Living with multiple sclerosis (MS) can present numerous challenges, and for individuals in rural communities, those challenges can be even more pronounced. In rural areas, access to MS specialists can be limited, and often rural hospitals and clinics are the primary locations where residents seek diagnosis and care for MS.
Rurality and its Connection to Neurological and Multiple Sclerosis Care Deserts
A recent study conducted by the National Multiple Sclerosis Society, in collaboration with Deloitte Consulting LLP, defined and identified neurologist and MS specialty deserts and examined demographics and social drivers of health (SDoH) in counties with varying access to neurological care. Neurologist access increased with urbanicity, with 97% of those in urban areas having full access compared to 13% in rural counties. Almost a quarter of the US population lives in MS specialist deserts and 83% living in rural areas live in MS specialist deserts. Lower neurologist access was associated with an older population, increased risk of chronic vascular conditions, depression, smoking, and less racial diversity.1
The Society has recently embarked on focused efforts to expand access to treatment, care, and support for people living with MS in medically underserved rural communities; this project has been supported by the Bristol Myers Squibb Foundation. This multifaceted initiative aims to increase awareness of, and connection to, the supportive resources available through the Society while also improving access, delivery, and utilization of MS care in rural communities. Three current focus states—Alabama, Arkansas, and Mississippi—were chosen based on review of multiple data sources, including administrative claims and Census information, proprietary data that tracks MS diagnoses across counties and states, the Society’s data on constituent interactions, and best prevalence estimates of the MS affected population. The Society also selected these states based on their larger rural populations, the disparity between numbers of people identified as living with MS versus best prevalence estimates, insufficient available clinicians, and underserved populations in rural communities.
Engagement with Community Members and Healthcare Professionals
The National Multiple Sclerosis Society has been engaged in meaningful discussions with key community members and healthcare professionals in these focus states to learn about the unique challenges faced by individuals living with MS and their care partners in rural communities. Through these discussions, the Society has gained insight into barriers to MS care in rural areas, including issues relating to transportation, workforce shortages, and absence of broadband and internet connection for telehealth visits. These conversations have also been instrumental in giving shape to interventions within these focus states.
The Society is thinking “outside-the-neurology-box” when it comes to its’ rural health initiative, considering where along the MS care journey there are opportunities to accelerate time to diagnosis and treatment. Through engaging healthcare professionals such as community health workers and primary care providers, the Society is implementing an upstream approach to decrease time to diagnosis and treatment. The Society is building knowledge with healthcare professionals beyond MS specialists and general neurologists in recognition that a patient-centered, comprehensive care team optimizes MS care. Additionally, fostering recognition of, and promoting knowledge of, MS across disciplines improves opportunity for earlier detection and earlier treatment. Building awareness of early signs and symptoms, as well as risk factors for MS amongst healthcare professionals in rural communities is a powerful strategy to dispel misconceptions about MS, ultimately improving access to care and reducing health disparities.
Recently, the Society attended the Southeast Community Health Worker (CHW) Network Summit in December 2024 that took place in Atlanta, GA. At this conference, the Society connected with community health workers working in rural, remote areas of their respective states. During the conference, Society team members were able to educate CHWs about MS and connect them with Society resources, such as the MS Navigator online referral form. Through the referral form, healthcare professionals can directly refer patients to the Society’s MS Navigators, who are trained to connect and provide patients with newly diagnosed information, symptom management strategies, financial planning, information on health benefits, assistance with employment issues, and can connect patients with other individuals living with MS.
Key Partnership with the National Rural Health Association
As part of its rural health initiative, the National Multiple Sclerosis Society has also partnered with the National Rural Health Association (NRHA) to raise awareness about MS and equip rural healthcare professionals with the knowledge and tools necessary to delivery high quality care for individuals living with MS. The NRHA is the nation’s leading rural health advocate and actively supports rural health policy and legislation through initiatives including the NRHA’s Government Affairs Office in Washington, DC, the Annual Rural Health Policy Institute and ongoing grassroots campaigns. The NRHA has an extensive network of over 2,000 hospitals and 5,000 clinics, including critical access hospitals and Federally Qualified Health Centers (FQHCs). This partnership has enabled the Society to connect with healthcare professionals in rural communities who have the regional insight and experience to guide the Society’s actions, ensuring that the Society’s work in rural communities is sustainable, impactful, and accessible.
An essential component of the Society’s partnership with the NRHA is developing educational opportunities for rural healthcare professionals and connecting them to Society resources. The Society recently hosted an NRHA educational series, “How to Know Multiple Sclerosis When You See It: Identifying Early Signs and Symptoms for Rural Health Care Professionals.” Led by Dr. Carolyn Bevan, an expert in multiple sclerosis and neuroimmunology with extensive experience improving care access for underserved and rural populations, the educational series addressed the specific challenges MS poses in rural areas. That educational series can be viewed by registering here.
Conclusion
The National Multiple Sclerosis Society is committed to ensuring that no one faces MS alone, regardless of where they live. The Society’s ongoing rural health initiative continues to work towards increasing visibility of individuals living with MS in rural areas who have been historically marginalized and to engage all healthcare professionals as advocates to ensure equitable MS care for all.
References:
- Barnola A, Fiol J, M. Snyder M, et al. The Identification and Characteristics of Neurological and Multiple Sclerosis Care Deserts Across the United States. Presented at ACTRIMS Forum 2024; February 29 to March 2; West Palm Beach, Florida. P194.
Disclosures: This short article was prepared by the National Multiple Sclerosis Society for touchNEUROLOGY. No fees or funding were associated with the publication of this article.
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