Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Mult Scler Relat Disord. 2019 Feb;28:17-25. doi: 10.1016/j.msard.2018.11.033. Epub 2018 Dec 2.
Current guidelines recommend regular neurological MS care in persons diagnosed with MS, but little is known about implementation of this recommendation or potential access barriers. This study examined disease-specific and sociodemographic differences between MS patients in Neurological Care (NeC), General Practitioner Care (GPC), or no Physician Care (NoPC) to identify group differences and characteristics that may suggest care access barriers.
Patient-reported data were analyzed from 1038 Swiss Multiple Sclerosis Registry participants by means of multivariable regression to identify systematic differences across the three care groups. Assessments included comprehensive data on clinical, sociodemographic, and geographic factors.
89% reported being in regular care by a neurologist (56% in private practices, 44% in hospitals), 5% were in GPC, and 6% reported No Physician Care (NoPC). Compared with the NeC group, patients not seeing a neurologist included two subgroups, one consisting of persons with a primary progressive MS (PPMS) and/or an extended MS history. The second subgroup included persons with a recent MS diagnosis within the last 2 years. Within the NeC group, the patients seen in private practices were of older age and more frequently female compared to those at clinics, but no differences were detected with regard to disability status, MS type, or treatment patterns.
Access to neurological care is high in Switzerland. Given the emerging paradigm for early treatment and new drugs for progressive MS, regular neurology visits should be promoted among patient groups currently less in neurological care such as persons with PPMS or recently diagnosed.
目前的指南建议对诊断出 MS 的患者进行定期的神经科 MS 护理，但对于实施这一建议或潜在的获得障碍知之甚少。本研究通过多变量回归分析了神经科护理（NeC）、全科医生护理（GPC）或无医生护理（NoPC）的 MS 患者的疾病特异性和社会人口统计学差异，以确定组间差异和可能提示获得障碍的特征。
对来自瑞士多发性硬化症登记处的 1038 名参与者的患者报告数据进行了分析，采用多变量回归来确定三种护理组之间的系统差异。评估包括临床、社会人口统计学和地理因素的综合数据。
89%的患者报告定期接受神经科医生的护理（56%在私人诊所，44%在医院），5%的患者在 GPC 接受护理，6%的患者报告没有医生护理（NoPC）。与 NeC 组相比，未接受神经科医生治疗的患者包括两个亚组，一个由原发性进展性 MS（PPMS）和/或扩展 MS 病史的患者组成。第二个亚组包括在过去 2 年内最近被诊断为 MS 的患者。在 NeC 组中，在私人诊所就诊的患者年龄较大，女性比例较高，而在诊所就诊的患者则没有差异，但在残疾状况、MS 类型或治疗模式方面没有差异。
瑞士获得神经科护理的机会很高。鉴于早期治疗和新型治疗进展性 MS 的药物的出现，应在目前较少接受神经科护理的患者群体中，如 PPMS 或最近诊断的患者中，推广定期的神经科就诊。
