Underserved Patient Access to Multidisciplinary Rehabilitation for Movement Disorders in a Single Tertiary Academic Referral Center

Objective: Identify the geographic and demographic profile of underserved patients accessing multidisciplinary care at a single tertiary movement disorders center.

Background: Patients on Medicaid or without medical insurance belong to an underserved and potentially vulnerable population. Many of these patients travel far distances to obtain specialized services including multidisciplinary rehabilitation (including physical, occupational and speech therapy). Identifying geographic and demographic characteristics of these underserved patients will be informative in developing strategies to help increase access to integrative care.

Design/Methods: We performed a retrospective chart review of patients seen at the University of Florida (UF) Fixel Institute for Neurological Diseases. We reviewed movement disorders diagnosis, age, gender, ZIP code, and treatment including multidisciplinary rehabilitation. We identified other movement disorder centers (MDC) in the state of Florida. Geographical analysis utilizing distance between zip code of residence and nearest MDC and UF were performed using ArcGIS 10.3 software.

Results: A total of 6867 patients were identified. Of these, 355 patients were classified as Medicaid/self-pay (underserved). The most common diagnoses included tic disorder (19.2%), dystonia (18.3%), Parkinson’s disease (PD) (14.3%). 34.7% received at least one rehabilitation service (physical, occupational, or speech therapy). The diagnoses that most commonly utilized rehabilitation services included PD and tic disorders (23.0% each), dystonia (13.9%) and Huntington’s disease (9.8%). Patients receiving rehabilitation services were found to travel further to UF than to a closer MDC (149.17 ± 198.51km vs. 103.38 ± 173.49km, p<0.001).

Conclusions: Patients receiving rehabilitation services travelled past closer movement disorder centers. Potential reasons for this include research opportunities, center of excellence accreditations, complex management strategies, and limited specialist availability locally. These factors should be explored in future studies. Our results highlight the need for increased awareness of available local centers and additional comprehensive multidisciplinary movement disorders centers to help offset transportation barriers and improve access to care in underserved movement disorders patients.