Research: MSers visit the Docs more before diagnosis

Marrie RA, Yu N, Wei Y, Elliott L, Blanchard J. High rates of physician services utilization at least five years before multiple sclerosis diagnosis. Mult Scler. 2012 Dec [Epub ahead of print]

BACKGROUND: Multiple sclerosis (MS) management has changed over time, but changes in health care utilization by MS patients remain understudied. We estimated physician services utilization in the five-year periods before and after MS diagnosis, and over the period 1984-2008.

METHODS: Using administrative data we identified 4092 persons with MS and a matched general population (GPOP) cohort of 21,446 persons. Using general linear models we compared physician visits between the MS and GPOPs for the period 1984-2008, the year of MS diagnosis, and for the five-year periods pre- and post-diagnosis.

RESULTS: From 1984 to 2008, 98% of the MS population averaged ≥1 physician visits/year versus 87% of the GPOP. In 2008, the MS population had 12.9 physician visits/person-year while the GPOP had 8.4 (rate ratio (RR) 1.53; 95% confidence interval (CI): 1.52-1.55). Five years pre-MS diagnosis, the MS population had more physician visits than the GPOP (RR 1.15; 95% CI; 1.10-1.21). The number of visits peaked the year of MS diagnosis (19.0), decreasing thereafter, but remaining elevated versus the pre-diagnosis period.

CONCLUSION: The MS population uses more physician services than the GPOP, starting at least five years pre-MS diagnosis. A better understanding of the reasons for these higher utilization rates may ultimately improve outcomes in MS

MSers visit the Doctors a few times more than the General population in the years leading up to the diagnosis of MS. Is this just statistical hogwash?

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  • It is a case of stating the obvious! However many women could be visiting for gynaecological reasons, or because they are pregnant etc. IF something can come out of this research that helps outcomes, great, but how likely is that?

  • If the higher utilization rates are because people are going to the doctor with undiagnosed MS symptoms, then getting diagnosed earlier would be helpful. Getting diagnosed earlier could mean more opportunity for early aggressive treatment. I don't think this is hogwash, I think it might be evidence of opportunities to diagnose MS earlier.

  • I can give at least anecdotal support to this proposition. I'm in my 40's, now three months post diagnosis. This report matches my experience exactly.

    Over the last five years I changed from someone who never bothered doctors, to someone who went in frequently for unexplained symptoms and pain of unknown origin. I also twisted my ankle three times and was treated for that. This past year, I got a neurology referral, was diagnosed quickly, but that required many blood tests and two MRI exams.

    I will never forget the confusion and frustration of knowing something was wrong that the doctors could not find or verify. It didn't help that the symptoms would disappear within a few weeks.

  • I certainly did not visit my doctor any more in the 5 years prior to diagnosis than I did at any other time in my life (probably largely as a result of being raised by parents who taught us to allow our bodies a chance to recover from things on their own before bothering a doctor), but also because the things I have thought about with hindsight since diagnosis (hand trembling, eye fluttering and eye pain) seemed to come and go with no pattern, so as (like most people) I was busy getting on with life, the only time I thought about seeing a doctor was when one or more of these was happening and I was invariably too busy!

    The only time I have ever made more than one appointment in a six month period was after the symptoms of my first episode when I knew damn well that something was wrong and there was no way I was getting fobbed-off without full tests and hopefully a diagnosis. Thank goodness for my company's BUPA cover!

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