Access to MS care poorer for rural regions, select patient groups in US

Geographical proximity to neurologists and multiple sclerosis (MS) speciality care centers is lower for people living in rural regions of the U.S. relative to metropolitan areas, according to recent research.

Areas with higher proportions of Hispanic individuals, uninsured people, and those with disabilities generally also were more likely to lack ready access to these services.

“These findings highlight concerning gaps in access to subspecialty MS care and where the healthcare system is falling short,” Marisa McGinley, a neurologist with Cleveland Clinic’s Mellen Center for Multiple Sclerosis and the study’s first author, said in a statement to Multiple Sclerosis News Today. 

“We hope these findings will be used by policy makers to help identify more equitable healthcare delivery models, such as the use of teleneurology and increased access to affordable broadband internet,” McGinley added.

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The study, “Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States,” was published in Neurology.

The U.S. currently has a shortage of neurologists and neurological disease speciality centers (e.g., MS care centers), a problem that is expected to increase in coming years as more people are living with neurological diseases.

However, the prevalence of these specialists and patients’ ability to access them for care, can dramatically differ across regions of the country, contributing to existing disparities in healthcare outcomes.

MS research, particularly, shows health disparities in underrepresented U.S. communities.

“When you factor in that MS is the leading cause of non-traumatic disability in young adults and requires complex multidisciplinary care, it becomes increasingly important to further understand the barriers that contribute to these disparities,” McGinley said.

Geographical proximity to providers is known to influence care access, but this factor is “not well understood,” according to the scientists.

As such, McGinley and colleagues investigated differences in the geographical availability of neurologists and MS speciality care across the country. Their ultimate goal was to “identify the characteristics of underserved areas and communities to help inform appropriate interventions to better serve those living with MS,” McGinley said.

They used a number of publicly available data sources, including the U.S. Census Bureau, to identify neurologists and MS centers within individual census tracts, or small U.S. subdivisions.

MS care centers likely to treat 2,300 to 5,100 patients, depending on region

Across the study area, there were 34,143 neurology practice centers and 185 MS centers, with a total of 15,113 neurologists between the two. Based on the estimated number of people living with MS in the U.S., each MS center would be responsible for caring for some 2,300  to 5,100 patients, depending on the geographical region (Northeast U.S., West, South, or Midwest).

Of 70,858 census tracts analyzed across the country (96.9% of all tracts), most had some degree of access to neurologists within 60 miles (about 97 kilometers), while 388 had none. In contrast, 17,937 (25.8%) of 69,425 tracts with available data on distance to an MS center had no centers within 60 miles.

The degree of access to neurology care was lower in rural and smaller urban centers (micropolitan areas) compared to metropolitan areas, those with larger cities. Estimated access also was lower in areas with a higher proportion of people who are Hispanic, male, uninsured, or with hearing, vision, or walking impairments/disabilities.

Better access was observed in areas with a higher proportion of Black and older people, as well as those with college degrees, computers, cognitive difficulties, limited English language proficiency, and no personal transportation like a car.

Similar patterns were seen for access specifically to MS centers, “but there were fewer MS centers, leading to poorer geospatial access across the US,” the researchers wrote.

“Vulnerable populations, such as rural patients with MS with disabilities, likely have difficulty traveling to these centers,” the team noted, adding that this can lead to significant health disadvantages.

Notably, access to neurology and MS care center in communities with a higher proportion of Black residents (10%) depended on the type of area they lived in. In metropolitan areas, these communities had better access to neurology care and MS centers than did larger Black communities in rural areas.

“Healthcare delivery interventions for rural Black communities may need to be different than urban Black communities where proximity to neurologists is not the main driver to poor access to care,” the researchers wrote.

One way to boost access is telemedicine, specifically teleneurology and virtual specialist visits. McGinley notes that the Mellen center, where she practices, has expanded teleneurology visits to better accommodate MS patients who live distances from the clinic.

“We also strategically coordinate visit needs such as MRI, infusions, and rehabilitation appointments to be on the same day as visits with the patient’s neurologists or advanced practice provider,” she said.

“As an MS community there is a need to develop a better understanding of patient’s barriers to care and create healthcare models that meet our patient’s needs,” McGinley concluded.