Gordon Smith, MD, Professor and Chair of Neurology, Virginia Commonwealth University, explains how the current healthcare system leads to inequalities in diagnosis and treatment of myasthenia gravis.
Transcription:
I’m Gordon Smith. I’m a Professor and Chair of Neurology at Virginia Commonwealth University. I have an interest in myasthenia gravis and became interested in the issue of healthcare disparities in myasthenia when I moved to VCU about six years ago. I’d been at the University of Utah for about 20 years.
One of the things that’s really amazing about VCU among many is that we’re both quaternary care health systems with patients coming from all over the country or all over the world. But we also have a very strong and very important to us safety net mission. We care for a very diverse and at-risk population, including a large urban population, as well as a large rural population.
I observed right away that our patients with myasthenia were heavily impacted by social determinants of health, and there were disparities that were concerning to me. The work we’ve presented here at the AANEM meeting was made possible by Argenx, who fortunately were interested in looking at this with us. Basically, what we did was to survey US neurologists about the impact of social determinants of health on their patients with myasthenia. We identified or received surveys back from 150 neurologists who met the required criteria in terms of years of practice and board certification and the number of myasthenia patients they followed.
The bottom line is, as we hypothesized, there does appear to be significant impacts in a couple of domains. One of the posters is really about access to care, and access is certainly impacted by social determinants of health. Just to give you some numbers, about 90% of respondents felt that financial distress and financial pressure was a major driver of healthcare disparities, and about half felt that race and ethnicity also impacted healthcare disparities. More than two-thirds, more than 70%, believed that their patients who were struggling with social determinants of health issues, had difficulty in accessing clinics, were more likely to not show up to visit. Over half felt that social determinants felt delayed diagnosis and led to diagnosis in an acute setting.
The same is true with access to therapies. While the respondents felt that their patients had about equal access to thymectomy relative to their SDOH issues, overwhelming majorities felt that for all both the newer therapies, but also IVIG much more difficulty in terms of getting prior authorization and accessing those therapies. It was clear that the perception was that financial drivers were most important, access to insurance, copays, these sorts of things, but also to physical proximity in travel.
The respondents had really good ideas about how we might address these that are unsurprising, but I think they’re impactful, and that is focusing on the ability to provide care within the community, training primary care doctors more in myasthenia, focusing on access to home infusions, strategies to limit the financial toxicity of medications, and things like that. At the end of the day, I thought this was affirming for what I think most of us see in our clinical practice. It suggested strategies we might use and certainly lays the foundation for future work in this area.
To learn more: https://checkrare.com/diseases/autoimmune-auto-inflammatory-disorders/