Do MSers utilize more healthcare than is necessary?

What can we do to reduce the number of healthcare resources that MSers consume? 

This Canadian study shows that pwMS who have fatigue and high physical comorbidity counts (additional neurological problems), anxiety, disruptive pain and perceived functional cognitive difficulties have higher rates of physician encounters, prescriptions filled and hospitalizations. Is this stating the obvious or not? 

The more damage MS causes the more problems you will develop and consequently the more healthcare you will need and consume. The solution? Early effective treatment to prevent damage accumulation. This is what we are trying to promote with our 'Brain Health: Time Matters' policy document and what I try and capture in my 'Holistic Management' of MS Tube map. The tube map depicts MS as a journey and as you become more disabled you acquire more symptomatic problems along the way. 

For the cynics reading this: please note there is a new line on the map that is still under construction (dotted grey line) with three stops; (1) Long-term remission, (2) MS Cure and (3) Healthy Ageing. This is what I call positive thinking and a message of hope and why our treatment targets in MS need to be more ambitious. 

McKay et al. Comorbidities Are Associated with Altered Health Services Use in Multiple Sclerosis: A Prospective Cohort Study. Neuroepidemiology. 2018 May 15;51(1-2):1-10.

BACKGROUND: Persons with multiple sclerosis (MS) use health resources with greater frequency than the general population. However, little is known regarding which patient characteristics might contribute.

OBJECTIVE: The study aimed to evaluate characteristics associated with healthcare use in MS patients.

METHODS: Consecutive MS clinic attendees were recruited (September-November 2010), with clinical, demographic, and patient-completed questionnaires collected at 3 visits over 2 years. Linkage with administrative data (hospital, physician, and pharmacy records) provided healthcare use outcomes until December 31, 2013. Findings were reported as adjusted rate ratios (adjRRs) using negative binomial regression.

RESULTS: A total of 340 MS patients with a mean (SD) age of 48.4 (12.0) years and subsequent follow-up of 3.1 (0.34) years were included. Fatigue and high physical comorbidity count (≥3 vs. none) were significantly associated with higher rates of physician encounters (adjRRs: 1.37 and 1.52, respectively), prescriptions filled (adjRRs: 1.25 and 1.40), and hospitalizations (adjRRs: 4.02 and 3.45). In addition, anxiety, disruptive pain, and perceived functional cognitive difficulties were associated with higher rates of physician encounters and prescriptions dispensed (adjRR ranged from 1.28 to 1.48).

DISCUSSION: The presence of fatigue and higher physical comorbidity burden were associated with higher rates of health services use. Findings have implications for those examining healthcare burden or organizing health services for persons with MS.


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