General neurologist and subspecialist care for multiple sclerosis - Patients' perceptions

Objective: To compare general neurologists and MS specialists on patients' clinical characteristics and MS care as perceived by patients with MS. Meth ods: 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-f or-service portion of 23 randomly selected California neurologists' practic es. In mid-1996, 694 subjects were mailed questionnaires; 532 (77%) respond ed. Sociodemographic/clinical characteristics, recent utilization of servic es/treatments, unmet needs, symptom care, and research participation were m easured. Of 502 subjects (94%) who indicated their usual physician providin g MS care was a neurologist, 217 (43%) reported having a general neurologis t and 285 (57%) reported having an MS specialist. Comparisons between these two groups were adjusted for comorbidity and disease severity. Results: Ge neral neurologist and MS specialist patient groups did not differ on any so ciodemographic or clinical characteristic except age (p < 0.05), Although h ealth care utilization generally was similar, higher proportions of the MS specialist-group were aware of or had discussed interferon beta-lb (IFN bet a-1b) with their physician (p < 0.05) and were currently taking it (p < 0.0 5); a smaller proportion of the MS specialist group reported stopping it be cause of side effects (p < 0.01). Overall, levels of unmet need and care fo r recent symptoms were similar, but the MS specialist group reported more c onfidence 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 s tudies 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.