OBJECTIVE: To determine if general neurologists and multiple sclerosis (MS) specialists provide similar care for MS patients. BACKGROUND: To describe which model of caring for chronic conditions provides good quality of care and at what societal cost, information is needed about current care patterns. Although attention has been focused on the proper rotes of generalists and specialists, similar issues exists for specialist vs. subspecialist care. DESIGN/METHODS: Adults with MS were sampled from 2 sources: all patients with physician visits for MS in a health plan in the midwest, and practices of 23 randomly selected neurologists in southern California. All patients were administered mailed questionnaires in 1995, with an overall response rate of 77%. 502 (94%) of patients reported that the doctor they usually saw for their MS care was either a general neurologist (43%) or an MS specialist (57%). Subjects were asked about their recent MS care, utilization of services, receipt of preventive health services, use of alternative medicine, health-related quality of life (HROOL), comorbidity, disability, and socidemographic characteristics. Bivariate and multivariate analyses were used. RESULTS: Patients of general neurologists and specialists did not differ on any sociodemographic characteristics except that MS specialists' patients were younger (46yrs. vs. 49 yrs.; p<0.02). The groups did not differ on HRQOL, comorbidity, and disability. More general neurologists' patients reported never having heard of beta-interferon (the latest drug for treating relapsing/remitting MS at the time of survey) than MS specialists' patients (12% vs. 4%, p<0.001). Of those who had ever taken the drug (30% of the general neurologist group vs. 35% of the MS specialist group. p>0.10), more MS specialists were currently taking beta-interferon, 24%. compared to only 15% of the general neurologists' patients (p<0.04). Twice as many general neurologists' patients had taken the drug but stopped due to side effects (12% vs. 6%, p<0.01). Finally, a higher proportion of MS specialists' patients had recently participated in an MS research study (9% vs. 4%, p<0.05). There were no differences in the percentage of patients receiving preventive health services, use of alternative medicine, hospitalizations, or frequency of outpatient visits and referrals (all p>0.05). All significant differences remained after adjusting for disability, MS duration, sampling source, and comorbidity. CONCLUSION: Many aspects of MS care were no different for patients reporting their physicians were general neurologists vs. MS specialists. Where there were difference, it related to the use of and provision of information regarding beta-interferon. Differences in specialty vs. subspecialty care may be more likely to occur in relation to introduction of new treatments.
|Journal||Journal of Investigative Medicine|
|State||Published - Feb 1999|