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Abstract
Objective: To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes.
Methods: This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician–treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty.
Results: More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76–0.80) and nonwhites (OR 0.83, 95% CI 0.79–0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77–0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80–0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77–0.79).
Conclusions: Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
GLOSSARY
- CI=
- confidence interval;
- HR=
- hazard ratio;
- ICD-9=
- International Classification of Diseases, ninth revision;
- OR=
- odds ratio;
- PD=
- Parkinson disease;
- SNF=
- skilled nursing facility
Footnotes
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Study funding: Supported by the NIH (NIEHS K24-ES017765, NINDS 5T3–2NS007205–27, NCRR, and Roadmap for Medical Research UL1RR02499 and KL2RR024994), the St. Louis Chapter of the American Parkinson Disease Association, the American Parkinson Disease Association, Walter and Connie Donius, and the Robert Renschen Fund.
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Editorial, page 814
- Received October 30, 2010.
- Accepted March 31, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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