A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland
| Autor: | Raeburn B Forbes, Luke Vincent McCarron, Mark O. McCarron, Paul Burns, Michael McCormick, Fiona Mullan, Mike Clarke, Ferghal McVerry, Peter McCarron |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Neurology medicine.medical_treatment Population Disease Northern ireland multiple sclerosis lcsh:RC346-429 mechanical thrombectomy disease modifying drug thrombolysis (tPA) Health care medicine education Stroke lcsh:Neurology. Diseases of the nervous system disparities education.field_of_study business.industry Thrombolysis Brief Research Report medicine.disease stroke Mechanical thrombectomy Emergency medicine Neurology (clinical) business |
| Zdroj: | Frontiers in Neurology, Vol 12 (2021) Frontiers in Neurology McCarron, M O, Clarke, M, Burns, P, McCormick, M, McCarron, P, Forbes, R B, McCarron, L V, Mullan, F & McVerry, F 2021, ' A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland ', Frontiers in Neurology, vol. 12, 608070 . https://doi.org/10.3389/fneur.2021.608070 |
| ISSN: | 1664-2295 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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