In this atlas, we have examined whether the use of health services for patients with selected chronic conditions varies based on their place of residence - defined by the health institutions' referral areas. The conditions presented in the atlas have been selected on the basis of five criteria, among those are: data quality, the size of the patient group, and whether the patients require follow-up in the specialist healthcare system over time.
About the atlas
The atlas is divided into three parts which are published separately at intervals of a few months. The first part was published on 29 April 2022 and contains the four neurological conditions: epilepsy, migraine, multiple sclerosis (MS) and Parkinson's disease.
The other two parts will present analysis on autoimmune diseases (arthritis, inflammatory bowel disease and psoriasis) and update three diseases chosen from previous health atlases published by SKDE (endometriosis, heart failure and COPD).
Neurological conditions
Main findings
- The proportion of patients with multiple sclerosis who were being treated with high-efficacy drugs varied widely between the referral areas. The variation is considered unwarranted.
- There was high geographical variation in the use of botulinum toxin for patients with migraine. Health North and Health West both had the lowest proportion of patients treated with botulinum toxin, and the lowest proportion of patients treated with CGRP inhibitors.
- Nationally, 20% of the migraine patients are on sick leave every year. The migraine patients have an average of three sick leaves per year due to migraine.
- Around 11,600 patients were treated annually for Parkinson's disease in the general practitioner or specialist healthcare service.
- There was high geographical variation in the use of specialist consultations for patients with Parkinson's disease.
- Use of specialist consultations for the elderly (aged 65 and over) with epilepsy varied widely between referral areas. The variation is considered unwarranted.
As an interpretation framework for the analyses, we have assumed that morbidity is similar across Norway and that the observed geographical variation is not primarily due to variation in morbidity. A thorough description of how we assess variation in the use of healthcare services can be found in the Elderly HealthCare Atlas for Norway.
The analyses show healthcare usage for a limited selection of patients, who in 2018–2021 had at least three contacts with the general practitioner or specialist healthcare service. The reason for such selected patient groups is primarily due to data quality, but there has also been a desire to describe services for patients who have needed healthcare services over time. The vast majority of the patients included in the analyses have received treatment in the health service over a period of at least one year.
The analyses present average figures for the three-year period 2019–2021. For the neurological conditions, we have not focused on investigating the effect of the COVID-19 pandemic. How the pandemic has affected the use of specialist healthcare services, including services for the chronically ill, was described in a separate report Ett år inn i koronapandemien (only available in Norwegian).
Epilepsy
Main findings
- The number of patients with epilepsy per 1,000 inhabitants varied very little between the referral areas.
- There was large and unwarranted variation in the use of specialist consultations for the elderly (ages 65 and over) with epilepsy. There was also considerable geographical variation in the use of specialist consultations for children.
- The proportion of patients who had contacts only in the general practitioner service varied from 19.2% in the referral area Østfold to 8.6% in the referral areas Nordland and Diakonhjemmet.
- The annual number of operations for epilepsy was significantly lower than expected.
Migraine
Main findings
- Annually, approximately 58,000 patients had repeated contact with the health service due to migraine, corresponding to 12% of the estimated number of patients with migraine in Norway.
- There was large geographical variation in the use of specialist consultations, and the variation increased throughout the period of analysis
- There was high geographical variation in preventive treatment of migraine with botulinum toxin and with CGRP inhibitors
- 20% of the patients in the sample were granted at least one sick-leave by a general practitioner, and these had an average of three sick-leaves per year due to migraines
Multiple sclerosis (MS)
Main findings
- Most MS patients had contacts both at the GP and in the specialist health service
- There was a large geographical variation between the referral areas in the proportion of patients with MS who were being treated with high-efficacy drugs in the period 2019–2021
- There was high geographical variation in the use of the less expensive drug Rituximab
Parkinson's disease
Main findings
- Around 11,600 patients were treated annually for Parkinson's disease in Norway in the general practitioner and specialist health services. This is more than expected.
- Close to 1,000 Parkinson's patients were followed up exclusively in the general practitioner health service.
- There was large geographical variation in the use of specialist consultations for patients with Parkinson's disease
Contact us
If you have any questions or feedback, please contact us!
You can contact us by sending an e-mail to helseatlas@skde.no.