Specialist PD care less likely among women, ethnic minorities
MedWire News: Women and ethnic minorities with Parkinson disease (PD) are significantly less likely to obtain specialist care than White men, suggest study findings showing improved clinical outcomes and survival with neurologist treatment.
"Our data demonstrate that many people diagnosed with PD do not see a neurologist," say Allison Wright Willis (Washington University School of Medicine, St Louis, Missouri, USA) and co-authors.
For the study, the team identified 138,728 incident cases of PD among beneficiaries of Medicare during 2002. Logistic regression was then performed to determine which patient characteristics predicted neurologist care between 2002 and 2005.
In addition, the researchers calculated the adjusted 6-year risk for death using incident PD cases, which were stratified by physician speciality.
In total, 58% of patients with PD received neurologist care between 2002 and 2005, with the remaining patients treated by a primary care physician specializing in internal medicine (18.9%), family practice (11.9%), or geriatric medicine (0.8%).
Regression analysis showed that women and non-Whites were significantly less likely to receive specialist care compared with White men (odds ratio [OR]=0.78 and 0.83, respectively), after adjusting for age, race, gender, modified comorbidity index, and socioeconomic deprivation score.
Furthermore, Black women with PD were significantly less likely to receive care by a neurologist in the study period (OR=0.67), followed by Black men (OR=0.68), and White women (OR=0.76) compared with White men.
The researchers note that adjusting for comorbidity and socioeconomic variables did not alter race/gender relationships significantly, suggesting that race and gender are major predictors of specialist referral, after accounting for age.
Among a subgroup of 124,173 Medicare beneficiaries with a claims diagnosis of PD but without incident stroke/transient ischemic attack, those cared for by a neurologist had the lowest 1-year skilled nursing facility (SNF) placement rates compared with patients cared for by all types of primary care physicians (18%), with the highest rates seen among those treated by geriatricians (31.5%), followed by internists (24.1%) and family practice physicians (21.1%).
In addition, regression analysis adjusting for all variables showed that patients who received neurologist care were significantly less likely to be placed in a SNF (OR=0.79), and were less likely to experience hip fracture (OR=0.86).
Survival analysis showed that patients with PD who were treated by neurologists had a significantly lower likelihood of death compared with those receiving PD treatment only by primary care physicians (hazard ratio=0.78).
"If the improved clinical outcomes and survival are confirmed in future studies, consistent neurologist care and increased neurologic education at all levels of medical training could emerge as significant disease-modifying features," conclude the authors in the journal Neurology.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Ingrid Grasmo