Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner

Oh, Jiwon; Gagné-Brosseau, Marie Sarah; Guenette, Melanie; Larochelle, Catherine; Lemieux, François; Menon, Suresh; Morrow, Sarah A.; Poliquin‐Lasnier, Laurence; Roy-Hewitson, Chantal; Rush, Carolina; Trudelle, Anne Marie; Giacomini, Paul S.

doi:10.1017/cjn.2018.7

Cited by 7 publications

(8 citation statements)

References 55 publications

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“…Family physicians are well positioned to provide ongoing continuous care that is accessible and available 52 , and they are already commonly relied on by persons with MS 53,54 . They could take on shared responsibility with neurologist to care for this patient population, as suggested by Oh et al, by supporting ongoing health maintenance, MS symptom and comorbidity management, and referrals to secondary services 55 . As Canada and Ontario move towards the adoption of patient medical homes, interprofessional team‐based, patient‐centred, continuous and comprehensive primary care 56 , the implementation of this shared care model 57 becomes even more relevant, as it has the potential to address many of the concerns raised by persons with MS.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, including outcome measures of quality of life, participation and independence to the care protocol of persons with MS may positively influence their satisfaction with care36 .To mitigate the low availability of MS neurologists, we should aim to equip family physicians with the appropriate MS-related knowledge and skills to take on a larger role in the care of MS patients.Family physicians are well positioned to provide ongoing continuous care that is accessible and available 52 , and they are already commonly relied on by persons with MS53,54 . They could take on shared responsibility with neurologist to care for this patient population, as suggested by Oh et al, by supporting ongoing health maintenance, MS symptom and comorbidity management, and referrals to secondary services55 . As Canada and Ontario move towards the adoption of patient medical homes, interprofessional team-based, patient-centred, continuous and comprehensive primary care56 , the implementation of this shared care model 57 becomes even more relevant, as it has the potential to address many of the concerns raised by persons with MS.Comprehensive care for persons with MS should include MSrelated knowledge and patient-centred care.…”

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confidence: 99%

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Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition

Pétrin

Donnelly

McColl

et al. 2020

Health Expectations

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Background People with multiple sclerosis (MS) require complex care throughout life. Canadians with MS are high users of health‐care services, yet still report unmet health‐care needs and low satisfaction with services received. Objective This study aimed to investigate the health‐care access experiences of Ontarians with MS as they manage their condition. Design and Participants Interpretive description guided data collection and analysis. Forty‐eight people living across seven communities participated. Thirty‐eight participated in one of five focus groups; the remaining 10 participated in an individual semi‐structured interview. Results Participants described the experience of accessing care as a decisional process, guided by a form of cost‐benefit analysis. The process determined whether seeking conventional health‐care services ‘is worth it’. Most participants felt that the energy and resources required to access the health‐care system outweighed their expected outcomes, based on past experiences. Participants who did not see the benefit of care seeking turned to self‐treatment, use of complementary and alternative services, and engaged in patterns of health‐care avoidance until a crisis arose. Discussion and Conclusion Findings suggest that a renewed effort to promote patient‐centred care and a biopsychosocial approach may improve the health‐care access experiences of persons with MS and reduce service avoidance.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition

Pétrin

Donnelly

McColl

et al. 2020

Health Expectations

View full text Add to dashboard Cite

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“…Telehealth, best developed for the assessment of stroke, has recently been used with multiple sclerosis 7 and Parkinson's disease 8 . Shared care models, in which neurologists and PCPs share responsibility for a patient's care, are successful in chronic medical conditions and are expanding to neurologic conditions 9 …”

Section: Discussionmentioning

confidence: 99%

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

Lin

Hill

Burke

et al. 2020

Evaluation Clinical Practice

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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.

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“…Hospitalization is usually required only for more severe attacks, the risk of which is reduced by DMT [10]. Regular primary care visits may be appropriate if they complement rather than substitute for specialty neurology care and should be interpreted in that context [12].…”

Section: Introductionmentioning

confidence: 99%

Health service utilization in immigrants with multiple sclerosis

Rotstein

Marrie

et al. 2020

PLoS ONE

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Background Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. Objective To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. Methods We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus longterm residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. Results From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent.

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Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner

Cited by 7 publications

References 55 publications

Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition

Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition

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

Health service utilization in immigrants with multiple sclerosis

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