Access to Multiple Sclerosis Specialty Care

Abstract

Access to care in rural areas and areas at a greater distance from a major medical center represent notable barriers to rehabilitation and other multiple sclerosis-related care.

Chronic Lower Limb Wound Outcomes Among Rural and Urban Veterans

“…As expected, rural veterans used less VHA specialty wound care than urban veterans. This is consistent with a number of other studies that reported poorer specialty access for rural veterans . The mean number of outpatient visits observed in this study was higher than that in a study of VHA patients with an incident diabetic foot ulcer (average of 5 visits) but similar to the nonintervention group in a study of diabetic foot ulcers set in a public hospital .…”

“…Veterans living in rural areas use fewer health care services than their urban counterparts, often related to transportation, time, and cost barriers . Rural veterans also receive less specialized care than urban veterans . Coordinated, specialized wound care has been shown to improve chronic wound healing .…”

Barriers to the Accessibility and Continuity of Health-Care Services in People with Multiple Sclerosis

“…28 Individuals with MS often need multiple specialtycare services and often receive numerous subspecialty or allied health referrals, including for radiology; occupational, physical, speech, and vocational therapies; nutrition; and pain specialists. However, delayed or discontinued referrals are not uncommon for individuals with MS. 9,17,20,23 Furthermore, as was identified in the present review, primary-care providers often address only one focal condition rather than taking a comprehensive view, including consideration of comorbid conditions and secondary health problems. A care coordination service by a professional specialized in disability and life span care is a critical component of care for many patients with MS. A professional case manager or life span coach specialized in disability can integrate a client's needed health-care services and health-care coverage across an individual's life stages.…”

“…We reviewed the full text of these eight citations and elected to exclude one study involving 9643 veterans with MS 17 because the study did not use interviews to inquire about specific barriers. Of the seven remaining studies, 9,[18][19][20][21][22][23] four used focus group interviews, two used telephone interviews and surveys, and one used a survey with questions generated from a focus group interview.…”

Rates of Early Treatment for US Veterans With Multiple Sclerosis

“…Both studies determined that access to care is comparable between veterans and nonveterans, but that veterans are less likely to use disease-modifying agents. 16,17 The VA's Multiple Sclerosis Centers of Excellence, utilizing the Multiple Sclerosis National Data Repository, have also conducted numerous epidemiologic studies on varying aspects of veteran MS patient treatment, [18][19][20][21][22] most involving surveys of willing participants, rather than system-wide database studies of all patients.…”