PRACTICE STYLES OF US COMPARED TO UK NEUROLOGISTS

Objective: This study assessed variation between neurologists in the U nited States and United Kingdom in their diagnostic and treatment deci sions for commonly encountered neurologic presentations, and identifie d explanatory factors for any observed variation. Methods: All 210 con sultant neurologists in the United Kingdom and a nationally representa tive sample of 595 US neurologists received mailed surveys containing three detailed clinical scenarios depicting patients with (1) a single unprovoked seizure occurring 3 days previously, (2) early Parkinson's disease, and (3) dementia. The main study outcome measures were self- reported decisions regarding diagnostic test ordering and treatment, w hich were assessed after each scenario. Neurologists' practice charact eristics, certainty about the diagnosis, and attitudes toward uncertai nty were also measured. Survey response rates were 92% of US and 63% o f UK neurologists, Results: A higher proportion of US than UK neurolog ists indicated they would order additional diagnostic tests for all th ree scenarios (all p < 0.05); 77% of UK compared with 26% of US neurol ogists would manage a single unprovoked seizure without antiepileptic medication (p < 0.0001), but treatment of early Parkinson's disease wa s not different. Nearly all US and UK neurologists would obtain a neur oimaging study in the evaluation of dementia. International difference s persisted after adjustment for differences in demographic and practi ce characteristics and for attitudes toward test use and clinical unce rtainty. Conclusions: We identified large international variation in c linical decisions across three common neurologic conditions, Cross-cou ntry collaboration should explore these differences to develop consens us on standards of care.