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Practice styles of US compared to UK neurologists
B G Vickrey1, D R Gifford, T R Belin
1Department of Neurology, University of California, Los Angeles 90095-1769, USA.
Neurology
|June 20, 1998
Summary
US and UK neurologists show significant variation in diagnosing and treating common neurologic conditions like seizures and dementia. Differences persist after accounting for practice and attitude factors, suggesting a need for care standards.
Area of Science:
- Neurology
- Clinical Practice Variation
- International Healthcare Comparison
Background:
- Neurologic disease diagnosis and treatment can vary significantly.
- Understanding international differences in clinical decision-making is crucial for standardizing care.
Purpose of the Study:
- To assess and explain variations in diagnostic and treatment decisions among US and UK neurologists for common neurologic presentations.
- To identify factors contributing to observed international differences in neurologic care.
Main Methods:
- Mailed surveys were sent to 210 UK and 595 US neurologists, presenting three clinical scenarios: unprovoked seizure, early Parkinson's disease, and dementia.
- Outcome measures included self-reported diagnostic test ordering and treatment decisions.
- Neurologists' practice characteristics, diagnostic certainty, and attitudes toward uncertainty were also assessed.
Main Results:
- US neurologists were more likely to order additional diagnostic tests across all scenarios compared to UK neurologists (p < 0.05).
- A significantly higher proportion of UK neurologists (77%) would manage a single unprovoked seizure without medication compared to US neurologists (26%) (p < 0.0001).
- Treatment for early Parkinson's disease showed no significant international difference, while neuroimaging for dementia was common in both countries.
Conclusions:
- Substantial international variation exists in the clinical management of common neurologic conditions between the US and UK.
- These persistent differences, even after statistical adjustment, highlight the need for cross-country collaboration to establish consensus on neurologic care standards.