ArticleFrontiers in neurology
Mind the gap: a German case study on the discrepancy between geographic accessibility and real-world utilization of botulinum toxin therapy.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: Botulinum toxin A (BoNT-A) is widely used in the treatment of neurological disorders. Despite guideline recommendations, particularly regarding BoNT-A injections for post-stroke spasticity, current evidence shows that many patients in Germany do not receive BoNT-A therapy. Methods: An analysis of travel time to neurological Botulinum Toxin (BoNT-A) centers was conducted based on German hospital quality reports. Additionally, the German Botulinum Toxin Working Group (Arbeitskreis Botulinumtoxin e. V.; AK-BoNT) performed an anonymous online survey of its members, who treat with BoNT, between November 2023 and March 2024 to document experiences, identify perceived barriers, and explore potential improvements in BoNT-A therapy. Results: The geospatial analysis showed theoretical accessibility to specialized neurological BoNT-A centers in Germany with 96.72% of the population residing within a 60-min drive of a qualified facility. Of 632 invited AK-BoNT members, 191 completed the survey in full (30.2% response rate). 79.6% of the respondents worked in neurology and two thirds of the respondents had more than 10 years of experience with BoNT-A. Although more than 60% of respondents rated BoNT-A therapy as effective regardless of indication, many pointed to structural and economic barriers, including inadequate reimbursement pathways and limited multidisciplinary collaboration. Conclusion: The results indicate that BoNT-A is recognized and provides therapeutic benefit from the perspective of the treating physician, but structural and economic barriers hinder the use of this therapy. Interestingly, even in a well-resourced system with broad geographic access to specialized care, significant treatment gaps may persist. Recommendations include standardized reimbursement structures, improved education, and increased cross-sector collaboration.
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