SAN DIEGO—Patients with multiple sclerosis (MS) who are treated by primary care physicians are significantly less likely to receive disease-modifying therapies (DMTs) than patients treated by neurologists, even though they have more symptoms, according to a study reported at the ACTRIMS 2018 Forum.
Approximately 85% of patients treated by neurologists at MS centers receive DMTs, compared with 51% of those treated at primary care offices.
In addition, patients treated at primary care practices have several kinds of symptoms. “This [finding] suggests there is 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, Associate Professor of Public Health at Temple University in Philadelphia.
Dr. Halpern and colleagues analyzed data from the Sonya Slifka Longitudinal MS Study. They focused on patients with MS 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 (from 77% to 82%). Compared with patients treated at MS centers, those who were treated at primary care practices were more likely to be white (98% vs 82%), to have less than a college education (69% vs 42%), and to have Medicaid or veteran coverage, or be uninsured (22% vs 11%).
The rate of patients receiving DMTs was 84% at MS centers and 79% at neurology practices. About 51% of patients treated by primary care doctors received DMTs, even though they reported more symptoms in areas such as vision, walking, bowel, speech, and numbness, compared with patients in the other groups.
The study does not indicate why the patients with MS who are treated by primary care physicians are not receiving appropriate therapies, and it is not known whether the absence of treatment makes their conditions worse.
Nevertheless, it has been well documented that DMTs can reduce disease progression and relapses, Dr. Halpern said. “Individuals with MS who are not being appropriately treated are more likely to experience symptoms, relapses, and faster [accumulation of] disability.”
Primary care doctors may not be providing appropriate treatment because they lack the training and expertise to properly prescribe MS medications, said Dr. Halpern. Whatever the explanation, MS subspecialists and primary care doctors clearly need to collaborate more, he said.