One-Year Healthcare Utilization in People With Multiple Sclerosis and Controls in Wales

OBJECTIVES: Using Multiple Sclerosis (MS) as an exemplar of chronic disease we compared healthcare utilisation in people with MS (pwMS) patients and the general population. Here compared the rate of primary (General Practice (GP)) and secondary care (hospitals and outpatients) contacts between the two groups in Wales using the Secure Anonymised Information Linkage (SAIL) databank.

METHODS: The SAIL Multiple Sclerosis Algorithm cohort (Nicholas et al., 2024) was used to identify people with MS (pwMS) from the Welsh Longitudinal General Practice dataset (WLGP) and Welsh Demographics Service Dataset (WDSD). Hospital admissions were extracted from the Patient Episode Dataset for Wales (PEDW) between 01-01-2019 to 31-12-2019, along with Outpatient Database for Wales (OPDW) contacts. Rate ratios (RR) (±95% confidence intervals (CI)) of contact with PEDW, OPDW, and WLGP were compared between: 1) the MS cohort and 2) age and sex-matched controls from the general population, with a case-control ratio of 1:9.

RESULTS: 1579 pwMS were identified, 1160 were female (73%). Significantly higher rates of hospital utilisation were found among the pwMS cohort: rate ratio of 2.98 (CI: 2.80–3.18), vs the general population. PwMS also had longer hospital stays: mean 9.17 days (IQR: 2–10), vs general population: 7.12 days (IQR: 1–5). PwMS had higher OPDW use: rate ratio of 1.84 (CI: 1.78-1.89) vs the general population, whereas pwMS had a lower utilisation of GP resources: contact rate ratio of 0.96 (CI: 0.95–0.97).

CONCLUSIONS: pwMS had a 3-fold increase in inpatient attendances at Welsh hospitals and were admitted for longer (2 days) than a case-matched cohort in 2019. Additionally, they had more visits to hospital outpatient departments but considerably less attendance at GPs. This highlights the shift in care for complex medical patients to specialist services and the resultant lesser impact on GP services.