Multiple sclerosis management for low-income minorities.

Low-income minorities with complex chronic diseases and physical disabilities have difficulty accessing appropriate healthcare often resulting in suboptimal care. A survey was performed to determine the impact of cultural and socioeconomic factors on the quality of care for low-income minorities with multiple sclerosis (MS) enrolled in Independence Care System (ICS), a Medicaid long-term managed care plan. All 92 ICS members with a diagnosis of MS were surveyed on three aspects of their care: specialty contact, immunomodulating drug therapy and osteoporosis prevention. Of those surveyed, 32% were never seen by an MS specialist. One third were not taking immunomodulatory medications, primarily due to noncompliance caused by a lack of understanding about these drugs. The prevention of osteoporosis and potential fracture in this high-risk population was largely neglected by providers despite the fact that the majority of those surveyed also reported balance difficulties and a history of falling. The survey revealed several deficiencies in the care of low-income minorities with MS. A major issue was the lack of adequate education, particularly about the immunomodulating drugs. Education about the importance of osteoporosis prevention, falls mitigation programmes and rehabilitation evaluations are critical interventions to decrease the risk of fracture.