Wait Time to See a Neurologist After Referral Among Medicare Participants.

BACKGROUND AND

objectivesTimely access to specialist care is crucial in expeditious diagnosis and treatment. Our study aimed to assess the time patients wait from being referred by a physician to seeing a neurologist using Medicare data. Specifically, we evaluated differences in access related to sex, race/ethnicity, geography, and availability of neurologists.

methodsWe conducted a cross-sectional analysis using a 2018-2019 Medicare sample of patients who had a new patient visit to a neurologist. Our primary outcome was the wait time between their last visit with the referring physician and their first visit with the neurologist (the index neurologist visit). We also looked at the time between the first visit for a neurologic condition and the index neurologist visit for that same condition. We used a linear mixed-effects model to identify the factors associated with the wait time, considering the patients' hospital referral regions (HRRs).

resultsWe identified 163,313 Medicare beneficiaries who had a new patient visit with a neurologist in 2018-2019 after their physician referred them. Their average age was 73.8 (SD 10.7). The median (interquartile range) wait time to the index neurologist visit was 34 days (15-70), and 18% of patients waited >90 days. Patients with multiple sclerosis (MS) had to wait an average of 29.4 days longer, patients with epilepsy waited 10.4 days longer, and patients with Parkinson disease (PD) waited 9.3 days longer than patients with back pain. There were no significant differences in wait times across race/ethnicity and sex. Our study also showed no significant differences in wait times across regions with varying levels of neurologist availability. When patients visited a neurologist located outside of their residential or referring physician's HRR, the wait time was extended by an average of 11 days. DISCUSSION: We found that, patients waited 34 days to see a neurologist after their physician referred them while 18% of them waited more than 90 days. Factors such as sex, race/ethnicity, and neurologist availability did not significantly affect timely access to neurologists. Patients with MS, epilepsy, and PD had longer wait times, despite needing the specialized care that neurologists can provide. This highlights the need for innovative approaches to improve timely access to neurologists.