Treatment patterns among physician specialties in the management of fibromyalgia: results of a cross-sectional study in the United States

Abstract

Background:

Fibromyalgia (FM) is characterized by persistent and widespread pain and often associated with other symptoms and comorbidities. Thus, FM patients seek care from multiple physician specialties. This study compared prescribing patterns, patient-reported outcomes (PROs), healthcare resource use (HRU), and direct costs related to FM in routine clinical practice across physician specialties.

Methods:

This cross-sectional, observational study recruited 203 FM subjects from 20 community-based physician offices (eight primary care, six rheumatology, three neurology, three psychiatry). Subjects completed questions about pain, other symptoms, quality of life, productivity, treatment effectiveness and satisfaction, and out-of-pocket expenses related to FM; site staff recorded subjects’ treatment and HRU based on medical chart review. Results were compared across specialties. Statistical significance was evaluated at the 0.05 level. Annual direct costs associated with FM were calculated in 2009 US dollars.

Results:

Subject demographic and clinical characteristics were not significantly different across physician specialties, except psychiatry subjects had the highest mean number of co-morbid conditions; p < 0.001. PROs were similar across physician specialties except fatigue; neurology subjects reported the highest levels. There were no significant differences in subject-reported outcomes of medication effectiveness (p = 0.782) and medication satisfaction (p = 0.338) for FM. Psychiatry subjects had more FM-related physician visits compared to other specialties (p = 0.013) and a higher proportion received diagnostic tests related to FM (p = 0.013). The mean (SD) number of FM prescription medications prescribed per subject was highest in the primary care and lowest in the neurology group; p = 0.024. The proportion of hypnotic (p = 0.001), muscle relaxant (p = 0.005), anxiolytic (p = 0.005), anti-epileptic (p = 0.007), and other medications (p = 0.044) prescribed for FM were significantly different across specialties. Overall direct medical costs did not differ significantly (p = 0.284) across specialties.

Conclusions:

Patient characteristics were similar across specialties, except with regards to comorbidity burden. This study noted significant differences among physician specialties in HRU and treatment patterns among medications, diagnostics, and outpatient visits. Consistent with other studies, this study did not identify a dominant strategy for FM management across physician specialties as overall per patient medical costs and subject-reported treatment satisfaction were similar. Future research to better characterize differences among physician specialties in FM management, as well as the reasons for these differences, would be useful.

Key words::

• Burden of illness
• Fibromyalgia
• Clinical practice patterns
• Physician's practice patterns
• Cost

Transparency

Declaration of funding

This study was funded by Pfizer, Inc.

Declaration of financial/other relationships

This study was funded by Pfizer, Inc. M. McN. is an employee of the APAC Centers for Pain Management. D.G. is an employee of Newton-Wellesley Hospital. M.McN. and D.G. were not compensated for their contributions. C.S., M.H., and R.B. were employed by a contract research organization, Covance Market Access Services Inc., at the time that this study was performed. Covance Market Access Services Inc. was paid by Pfizer Inc. to conduct this study and develop this manuscript. A.C. and G.Z. are employees of Pfizer, Inc.

Acknowledgments

The authors would like to thank Kate Anastassopoulos, an employee of Covance Market Access Services Inc., for her support in the analysis and the principal investigators who participated in this study: Dr John Peniston, Dr Gary Bedel, Dr Jeffrey Rosen, Dr Judith Kirstein, Dr Jay Fawver, Dr Don Goldenberg, Dr Alan Kivitz, Dr Michael Hassman, Dr Dana Trotter, Dr Lawrence Ginsberg, Dr Steven Katz, Dr Ara Dikranian, Dr Michael McNett, Dr Angela Stupi, Dr Robert Gerwin, Dr Jan Brandes, Dr Paul Gross, Dr Standiford Helm, Dr Alan Lichtbroun, and Dr Shahram Jacobs.

This research was presented in part via poster presentation at The American Pain Society Annual Meeting from May 6–10, 2010, in Baltimore, Maryland, USA.