People with Parkinson's disease who go to a neurologist for their care are more likely to live longer, less likely to be placed in a nursing home and less likely to break a hip than people who go to a primary care physician, according to a study published in the August 10, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology (AAN).
The study also found that women and minorities were less likely to see a neurologist than men and Caucasians, even after adjusting for factors such as age, socioeconomic status and other health conditions.
"If these findings are confirmed in future studies, they will have important policy implications," said James F. Burke, MD, of the University of Michigan in Ann Arbor and a member of the American Academy of Neurology, who wrote an editorial about the study. "Disparities in access to care should become a pressing priority if these limits to access are associated with worse outcomes. Policy changes could focus on improving access to neurologists or on improving the knowledge and care given by primary care physicians."
For the study, researchers examined the records of everyone on Medicare with a new diagnosis of Parkinson's disease who was seen in an outpatient clinic during 2002. Of the 138,000 people who were diagnosed with Parkinson's disease that year, 68 percent were seen by a neurologist from 2002 to 2005.
Those seen by a neurologist were 20 percent less likely to die over a six-year period than those seen by a primary care physician. They were also 20 percent less likely to be placed in a nursing home and 14 percent less likely to have a broken hip.
Women were 22 percent less likely to see a neurologist than men, and minorities were 17 percent less likely to see a neurologist than Caucasians.
Study author Allison Wright Willis, MD, of Washington University School of Medicine in St. Louis and a member of the American Academy of Neurology, said, "We need to understand how care may affect people's health care outcomes to improve the quality of life for people with Parkinson's and also to minimize any avoidable health care costs."
Other studies have shown that the one year per-person direct cost of a hip fracture is up to $26,000. "Of course, the benefit to people with Parkinson's disease and their families of avoiding a hip fracture or delaying the need for nursing home placement is immeasurable," she said.
Willis said there are several possible reasons why women and minorities may receive neurologist care less often than men and Caucasians. "Complicated types of Parkinson's may be more common in some groups," she said. "Women and their spouses may not request specialist care as often as men and their spouses do."
Burke noted that various limitations of the study could affect the results. For example, the study did not take into account the severity of the disease.
The study was supported by the National Center for Research Resources and National Institutes of Health Roadmap for Medical Research, National Institute for Environmental Health Sciences, National Institute of Neurological Disorders and Stroke, Washington University School of Medicine, the American Parkinson Disease Association and its St. Louis chapter, Walter and Connie Donius and the Robert Renschen Fund.
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