Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
Neurology. 2011 Aug 30;77(9):851-7. doi: 10.1212/WNL.0b013e31822c9123. Epub 2011 Aug 10.
To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes.
This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty.
More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79).
Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
调查美国治疗帕金森病 (PD) 患者的神经科医生服务利用情况，并确定神经科医生治疗是否与改善临床结局相关。
这是一项对 2002 年医疗保险受益人的 PD 回顾性观察队列研究。采用多水平逻辑回归确定 2002 年至 2005 年间哪些患者特征预测了神经科医生的治疗，并比较了接受神经科医生和初级保健医生治疗的 PD 患者的年龄、种族、性别和合并症调整后的熟练护理机构安置和髋部骨折的年风险。使用 Cox 比例风险模型确定使用事件性 PD 病例，按医生专业划分的 6 年死亡调整风险。
确定了超过 138,000 例新发 PD 病例。只有 58%的 PD 患者在 2002 年至 2005 年间接受了神经科医生的治疗。种族和性别是神经科医生治疗的重要人口统计学预测因素：女性（比值比 [OR] 0.78，95%置信区间 [CI] 0.76-0.80）和非白人（OR 0.83，95% CI 0.79-0.87）接受神经科医生治疗的可能性较小。在包括人口统计学、临床和社会经济协变量的逻辑回归模型中，接受神经科医生治疗的患者更不可能被安置在熟练护理机构（OR 0.79，95% CI 0.77-0.82），髋部骨折的风险较低（OR 0.86，95% CI 0.80-0.92）。在调整后的模型中，接受神经科医生治疗的患者死亡的可能性也较低（风险比 0.78，95% CI 0.77-0.79）。
PD 女性和少数民族患者获得专家治疗的机会比白人男性少。神经科医生对 PD 患者的治疗可能与改善某些临床结局和提高生存率有关。
