Primary care providers perform more neurologic visits than neurologists among Medicare beneficiaries

Abstract

Rationale, aims and objectives Little is known about which medical providers, other than neurologists, are involved in the care of neurologic conditions. We aimed to describe the current distribution of outpatient neurologic care by provider type. Methods We conducted a restrospective, cross‐sectional analysis using a 20% national sample claims database that contains information on medical care utilizations from adult Fee‐for‐Service Medicare beneficiaries in 2015. We identified patient visits for evaluation and management services for common neurologic conditions and by medical provider type. The main outcome was the proportion of visits for neurologic conditions by medical provider type, both in aggregate and across neurologic conditions. Results 40% of neurologic visits were performed by primary care providers (PCPs) and 17.5% by neurologists. The most common neurologic conditions were back pain (49.3%), sleep disorders (8.0%), chronic pain/abnormality of gait (6.4%), peripheral neuropathy (5.9%), and stroke (5.5%). Neurologists cared for a large proportion of visits for Parkinson's disease (75.6% vs 20.8%), epilepsy (70.9% vs 26.6%), multiple sclerosis (63.9% vs 26.2%), other central NS disorders (54.2% vs 24.9%), and tremor/RLS/ALS (54.0% vs 31.2%) compared to PCPs. PCPs provided a greater proportion of visits for dizziness/vertigo (57.8% vs 9.3%) and headache/migraine (50.4% vs 35.0%) compared to neurologists. Conclusions PCPs perform more neurologic visits than neurologists. With the anticipated increased demand for neurologic care, strategies to optimize neurologic care delivery could consider expanding access to neurologists as well as supporting PCP care for neurologic conditions.

Difference in rural and urban Medicare prescription pattern for Parkinson’s disease in Hawai‘i

“…Although over 20% of the population resides in a rural area, 87% of the prescriptions were written by urban providers. In the urban areas, 74.4% of the prescriptions were provided by neurologists, compatible with previous studies showing that even in an area with low density of neurologists, high proportion (75–80%) of PD care is provided by neurologists [5] , [6] , [7] , [8] . This was in contrast with rural areas of Hawai‘i, where only 25.1% of the prescriptions were written by neurologists.…”

“…However, for PD, a remarkably high proportion (>80%) of neurologist involvement was seen even in the lowest quintile regions [5] . In another study, primary care clinicians provided more neurological care than neurologists in many neurological conditions, including dizziness and headaches, but PD care was predominantly provided by neurologists (75.6%) vs primary care clinicians (20.8%) [8] . Beyond this, there are not many studies examining the access gap and urban–rural disparity patients with PD face.…”

Barriers to Vaccination Among People with Parkinson’s Disease and Implications for COVID-19

“…[22], we hypothesized that individuals who either have lost or are at risk of losing access to neurological care may similarly be at risk of losing access to primary care, and thus, vaccinations [23,24]. Fur- The team asked participants how many times they Table 2 shows the results for vaccination rates, healthcare utilization, and self-reported illnesses.…”

Increased Risk of Injury Following a Diagnosis of Vertigo: A Population‐based Study

“…Vertigo and dizziness are among the most frequent presenting symptoms in outpatient consultations, surpassing headaches in the United States 1 . This symptom entity encompasses a number of sensorimotor and multisensory syndromes of numerous etiologies and pathogeneses, such as cardiovascular disease, stroke in the brainstem, or cerebellum, and the most widely prevalent of all, peripheral vestibular disorders (PVD).…”