Conference Coverage

Nearly half of MS patients treated by primary docs miss out on meds


 

REPORTING FROM ACTRIMS FORUM 2018

Multiple sclerosis (MS) patients treated by primary care physicians are dramatically less likely to receive disease-modifying therapies than are those treated by neurologists, even though they have more symptoms.

Dr. Michael T. Halpern of Temple University College of Public Health

Dr. Michael T. Halpern

That’s not all. Those treated at primary care practices actually have several kinds of symptoms. “This suggests there’s a critical need for neurologists, especially MS specialists, to reach out and collaborate with these primary care providers and provide education about how to manage MS and improve both the treatment and the outcomes,” said lead study author Michael T. Halpern, MD, PhD, of Temple University College of Public Health, Philadelphia.

Dr. Halpern spoke in an interview at the ACTRIMS Forum.

The researchers analyzed data from the Sonya Slifka Longitudinal Multiple Sclerosis Study and focused on MS patients who received care at MS centers (376 patients, all treated by neurologists), neurology practices (552 patients), and primary care practices (55 patients).

In the three groups, most of the patients were female (77%-82%). To a statistically significant degree, those who were treated at primary care practices, compared with those at MS centers, were more likely to be white (98% vs. 82%), to have less than a college education (69% vs. 42%), and to have Medicaid/veteran coverage or be uninsured (22% vs. 11%).

In terms of rates of patients receiving disease-modifying therapies, there was a small difference between MS centers (84%) and neurology practices (79%); P less than .05.

However, the gap between these patients and those treated by primary care doctors was wide: Only 51% in the latter group received disease-modifying therapies, even though they reported more symptoms in areas such as vision, walking, bowel, speech, and numbness, compared with those in the other groups (P less than .05).

There was no statistically significant difference among the groups in reported symptoms of tremor, headache, pain, fatigue, cognition, swallowing, depression, mood, and anxiety.

The study doesn’t explain why the MS patients treated by primary care physicians are missing out on care, and it is not known whether the absence of treatment makes their conditions worse.

However, “it’s been well documented that the disease-modifying therapies can reduce the disease progression and the likelihood of experiencing relapses,” Dr. Halpern said. “Individuals with MS who are not being appropriately treated are more likely to experience symptoms, relapses, and faster disability.”

He speculated that primary care doctors may be falling behind on the treatment front because they lack the training and expertise to properly prescribe the MS medications, which are “difficult and complex drugs.”

Whatever the case, he said, there’s a clear need for more collaboration between MS subspecialists and primary care doctors.

The study was funded by the National MS Society. Dr. Halpern reported no relevant disclosures.

SOURCE: Halpern MT et al. ACTRIMS Forum 2018 Abstract P226.

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