Geospatial Analysis of Persons with Movement Disorders Living in Underserved Regions

A study authored by Ka Loong Kelvin Au, Oliver T. Nguyen, Kathryn Moore, Emily Dinh, Adolfo Ramirez-Zamora, Michael S. Okun, and Leonardo Almeida and published in the journal Tremor analyzed geographic & demographic profiles of Norman Fixel Institute for Neurological Diseases at UF Health patients and found that those from underserved areas travel farther to seek expert care, highlighting the need to improve delivery of care to underserved movement disorders populations.


Background: Movement disorders persons from underserved areas have increased barriers to access tertiary care. There is currently limited data on the geographic and demographic profile of movement disorders persons from underserved areas.

Methods: A retrospective chart review of the geographic and demographic profile of consecutive cases seen between 2002–2017 at the University of Florida Norman Fixel Institute for Neurological Diseases (UF‐NFIND) was performed. Information collected included age, sex, diagnosis, zip code, treatment received, and insurance information. The distances between each person’s home residence and the nearest movement disorders center of excellence (MDC) as well as the distance to the UF‐NFIND were calculated using ArcGIS 10.3.

Results: A total of 5.2% (355/6867) of the sample population were identified as a Medicaid/self‐pay population and classified as underserved. The most common diagnoses were tic disorder (19.2%), dystonia (18.3%), and Parkinson’s disease (14.3%). In underserved persons, the median distances from their homes to the UF-NFIND (82.19 [45.79–176.93] km) vs. their nearest MDC (63.34 [26.91–121.43] km) were significantly different (p < 0.001).

Discussion: Underserved persons in our study travelled further to receive subspecialty care at UF-NFIND than closer MDCs. Potential reasons for underutilization of closer care could possibly include research opportunities, availability of specific treatments or procedures, insurance restrictions, and limited specialist availability. Despite this observation, underserved persons were underrepresented at our institution compared to the proportion of Medicaid/uninsured patients in Florida. Our results highlight the need for increased awareness of care options for underserved movement disorders populations.