A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

Mark O Mccarron,Paul Burns,Luke V Mccarron,Michael Mccormick,Mike Clarke,Peter Mccarron,Raeburn B Forbes,Fiona Mullan,Ferghal Mcverry

doi:10.3389/fneur.2021.608070

Abstract

Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways—intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32–0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38–0.66) for MT in AIS patients, 0.78 (95%CI 0.67–0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99–1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities.

Highlights

Notable advances in the diagnosis and treatment of disabling neurological conditions have been achieved in recent years
We examined delivery of therapeutic interventions for two common neurological disorders—acute ischemic stroke (AIS) and multiple sclerosis (MS), and the real-time use of a single regional neurology inpatient ward using a population-based neurodisparity index (NDI)
Patients requiring intensive neurological assessment or monitoring, or investigations or treatment, or who cannot be managed in other Trusts due to limited neurological resources are expected to be transferred to the regional neurology ward in the neuroscience center in the Belfast HSC Trust (BHSCT) [5]

Summary

INTRODUCTION

Notable advances in the diagnosis and treatment of disabling neurological conditions have been achieved in recent years. A range of disease modifying treatments (DMTs) have been approved for primary progressive and relapsing forms of multiple sclerosis (MS), while reperfusion therapies such as intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS) substantially reduce a patient’s risk of death and dependency [1, 2]. Despite such advances, barriers to diagnosis and treatment could lead to inequity in patient benefits. We chose AIS and MS because they are common neurological disorders, and because new therapies for these diseases, have emerged in recent decades allowing an assessment of health care responsiveness to relatively recent therapeutic developments

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DISCUSSION

ETHICS STATEMENT