Nearly one-fifth of older adults travel 50-plus miles to see a neurologist

Older Americans with complex neurologic conditions may travel great distances for care, many of whom live in rural areas or regions with a limited number of specialists, a study finds.

Research led by Michigan Medicine explored data from Medicare beneficiaries with a neurologist visit in 2018, focusing on travel distance and time for visits across neurologic conditions and subspecialties.

Investigators found that 17.6% of older adults who saw a neurologist traveled 50 or more miles one way for care, and travel burden was highest for less common neurologic conditions that required coordinated multidisciplinary care.

Results are published in Neurology.

“Many patients have to travel long distances to see neurologists, which can affect patient care including the ability to see patients more than once,” said senior author Brian C. Callaghan, M.D., a neurologist at University of Michigan Health and the Eva L. Feldman., M.D, Ph.D., Professor of Neurology at U-M Medical School.

The median travel distance one way for patients was 81 miles and 90 minutes for patients requiring long-distance travel and 13 miles and 22 minutes for those without long distance travel requirements.

Among neurology patients, those who traveled long distances were more likely to live in rural areas or where there was a lower density of neurologists.

Patients seen for ALS or nervous system cancer also often traveled long distances.

Nearly one third of patients bypassed the nearest neurologist by 20-plus miles, and 7.3% of patients crossed state lines for neurologist care.

The results, researchers say, suggest that policymakers should look for affordable ways to improve access to neurologic care.

“Two potential ways to improve access to neurologists are to increase telemedicine visits and to increase neurological subspecialist support to local neurologists,” said lead author Chun Chieh (Anna) Lin, Ph.D., adjunct research faculty at the U-M and research associate professor at the Ohio State University.

In the study, these traveling long distances were 26% less likely to return for a follow up visit compared to people without such a travel burden.

The consequences of long travel for neurology appointments have not been well studied.

However, previous studies of cancer care showed that longer travel distance to a health care provider was associated with more advanced disease at diagnosis, inappropriate treatment and worse quality of life.

“Future studies are needed to better understand the impact of travel burden on patient outcomes and also to test interventions to reduce travel burden,” Lin said.

“We are also interested in learning how patient travel was impacted by the emergence of readily available telemedicine during the COVID-19 pandemic.”

Additional authors include, Chloe E. Hill, M.D., M.S., and Lindsey De Lott, M.D., both of University of Michigan, Kevin A. Kerber, M.D., M.S., and James F. Burke, M.D., M.S., both of the Ohio State University, Lesli E. Skolarus, M.D., M.S., of Northwestern University, Gregory J. Esper, M.D., M.B.A., of Emory University, and Adam de Havenon, M.D., M.Sci., of Yale University.

The study was funded by the American Academy of Neurology.

Esper performs medical legal consultations serves as a consultant for NeuroOne, Incorporated, an EEG device company, and is a member of the Board of Directors of AAN and AANI; A. de Havenon has received research funding from NIH/NINDS, the AAN, has received consultant fees from Integra and Novo Nordisk, royalty fees from UpToDate, and has equity in TitinKM and CertusB.C. Callaghan consults for DynaMed, receives research support from the American Academy of Neurology and performs medical legal consultations including consultations for the Vaccine Injury Compensation Program.