Objective:

Initiation of a community-academic partnership model to expand neurologic care

Background:

There is a significant gap between the demand for neurologic care and the number of neurologists in the USA. A 2013 AAN survey showed that within California the demand for neurologists is 6-19% more than supply. Furthermore, the number of patients with neurological disorders is increasing alongside advanced therapies that require expedited evaluation to mitigate disability.

Design/Methods:

To better understand the local impact of the nationwide mismatch between the need for neurologic care and supply, a community needs assessment was sent to local Federally Qualified Healthcare Centers (FQHCs) in Santa Clara and San Mateo County. The assessment focused on current access to neurologic care and barriers, and potential mechanisms of expanding care, followed by interviews with key stakeholders and a provider survey at a ‘pilot' FQHC.

Results:

The assessment responses(N=6) demonstrated a need for primary care provider assistance in the diagnosis and management of a wide variety of neurologic disorders due to discomfort in management without neurologic subspecialty input or further education. Additional barriers included distance to academic centers, difficulty getting patients accepted into neurology practices, and insurance status. Provider surveys at the pilot FQHC (N=6) showed an average confidence of 1.72 (maximum 5, likert scale) in the diagnosis/management of 15 common neurologic conditions. The top 3 topics of most relevance and interest were (1) the bedside neurologic exam for primary care providers, (2) thresholds/indications for brain imaging and (3) spine imaging.

Conclusions:

A community needs assessment led to a novel community based partnership: a bimonthly hybrid case-based neurology conference, facilitating collaboration between local community providers and neurology subspecialists. In this model, neurologists advise on cases, facilitate triage into an academic neurologic practice as needed, and produce educational sessions and materials addressing relevant neurologic topics collaboratively identified at the pilot FQHC.