High rates of physician services utilization at least five years before multiple sclerosis diagnosis

Abstract

Background: Multiple sclerosis (MS) management has changed over time, but changes in health care utilization by MS patients remain understudied. We estimated physician services utilization in the five-year periods before and after MS diagnosis, and over the period 1984–2008. Methods: Using administrative data we identified 4092 persons with MS and a matched general population (GPOP) cohort of 21,446 persons. Using general linear models we compared physician visits between the MS and GPOPs for the period 1984–2008, the year of MS diagnosis, and for the five-year periods pre- and post-diagnosis. Results: From 1984 to 2008, 98% of the MS population averaged ≥1 physician visits/year versus 87% of the GPOP. In 2008, the MS population had 12.9 physician visits/person-year while the GPOP had 8.4 (rate ratio (RR) 1.53; 95% confidence interval (CI): 1.52–1.55). Five years pre-MS diagnosis, the MS population had more physician visits than the GPOP (RR 1.15; 95% CI; 1.10–1.21). The number of visits peaked the year of MS diagnosis (19.0), decreasing thereafter, but remaining elevated versus the pre-diagnosis period. Conclusion: The MS population uses more physician services than the GPOP, starting at least five years pre-MS diagnosis. A better understanding of the reasons for these higher utilization rates may ultimately improve outcomes in MS.