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Parkinsonism in Ontario: Physician Utilization

  • M. Guttman (a1), P.M. Slaughter (a2), M-E. Theriault (a2), D.P. DeBoer (a2) and C.D. Naylor (a2) (a3)...
Abstract
Background:

Patients with Parkinsonism have a progressive disorder requiring substantial expertise to manage effectively.

Methods:

Over a six-year period we evaluated physician utilization and related costs for a large, unselected cohort of 15,304 Parkinsonian patients from the general population, comparing them to 30,608 age- and sex-matched controls within a universal health care system in Ontario, Canada.

Results:

On average, 45% of Parkinsonian patients saw neurologists annually. The cumulative rate of at least one neurological consultation was only 59.5% over the six years. Patients aged <65 had a much greater likelihood of consulting a neurologist (73.3%) compared to those ≥65 (37.2%). Most Parkinsonian patients (97.2%), regardless of age, saw family physicians/general practitioners each year; 50.4% saw internal medicine consultants.

Conclusions:

Parkinsonian patients had increased likelihood of utilizing neurologists, primary care physicians and internists compared to controls; related costs of physicians’ services were higher. Further research is necessary to evaluate differences in outcomes and costs between neurologists and other physician service providers.

RÉSUMÉ: Introduction:

Les patients parkinsoniens ont une maladie progressive dont la prise en charge efficace requiert une expertise substantielle.

Méthodes:

Nous avons évalué le recours aux soins prodigués par un médecin et les coûts afférents chez une cohorte de 15 304 patients parkinsoniens de la population en général sur une période de six ans et nous les avons comparés à ceux d’un groupe de 30 608 contrôles appariés pour lșâge et le sexe, tirés du système universel de soins de santé de l’Ontario, au Canada.

Résultats:

En moyenne, 45% des parkinsoniens ont vu un neurologue de façon annuelle. Le taux cumulatif d’au moins une consultation neurologique était seulement de 59,5% sur six ans. Les patients de moins de 65 ans étaient plus susceptibles d’avoir consulté un neurologue (73,3%) par rapport à ceux de plus de 65 ans (37,2%). La plupart des parkinsoniens (97,2%), sans égard à l’âge, consultaient un médecin de famille/médecin généraliste à chaque année; 50,4% voyaient un interniste.

Conclusions:

Les parkinsoniens avaient une plus grande probabilité d’utiliser les services d’un neurologue, d’un médecin de première ligne et d’un interniste que les contrôles; les coûts afférents aux services de médecins étaient plus élevés. L’évaluation de différences dans les résultats et les coûts des soins prodigués par les neurologues et les autres médecins nécessite des recherches plus poussées.

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References
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1. Miyasaki, JM, Martin, WRW, Suchowersky, O, Weiner, WJ, Lang, AE. Practice parameter: initiation of treatment for Parkinson’s disease: an evidence based review. Neurology 2002;58:1117.
2. Guttman, M, Slaughter, PM, Theriault, M-E, DeBoer, DP, Naylor, CD. Parkinsonism in Ontario: increased mortality compared to controls in a large cohort study. Neurology 2001;57:22782282.
3. Lang, AE, Lozano, AM. Parkinson’s disease: first of two parts. N Engl J Med 1998;339(15):10441053.
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5. Williams, JI, Young, W. A summary of studies on the quality of healthcare administrative databases in Canada. In: Goel, V, Anderson, GM, Fooks, C, Iron, K, Naylor, CD, eds. Patterns of Health Care in Ontario: the ICES Practice Atlas 2nd edition. Ottawa: Canadian Medical Association, 1996:339345.
6. Iron, K. Technical Appendix. In: Naylor, CD, Slaughter, PM, eds. Cardiovascular Health and Services in Ontario: An ICES Atlas. Toronto: Institute for Clinical Evaluative Studies 1999:18.
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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