DISBANDING A MULTIDISCIPLINARY CLINIC - EFFECTS ON THE HEALTH-CARE OF MYELOMENINGOCELE PATIENTS

A multidisciplinary clinic for the evaluation and care of children with central nervous system malformations was established at our hospital in 1963 and disbanded in 1988. Three years later, a retrospective telephone survey of myelomeningocele patients (n = 87) was used to identify the effect of clinic closing on the health and care of these patients. After the clinic was disbanded, 45-66% of myelomeningocele patients failed to have regular medical and specialty care, despite the continued availability of the same specialty care in the same location. The most significant correlation was that older patients had less frequent care; this failure in health care utilization was not related to the patients' insurance status. This lack of care is not benign. An increase in serious morbidity, including amputation and nephrectomy, was detected in those patients with the least follow-up, but not in the control group. A significant problem with coordination of the patients' care exists; neither the patient, the family, nor the local physician assumes the duties of coordinator of care. This review indicates that if a multidisciplinary clinic is disbanded, a large proportion of patients will fail to maintain adequate medical follow-up, and that significant morbidity can occur within several years. It is unrealistic to expect the continuation of effective care by merely maintaining the individual services of the disbanded clinic, without some coordinator of care.