Efficient practices associated with diagnosis, treatment and management of fibromyalgia among primary care physicians

Abstract

Objectives: To describe beliefs and practice patterns of primary care physicians (PCPs) providing fibromyalgia (FM) care, and to characterize differences between PCPs who report being able to provide timely and beneficial care versus the remaining PCPs.

Methods: A mixed-methods approach including surveys followed by semi-structured focus groups among United States-based PCPs in seven cities was used. Post hoc, a composite threshold of timely and beneficial care, defined as PCPs reports of at least one-half of their patients achieving an 'acceptable' quality of life within one to four office visits after diagnosis, was created to compare subgroups.

Results: Forty-six per cent of PCPs reported some uncertainty when diagnosing FM. PCPs reported personally treating approximately two-thirds of their patients (63%), and reported an average of three dosage titrations. In a post hoc exploratory analysis, 42.5% of PCPs met a composite threshold of self-reported timely and beneficial FM care. These PCPs reported fewer office visits to confirm an FM diagnosis (2.7 versus 4.0 visits [P<0.01]) and more patients with 'significant improvement' (38% versus 23% [P<0.01]) after six months of treatment compared with the remaining PCPs.

Conclusions: Physicians self-reported an inadequacy in diagnosing, treating and managing patients with FM in current practice. A subset of PCPs, however, perceived an ability to reach a definitive diagnosis and initiate treatment plans relatively sooner than the other respondents. If the perception of this subset can be confirmed with objective clinical outcomes, and these behaviours modelled, steps could be taken to improve FM care within the broader PCP setting.

Figure 1)

Distribution of fibromyalgia (FM) patients with ‘acceptable’ quality of life within one to four office visits. Based on survey question: “Think about the number of office visits typically required for you and your FM patients to find the ‘right’ FM treatment plan for them, defined as therapy that results in patients achieving a quality they deem as ‘acceptable’. How would you classify all of your FM patients currently receiving pharmacological treatment across the following series of office visits before a treatment was deemed appropriate and acceptable by either you or your FM patient?” Five office visit categories were provided for respondents to enter patient percentages, including two summed for subgroup creation: ‘1 to 2 office visits’ and ‘3 to 4 office visits’. PCP Primary care physician