Submissions List TBI Interagency Conference

Health care experiences of people with multiple sclerosis living in urban versus rural areas

  • Johnson, Kurt
  • Weir, Virginia
  • Verrall, Aimee
  • Amtmann, Dagmar


Health Care Access and Quality


440 community-dwelling adults with multiple sclerosis (MS) living in Washington, Alaska and Montana completed a telephone-based survey. Participants residing in a primarily rural area reported lower confidence in health care quality than urban participants.


Background: In a qualitative study we conducted prior to the study reported here, people with multiple sclerosis (MS) living in rural areas reported having inadequate access to specialized MS medical and rehabilitation care and less access to the greater MS community. In 2011, we conducted a needs assessment of people with MS living in Alaska, Montana, and Washington in collaboration with the Greater Northwest Chapter of the National MS Society.

Methods: The telephone-based survey was completed by community-dwelling adults with MS (N=440) residing in Alaska, Montana, and Washington. A purposive sampling plan was used to reach a target of 30% people living in a primarily self-reported rural area. Urban and rural location in this analysis was determined using the Centers for Medicare and Medicaid Services zip code designation.

Results:  31.1% of survey respondents resided in a primarily rural area. People residing in rural areas were significantly more likely to see a family practice or family care doctor (30.4% vs. 11.7%) as opposed to an MS specialist (35.6% vs. 57.9%) than people in urban areas for the majority of their MS care (P<0.0001). Living in a rural area was associated with significantly longer average travel time from home to primary MS physician (103 vs. 36 minutes, P<0.0001). People living in urban and rural areas reported similar health care coverage (Medicaid, Medicare, private insurance) and similar types of services covered by health care insurance. Lower levels of confidence were expressed with respect to physician knowledge about MS area including less confidence in physician being up-to-date on latest MS treatments by people living in a rural areas (P=0.0028)  People in rural areas also reported having less access to MS specialists than urban counterparts (P=0.0367). However, people living in a rural area did not report higher concerns about health care coverage continuity or financing.

Conclusions: People living in rural areas face considerable barriers to accessing knowledgeable health care providers. In collaboration with the MS Society, we are considering building a MS consultation network between centers of excellence and community providers and people with MS to increase access to MS care resources and expert knowledge.