sectional study. Multiple Sclerosis and Related Disorders, 28, pp. 17-25. Elsevier 10.1016/j.msard.2018.11.033

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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.

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