Health Care Resource Usage Among NARCOMS Participants

Introduction

The NARCOMS update surveys routinely include questions related to health care provider visits and treatment patterns. The following article summarizes the responses to some of these questions in the fall 2007 update survey. We are very pleased to share the results with MSQR readers and very grateful for the collaboration of the 10,131 NARCOMS participants who responded to this survey.

Health Care Providers

The twice-per-year NARCOMS updates track which health care providers NARCOMS participants have visited over the past 6 months. Table 1 summarizes the responses to the fall 2007 update survey regarding some of the provider specialties. Fifty-eight percent (58%) of responders indicated that they had been seen by a MS specialist neurologist, and 22% had been seen by a non-MS specialist neurologist in the past 6 months. Nearly 60% had an appointment with their primary care provider. A much smaller percentage saw a nurse clinician (12%), MS specialist nurse (9%), non-MS specialist nurse (8%), visiting nurse (9%), physician assistant (14%), or a home health aide (7%). Thirty-six percent (36%) visited an ophthalmologist, 26% visited an internal medicine physician, 20% visited a physical therapist, and 17% visited a urologist. Seven percent (7%) indicated they have visited a psychiatrist, 7% visited a psychologist, and 6% visited a counselor. Only 6% reported no visits with any health care provider or skipped the question altogether.

Approximately 6% of responders reported some type of support care at their place of residence. This includes those living in a private home with home health aide support and those in assisted living or nursing home. Table 2 shows a break down of the type of residence of fall 2007 survey responders.

Hospital Visits

Participants were asked if they had to visit the emergency room or were admitted to the hospital in the previous 6 months. As Table 3 illustrates, 14% of the responders had one or more emergency room visits in the previous 6 months and less than 10% were admitted to the hospital for an overnight stay.

Immunological Therapies

Monitoring trends and patterns in immunological therapy prescription and adherence is an essential part of the NARCOMS project. Each update survey asks participants to report on their immunological therapies during the previous 6 months. As seen in Table 4, almost 60% of the fall 2007 survey responders indicated that they were on one medication aimed to decrease MS attacks or progression of disability (monotherapy) and 11% responded that they were on more than one such medication (combination therapy). A comparison between fall 2007 and fall 2004 survey responses shows an increase in monotherapy from 51% in 2004 to 59% in 2007, with an associated decrease in the number of responders that indicated they were on no immunological therapy. The number of responders on combination therapy has remained approximately the same over the past 3 years.

Health Insurance Coverage

With the constantly rising cost of health care, health insurance coverage plays a critical role in access to health care. Most of the fall 2007 responders have at least one type of health care coverage. Table 5 shows that 15% of responders have only Medicare/Medicaid, 55% have only private insurance, and 29% have a combination of Medicare/Medicaid and private insurance. As seen in Figure 1, the type of insurance coverage shifts from predominantly private insurance coverage to a combination of Medicare/Medicaid and private insurance coverage in the 56 to 65 age range when agebased Medicare benefits become available.

Conclusion

This preliminary analysis of the update survey responses provides an overview of the health care related data that was collected in the fall 2007 survey. This information allows us and other research groups to gain insight into health care utilization patterns and will help identify areas requiring further research.

As always, we truly appreciate the time that NARCOMS participants and their families devote to completing the update surveys. The commitment of the participants and their families continues to be an important contribution to MS research.