Lin Chun Chieh, Muthukumar Lavanya, Reynolds Evan Lee, Hill Chloe E, Esper Gregory J, Callaghan Brian C
Department of Neurology, The Ohio State University, Columbus.
Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor; and.
Neurology. 2025 Feb 11;104(3):e210217. doi: 10.1212/WNL.0000000000210217. Epub 2025 Jan 8.
Timely access to specialist care is crucial in expeditious diagnosis and treatment. Our study aimed to assess the time patients wait from being referred by a physician to seeing a neurologist using Medicare data. Specifically, we evaluated differences in access related to sex, race/ethnicity, geography, and availability of neurologists.
We conducted a cross-sectional analysis using a 2018-2019 Medicare sample of patients who had a new patient visit to a neurologist. Our primary outcome was the wait time between their last visit with the referring physician and their first visit with the neurologist (the index neurologist visit). We also looked at the time between the first visit for a neurologic condition and the index neurologist visit for that same condition. We used a linear mixed-effects model to identify the factors associated with the wait time, considering the patients' hospital referral regions (HRRs).
We identified 163,313 Medicare beneficiaries who had a new patient visit with a neurologist in 2018-2019 after their physician referred them. Their average age was 73.8 (SD 10.7). The median (interquartile range) wait time to the index neurologist visit was 34 days (15-70), and 18% of patients waited >90 days. Patients with multiple sclerosis (MS) had to wait an average of 29.4 days longer, patients with epilepsy waited 10.4 days longer, and patients with Parkinson disease (PD) waited 9.3 days longer than patients with back pain. There were no significant differences in wait times across race/ethnicity and sex. Our study also showed no significant differences in wait times across regions with varying levels of neurologist availability. When patients visited a neurologist located outside of their residential or referring physician's HRR, the wait time was extended by an average of 11 days.
We found that, patients waited 34 days to see a neurologist after their physician referred them while 18% of them waited more than 90 days. Factors such as sex, race/ethnicity, and neurologist availability did not significantly affect timely access to neurologists. Patients with MS, epilepsy, and PD had longer wait times, despite needing the specialized care that neurologists can provide. This highlights the need for innovative approaches to improve timely access to neurologists.
及时获得专科护理对于快速诊断和治疗至关重要。我们的研究旨在利用医疗保险数据评估患者从被医生转诊到看神经科医生的等待时间。具体而言，我们评估了在性别、种族/民族、地理位置以及神经科医生可及性方面的就医差异。
我们使用2018 - 2019年医疗保险样本中首次就诊于神经科医生的患者进行横断面分析。我们的主要结局是患者最后一次就诊于转诊医生与首次就诊于神经科医生（索引神经科就诊）之间的等待时间。我们还研究了首次因神经系统疾病就诊与针对同一疾病的索引神经科就诊之间的时间。考虑到患者的医院转诊区域（HRR），我们使用线性混合效应模型来确定与等待时间相关的因素。
我们确定了163,313名医疗保险受益人，他们在2018 - 2019年被医生转诊后首次就诊于神经科医生。他们的平均年龄为73.8岁（标准差10.7）。索引神经科就诊的中位（四分位间距）等待时间为34天（15 - 70天），18%的患者等待时间超过90天。与背痛患者相比，患有多发性硬化症（MS）的患者平均多等待29.4天，癫痫患者多等待10.4天，帕金森病（PD）患者多等待9.3天。种族/民族和性别之间的等待时间没有显著差异。我们的研究还表明，在神经科医生可及性不同的地区，等待时间没有显著差异。当患者就诊于居住或转诊医生所在HRR以外的神经科医生时，等待时间平均延长11天。
我们发现，患者在被医生转诊后等待34天才能看神经科医生，其中18%的患者等待时间超过90天。性别、种族/民族和神经科医生可及性等因素并未显著影响及时看神经科医生。患有MS、癫痫和PD的患者等待时间更长，尽管他们需要神经科医生提供的专科护理。这凸显了需要创新方法来改善及时看神经科医生的情况。
