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Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care

Authors Able SL, Robinson R, Kroenke K, Mease P, Williams D, Chen Y, Wohlreich M, McCarberg B

Received 17 December 2014

Accepted for publication 17 August 2015

Published 20 May 2016 Volume 2016:7 Pages 11—20


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Stephen L Able,1 Rebecca L Robinson,2 Kurt Kroenke,3,4 Philip Mease,5,6 David A Williams,7 Yi Chen,8 Madelaine Wohlreich,9 Bill H McCarberg10

1US Health Outcomes and Technology Assessment, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 2Lilly Research Labs, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 3Department of Medicine, Indiana University, 4VA Health Services Research and Development Center for Health Information and Communication, Regenstrief Institute, Indianapolis, IN, USA; 5Rheumatology Associates, Division of Rheumatology Clinical Research, Swedish Medical Center, 6University of Washington School of Medicine, Seattle, WA, USA; 7Chronic Pain and Fatigue Research Center, Michigan Institute for Clinical and Health Research, University of Michigan School of Medicine, Ann Arbor, MI, USA; 8inVentiv Health Clinical, Indianapolis, IN, USA; 9USMD Neuroscience, Lilly USA LLC, Eli Lilly and Company, Indianapolis, IN, USA; 10Department of Family Medicine, University of California at San Diego School of Medicine, San Diego, CA, USA

Purpose: To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments.
Patients and methods: Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher’s exact tests, and Student’s t-tests.
Results: Physician specialist cohorts included rheumatologists (n=54), primary care physicians (n=25), and a heterogeneous group of physicians practicing pain or physical medicine, psychiatry, neurology, obstetrics and gynecology, osteopathy, or an unspecified specialty (n=12). The rheumatologists expressed higher confidence diagnosing FM (4.5 on a five-point scale) than primary care physicians (4.1) (P=0.037). All cohorts strongly agreed that recognizing FM is their responsibility. They agreed that psychological aspects of FM are important, but disagreed that symptoms are psychosomatic. All physician cohorts agreed with a multidisciplinary approach including nonpharmacological and pharmacological treatments, although physicians were more confident prescribing medications than alternative therapies. Most patients reported moderate to severe pain, multiple comorbidities, and treatment with several medications and nonpharmacologic therapies.
Conclusion: Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties.

Keywords: medical specialty, treatment, prospective observational study

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