Assessing family physicians awareness of ALS and establishing a link between tertiary health care and ALS patients to facilitate patient care

Objective: The management of ALS patients involves challenges and requires a multidisciplinary approach. Collaboration and coordination between Primary Care and Hospital Care are essential. It is clear that family physicians, as the foundation of primary healthcare services, can play a decisive role in this coordination. However, no study has yet been found that examines the coordination and relationship between primary care physicians and tertiary neurology specialists, who are primarily responsible for the diagnosis, treatment, and follow-up of patients. It can be anticipated that having family physicians assess patients when necessary, instead of referring them directly to a tertiary hospital, and enabling direct communication between family physicians and neurologists would have a positive impact on patients, their relatives, and the disease process. Methods: This study included family physicians in the central district of Antalya and neurology specialists working in secondary and tertiary hospitals. Surveys were conducted face-to-face with the participating doctors. A literature review was performed before the study to evaluate similar studies and their results; however, no suitable scale was identified, so a questionnaire was designed with appropriate questions. Two different surveys were applied: one for family physicians and another for neurology specialists working in secondary and tertiary healthcare institutions. An independent samples t-test was used to analyze the attitudes of doctors toward ALS awareness statements. The Kruskal-Wallis test and the Mann-Whitney U test were used to examine the attitudes of physicians with ALS patients in relation to specific characteristics of the diagnostic process. Correlation analysis was applied to assess the relationships between attitude levels. A p-value of less than 0.05 was considered statistically significant. Results: In the study, evaluations were conducted based on three groups: family physicians without ALS patients, family physicians with ALS patients, and neurology specialists. Records from 2023 showed that there were n1=429 family physicians without ALS patients, n2=62 family physicians with ALS patients, and n3=37 neurology specialists, making a total population of N=528. Using a simple random sampling method, with an acceptable margin of error of 5% and a 99% confidence level, it was calculated that at least n=268 individuals would be required to adequately represent the population. When stratified according to the population distribution, at least n1=218 family physicians, n2=31 family physicians with ALS patients, and n3=18 neurology specialists needed to be included in the study. Among the participating family physicians with ALS patients, 19 were male and 12 were female, while among the neurology specialists, 10 were male and 8 were female. The study compared the knowledge levels of family physicians with and without ALS patients regarding ALS. It also assessed the collaboration approaches of neurology specialists and family physicians with ALS patients. Additionally, the study examined whether the knowledge and attitude levels calculated for each group varied based on sociodemographic factors, duration of ALS patient follow-up, and other participant characteristics. Conclusions: It seems possible to increase family physicians' awareness of chronic disease monitoring and ALS by the influence of ALS patients in their regions. Neurology specialists also contribute to raising awareness of collaboration with family physicians in the follow-up of ALS patients and in solving complex health problems. Through this study applied to both family physicians and neurology specialists, it is believed that the cooperation between them in the care of ALS patients would facilitate disease management and positively impact patients' quality of life. However, due to the lack of communication between primary and tertiary healthcare institutions, the study concluded that neither group of doctors collaborated. It is believed that a multidisciplinary approach, where family physicians play a central role in ALS follow-up, could be valuable. Keywords: Amyotrophic Lateral Sclerosis (ALS), Multidisciplinary Approach to ALS, Family Medicine and ALS, ALS in Primary Care