Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada

Abstract

Background: Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. Objectives: We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. Methods: We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. Results: From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. Conclusion: The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.

Trajectories of disease-modifying therapies and associated sickness absence and disability pension among 1923 people with multiple sclerosis in Sweden

“…Sequence analysis has become an important method in social science studies and more recently employed in life-course studies, analysis of career pathways, and health trajectories (Ritschard and Studer, 2018). It has also recently been employed in MS studies which looked into care consumption patterns in France and Canada (Roux et al, 2019;Roux et al, 2022) and the usage of DMTs in France (Leblanc et al, 2021). Our findings were similar to the study from France (Leblanc et al, 2021) despite a slightly different design (treatment initiation was a starting point in the French study while onset date in our study).…”

Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study

“…19 Considering the wide variation in the clinical manifestations and the course of the disease, different patterns of care must be made available. 20 This requires an integrated, person-centered approach, as recommended by the World Health Organization. This in-press manuscript has been peer reviewed and accepted for publication by the International Journal of MS Care and appears here in nearly final form.…”

“…Recent recommendations call for a multidisciplinary plan to support the different management clusters that individuals may need during the course of their disease. 20 The gradual movement of MS care from hospitals to nonhospitals 22 means that alternative community care units should be introduced to provide an appropriate multidisciplinary plan of care. This should encompass outpatient centers, day care, supported accommodation, and other alternatives of community care.…”

Discovering patterns in outpatient neurology appointments using state sequence analysis

“…They used SSA to identify patterns of DMT use and were able to classify patients into groups with similar usage patterns. In addition, Roux et al used SSA to analyse care pathways of patients with MS (18,19). In their 2019 study they analysed the amount of care that patients 'consumed', including GP (General Practitioner) consultations, consultations with a neurologist, and hospital admissions.…”