In MS, Healthcare Inequities Based on Race & Ethnicity “Still Prevail”

In MS, Black and Hispanic patients had more trouble accessing care and reported lower-quality care than White patients.

“More than half of the US population is estimated to be living with one or more chronic health conditions,” Beth Schneider says. “Easy access to and quality of care are critical for managing these health conditions and stopping progression or worsening health.  There is increased awareness of health outcome disparities in the US, in which some segments of the population have easier and more affordable access to healthcare than others. Despite efforts to eradicate these inequities, healthcare is still not evenly meted out.”

One such condition impacted by these inequities is MS, Schneider notes.

For a study presented at CMSC 2023, Schneider and colleagues explored potential disparities in healthcare quality, affordability, and access based on sex, ethnicity, or race for patients living with MS, according to the study results. An invitation to complete a survey was sent to US members of MyMSTeam, a social network comprising more than 197,000 individuals.

Minority Groups Experience Access Issues & Lower-Quality Care

A total of 1,935 patients with MS completed the 34-question survey. They described the negative impact of MS on everyday chores (85%), mental health (77%), and employment (75%). “MS had a far-reaching negative impact on QOL regardless of race, ethnicity, or gender, but we also found that health inequities still prevail,” Schneider says.

Specific differences based on ethnicity, race, and sex included the finding that only 64% of Hispanic individuals reported having “convenient access to their doctor” compared with 76% of White patients and 78% of Black individuals. Hispanic patients were also more likely to use the ED or an urgent care center for MS (35%) than Black patients (25%) or White patients (19%) and more often unable to take time off work for appointments than White patients or Black patients.

Further, White patients described higher-quality interactions with healthcare professionals than Hispanic or Black patients. White patients were more likely to report feeling respected (81%) in healthcare visits than Black patients (72%) or Hispanic patients (65%) and that the clinician was non-judgmental (69% compared with 58% for Black patients and 52% for Hispanic patients).

The researchers also reported disparities based on sex, according to the study results. Male respondents were more likely to feel like their clinician explained test results well than female respondents (71% vs 62%).

Moving Beyond the Exam Room in MS Care

The findings indicate that “access to and quality of MS care are highly dependent on who you are and where you live,” Schneider says.

“An opportunity exists for doctors, pharmaceutical companies, and insurers to reflect on how to ensure all their patients are being provided with equitable and quality care,” she continues. “This includes building awareness of financial support options, such as co-pay programs, and ensuring that patients are being placed on the medications that are best for their needs, even if it means addressing insurance hurdles. For doctors, it also means taking the time to truly listen to patient needs, symptoms, and desired treatment outcomes regardless of race, ethnicity, or sex.”

Finally, the results may mean the healthcare system needs to expand its definition of clinical practice and extend access to care beyond the traditional clinic visit.

“For instance, one of the best ways to reach thousands of patients in an underserved population is to provide free patient education online, but it is critical that the doctors reflect the diversity of the population you are trying to reach,” Schneider says. “You can ‘bring the experts to the masses,’ so to speak, by partnering with Black and Latino physicians who are able to do live Q&A sessions and general patient education videos that reach hundreds of thousands of patients at a time.”

This all requires recognizing “that patients cannot always take time off from work to get to the doctor’s office, or that English may not be their first language,” she adds. “We have to recognize that they don’t always digest what they hear in the doctor’s office, and they need a way to reinforce what the doctor just told them.”