People in rural areas less likely to receive specialty care for neurologic conditions
A new study has found that while the prevalence of neurologic conditions like dementia, stroke, Parkinson's disease and multiple sclerosis (MS) is consistent across the U.S., the distribution of neurologists is not, and people in more rural areas may be less likely to receive specialty care for certain neurologic conditions. The study, funded by the American Academy of Neurology, is published in the December 23, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology.
"Neurologists in the United States are not evenly spread out, which affects whether patients can see a neurologist for certain conditions like dementia and stroke," said study author Brian C. Callaghan, MD, MS, of the University of Michigan in Ann Arbor and a Fellow of the American Academy of Neurology. "Our research found that some areas of the country have up to four times as many neurologists as the lowest served areas, and these differences mean that some people do not have access to neurologists who are specially trained in treating brain diseases."
However, Callaghan noted that the proportion of people receiving specialty care from a neurologist in more rural areas varied by condition. People with specific, less common conditions such as Parkinson's disease and multiple sclerosis were just as likely to see a neurologist in more rural areas as in more urban areas, while people with less specific neurologic symptoms that are more common, such as dementia, pain, dizziness or vertigo or sleep disorders, were more likely to see a neurologist in more urban areas than in more rural areas.
For the study, researchers reviewed one year of data for 20% of people enrolled in Medicare and identified 2.1 million people with at least one office visit for a neurologic condition.
Researchers recorded the number of times people had an office visit with a neurologist during that year and compared that to how many times people had office visits with other health care providers for a neurologic condition.
Researchers identified a total of 13,627 neurologists practicing in the regions where study participants lived.
Researchers found the areas with the fewest neurologists had an average of 10 neurologists for every 100,000 people, while the areas with the most neurologists had an average of 43 neurologists for every 100,000 people.
Researchers also found that the prevalence of neurologic conditions was not different across regions. Nearly one-third of people had at least one office visit for a neurologic condition.
Overall, 24% of people with a neurologic condition were seen by a neurologist. In more rural areas, this number was 21%, compared to 27% in the areas with the most neurologists. Most of that difference was made up of people with dementia, back pain and stroke. For dementia, 38% of people in more rural areas saw a neurologist, compared to 47% in more urban areas. For stroke, 21% of people in more rural areas saw a neurologist, compared to 31% in more urban areas.
On the other hand, more than 80% of people with Parkinson's disease received care from a neurologist, no matter where they lived. The numbers were similar for multiple sclerosis.
"It is important that all people have access to the best neurologic care," said James C. Stevens, MD, FAAN, President of the American Academy of Neurology. "Not surprisingly, more neurologists tend to work and live in metropolitan areas, but this study underlines the need to ensure that rural areas also have a supply of neurologists to meet demand. One way to give people more access to neurologic care is with telemedicine, which has been used successfully during the COVID-19 pandemic. Remote office visits by computer or telephone are one way to extend neurological service to people in underserved areas."
A limitation of the study is that researchers looked at neurologic visits only for people with Medicare coverage, so results may not be applicable to younger people with private insurance.