Access to multiple sclerosis diagnosis for Canadian neurologists

Background: Access to multiple sclerosis (MS) diagnosis in Canada has never been assessed. This study was designed to examine the pattern of MS diagno sis in Canada, including neurologists' diagnostic approach and waiting time s for investigations. Methods: A mail survey was forwarded to every registe red neurologist in Canada (n = 479) in late 1996, Questions included their diagnostic approach to MS including perceived waiting times for various inv estigations including MRI. Actual MRI waiting periods were separately obtai ned from booking clerks or neuroradiologists from every MRI unit in Canada. Results: 153 responses were received. Neurological assessment is obtained, on average, 1 month after referral. MRI is routinely ordered by 928 of neu rologists for suspected MS followed by evoked potentials (EP) (36%) and lum bar puncture (LP) (17%). The perceived waiting period for EP and LP is less than one month but 3 months for MRI. This is very similar to the actual wa iting periods obtained from the MRI units surveyed (mean of 101 days). Ther e is a trend for longer waiting periods as one moved east to west (Eastern provinces - mean of 62 days, Ontario - 95 days, Quebec - 102 days and 122 d ays in the Western provinces). Private MRI units have appeared in the Weste rn provinces and have thr shortest waiting periods (2 weeks maximum). The c urrent MRI/million population ratio in Canada is 1.8, far below the ratios of other developed nations. Conclusions: Canadian neurologists prefer MRI o f the brain to confirm an MS diagnosis and desire greater access to it. Acc ess to neurological assessment, EP and LP is probably adequate but the aver age wait for MRI of 3 months is relatively long. The perceived average wait ing period for MRI is similar to the actual waiting times of 3 months, with the Western provinces of Canada having the longest waits. Canada continues to have one of the lowest MRI/population ratios in the developed world.