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.


About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


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  • I've had progressive MS for a long time, and hardly ever visit my GP. I take no medications whatsoever. But I'd like to think that people with MS get all the help they need. I'd look to the people who just ruin their health through obvious things like smoking, eating and drinking too much first to make NHS savings.

    I don't care about the pointless tube map, sorry.

    • Re: "I don't care about the pointless tube map, sorry."

      No need to say sorry. A lot of people don't like it because it has a stope and line that refers to the terminal phase of the disease.

    • I don't think that's why Anonymous Sunday, May 20, 2018 4:23:00 pm finds your tube map pointless….. And people need to realise that life maps have a terminal phase! Are some of you immortal or something????

  • Another groundbreaking study by another pathetic Canadian research group in another low impact journal. What a shocker with a very unexpected outcome.

    Ridiculous, I cannot believe that a study like this takes away from funding of important MS research. It is identical to the studies that state MS patients are more anxious and depressed than an average individual.

    If this is the best the most afflicted country in the world, Canada, can do in terms of research, we are in fact doomed. This is almost all good as the pathetic minocycline studies by Metz et al?

    Let us interrupt the researcher's signals from their own brain and spinal cord making them fatigued, blinded, incontinent, having balance, motor or sensory difficulties or chronic pain and see how positive their mood is and see if they are an economic healthcare burden.

    Here is the fix. Find a cause of MS. Find a medicine that actually improves patient's clinical outcome and not just delays the inevitable. Call me crazy but find remyelination, neurodegeneration prevention and neurorestoration products and the world will be a much brighter and productive place for MS patients.

    • Who am I to argue? All I say is that the scientific process is long and complicated. I think we have found the cause of MS, the problem is convincing the funders to do the studies to provide the definitive proof.

  • This paper is what in academia I term 'a perfectly executed example of the bleedin obvious'. No sh!T Sherlock, as my kids would say. before I had MS I rarely sought or needed medical help. Now, in between physio, GP for prescriptions, MS nurses, orthotics and FES clinics for fine tuning, DMT visits, blood tests to check for DMT consequence, infrequent (but utterly worthwhile) consultant visits, exercise classes and also various treatments from a (wonderful) MS centre, I'm surprised have time to type this….. Oh, and I work full time (with very understanding employers).

  • Hello Professor Giovannoni, my name is Sterling.

    I am currently studying Health Care Management in Germany and really like your map. I am working on a similar concept.

    If you see my post, can you please tell me the best way to contact you?

    I will soon be writing my master’s thesis and would like to focus on ‘Knowledge Sharing in Health Care’, specifically within the field of MS.

    It would be a tremendous help if I could get your perspective on my research interests.

By Prof G



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