Researchers examined data on more than 279,000 patients, including
nearly 17,000 who reported having neurological disorders, like
epilepsy, Parkinson disease, multiple sclerosis or other conditions
like headaches or cerebrovascular disease.
They found that black patients were 28 percent less likely to see
neurologists for outpatient care than white patients. Hispanic
patients were 39 percent less likely to see neurologists, the study
“Previous studies have focused on specific neurologic diseases such
as stroke or Parkinson’s disease,” said lead study author Dr. Altaf
Saadi, a neurology chief resident at Massachusetts General Hospital
“This is the first study to look beyond individual neurologic
diseases and show racial disparities among a broad range of
neurologic illnesses, regardless of insurance, socioeconomic or
health status,” Saadi said by email.
“This is a much larger issue than previously documented,” she added.
Neurologic illness is common, affecting about 14 percent of American
households, researchers note in the journal Neurology. Stroke, for
example, is a leading cause of disability and the third most common
cause of death in the U.S., and rates of other neurologic disorders
like Alzheimer disease and Parkinson disease are projected to soar
as the population ages.
Saadi’s team examined data collected from 2006 to 2013 from a
nationally representative survey of medical expenditures.
Across the entire study population, just 6 percent reported having a
neurological disorder. About 2 percent, or 5,890 patients, received
a total of 13,685 outpatient neurology visits.
People who had at least one outpatient visit with a neurologist were
more likely to be female, older, white, nonimmigrant, more educated
and affluent and to have health benefits through Medicare or private
insurance, the study found.
Patients with certain neurologic diagnoses such as multiple
sclerosis, epilepsy and Parkinson disease were more likely to see
specialists than people with other types of neurologic conditions,
the study also found.
Among participants with known neurologic conditions, blacks were
more likely to be cared for in the emergency department, to have
more hospital stays, and to have higher per capita inpatient
expenditures than their white counterparts.
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For every 100 patients with neurological disorders, 12.55 black
patients went to the emergency room for care rather than seeing a
neurologist in an outpatient clinic, compared with 7.66 Hispanic
patients and 7.70 white patients.
Geography may explain some of these disparities, because outpatient
neurological services are more widely available in regions like the
Northeast, while there are fewer specialists in parts of the
Southeastern U.S. where far more people have neurologic disorders
requiring specialty care, the authors note.
One limitation of the study is that excludes people living in
nursing homes and other institutional settings where many patients
with seizures and dementia may reside, the authors point out.
Researchers also lacked data on individual patient or physician
choices or preferences about care, which might have influenced
whether some people received outpatient neurology services.
Even so, the findings suggest that insufficient outpatient care may
be disproportionately driving certain racial groups to the emergency
room, said Dr. Jorge Burneo, a neurology researcher at Western
University in London, Ontario, who wasn’t involved in the study.
These emergency department visits may also become more costly for
people who didn’t get outpatient care or waited until symptoms got
severe to seek help, Burneo said by email.
“If a patient visited his or her neurologist on a regular basis,
there would be better control of the neurological problem, which
would avoid an emergency room visit and admission to a hospital,”
SOURCE: http://bit.ly/2rV9Bf1 Neurology, online May 17, 2017.
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