#PoliticalSpeak & #ThinkHand: could foot hygiene be used as an index of deprivation?

Is poor foot hygiene a red flag for a wider problem? Social deprivation? #PoliticalSpeak #ThinkHand

My post on one of my patients from last week with onychogryphosis (poor toenail hygiene) has generated quite a discussion on the blog and within Barts-MS. My focus on hand function, and using it support our #ThinkHand campaign, may have been misguided. The real issue here is neglect and dare I say possible social deprivation. Why did this patient develop onychogryphosis? That's the real issue. Why did he/she neglect themselves? Where were their family, friends, carers, etc.? How do we let her/him slip through the cracks? If they are neglecting their feet, what else are they neglecting?

People with MS are no strangers to deprivation. If you are reading this blog the chances are that you are warm, safe, loved and cared for by someone. This clearly does not apply to all pwMS. What should we be doing to address the problem? Is it simply a political problem? Clearly there are more questions than answers. 

Owens et al. Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom. Eur J Health Econ. 2013 Apr;14(2):315-21.

Unlike other industrialised countries, the UK deferred the routine introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in favour of an experiment. Between 2002 and 2005, MS sufferers were identified, were offered DMTs only if deemed suitable by their physicians, and were monitored thereafter to assess long-term outcomes. It has been demonstrated for other therapies that judgements about suitability to receive treatment are conditioned by the patient's deprivation status. We hypothesised that this would have been the case for DMTs also. Using individual patient data for samples in Nottingham and in Glasgow, we matched patients' postcodes of residence with deprivation scores and confirmed that patients from more deprived areas were less likely to have been prescribed DMTs. A more detailed analysis of the Nottingham data revealed two channels through which this outcome was effected. First, people from less-deprived areas were more likely to possess clinical characteristics, such as less severe disease severity and shorter duration of the disease, that enhanced their suitability for treatment. Second, the analysis of the clinical notes detailing patients' correspondence with the medical teams suggested that less-deprived people were more able to exercise a voice capable of influencing physicians' prescribing decisions.

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