How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis. (April 2020)

• Record Type: Journal Article
• Authors: Barin, Laura; Kamm, Christian P; Salmen, Anke; Dressel, Holger; Calabrese, Pasquale; Pot, Caroline; Schippling, Sven; Gobbi, Claudio; Müller, Stefanie; Chan, Andrew; Rodgers, Stephanie; Kaufmann, Marco; Ajdacic-Gross, Vladeta; Steinemann, Nina; Kesselring, Jürg; Puhan, Milo A; von Wyl, Viktor
• Is Part Of: Multiple sclerosis. Volume 26:Number 4(2020)
• Page Start: 489
• Page End: 500
• Publication Date: 2020-04
• Subjects: Registries -- regression analysis -- time to diagnosis -- delayed diagnosis -- patient-reported outcomes -- epidemiology; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458518823955
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Diagnosing multiple sclerosis (MS) early is crucial to avoid future disability. However, potentially preventable delays in the diagnostic cascade from contact with a physician to definite diagnosis still occur and their causes are still unclear. Objective: To identify the possible causes of delays in the diagnostic process. Methods: We analyzed the data of the Swiss MS Registry. With logistic regression, we modeled the time from the first contact to the first consultation (contact-to-evaluation time, ⩽1 month/>1 month) and the evaluation-to-diagnosis time (⩽6 months/>6 months). Potential factors were health system characteristics, sociodemographic variables, first symptoms, and MS type. Results: We included 522 participants. Mostly, general practitioners (67%) were contacted first, without delaying the diagnosis. In contrast, first symptoms and MS type were the major contributors to delays: gait problems were associated with longer contact-to-evaluation times, depression as a concomitant symptom with longer evaluation-to-diagnosis times, and having primary progressive MS prolonged both phases. In addition, living in mountainous areas was associated with longer contact-to-evaluation times, whereas diagnosis after 2000 was associated with faster diagnoses. Conclusion: For a quicker diagnosis, awareness of MS as a differential diagnosis of gait disorders and the co-occurrence of depression at onset should be raised, and these symptoms should be attentively followed.