Survey Shows More Education About Fibromyalgia Needed Among Healthcare Providers
Fibromyalgia is a chronic pain disorder affecting approximately 2% to 4% of adults in the United States, and more than 5% of patients in general medical practice.1-3 The predominant symptom of fibromyalgia is chronic widespread musculoskeletal pain.1 Patients with fibromyalgia often present with additional symptoms, including sleep disturbance, fatigue, morning stiffness, paresthesias, headaches, and exercise intolerance.1,3 The symptoms of fibromyalgia can be prolonged and debilitating, and contribute to increased healthcare utilization and costs.1,4
Multiple published reports are available describing the results of surveys to assess physicians’ awareness and knowledge of fibromyalgia.5-9 Several of the projects surveyed rheumatologists from foreign countries5,6 or a combination of rheumatologists and general practitioners.7 A detailed questionnaire on fibromyalgia was completed by 172 family physicians in Israel.8 More recently, 1,622 physicians from an international study completed a survey conducted to outline descriptive data on fibromyalgia.9
Limited information is available describing similar physician surveys reviewing fibromyalgia in the United States. The National Fibromyalgia Association (NFA) commissioned an Internet-based survey of 557 physicians in 2007, including 101 primary care physicians.10 Recognizing an increasing focus on fibromyalgia and a developing need for information, we conducted a survey of providers, primarily from Vermont, with the goal of evaluating their awareness and treatment of fibromyalgia.
Study Design and Sample
Healthcare providers who attended an educational program in Vermont for family physicians and other primary care providers conducted in 2009 and 2010 were invited to participate. The annual program was sponsored by the University of Vermont (UVM), College of Medicine, and reviewed contemporary issues in the practice of family medicine. In addition, members from the Vermont Nurse Practitioners Association (VNPA), and physicians from a large medical practice in Western Massachusetts, were also invited to participate.
Using a convenience sample, a cross-sectional survey was administered to healthcare providers who were attending one of the educational programs, were members of the VNPA, or practiced at the targeted medical clinic. There were no exclusion criteria. Participation was voluntary and the healthcare providers were not compensated for their time. Participants were instructed to only complete the survey once. This study was granted exempt status by UVM’s Committees on Human Subjects Research.
The two-page written questionnaire was developed based on published reports previously conducted using surveys to review physicians’ attitudes and practices related to fibromyalgia.6,9,11 Prior to implementation, the survey was pretested for clarity by a small number of providers. The survey asked questions about providers’ demographics, training, awareness, and treatment practices associated with fibromyalgia. The estimated time to complete the survey was fewer than 15 minutes. The survey was designed as a scannable form, requiring the participant to shade an oval for the desired response or, for a limited number of questions, provide a numerical value. The survey did not contain any protected health information and was devoid of any unique identifiers.
Descriptive statistics were used, when appropriate, to describe the data. As this was exploratory research without an a priori hypothesis, we did not account for multiple comparisons.
A total of 133 prescribers completed the survey. The estimated response rate based on the number of participants attending the programs was 30%. Participants’ demographic information is shown in Table 1. The participants’ mean age was 49.5 years (SD+/-11.1) with a mean of 17.1 years (SD+/-11.3) in practice. Participants displayed a wide range in the number of patients treated with fibromyalgia; 0-200, median 10 patients.
Information related to fibromyalgia was received by 66 participants (49.6%) during their professional training, with 52 (39.1%) attending an educational program on fibromyalgia during the previous 2 years. Self-education on fibromyalgia within the previous 2 years was noted by 105 providers (78.9%), and 98 (73.7%) stated they needed more information about the condition. Additional information was requested by 28 nurse practitioners (NPs) (87.5%), 13 physician assistants (PAs) (81.3%), and 54 physicians (66.7%).
Fibromyalgia was considered a clinical condition by 104 providers (78.2%); 28 NPs (87.5%), 13 PAs (81.3%), and 54 physicians (66.7%). Fibromyalgia was considered both a medical and psychological condition by 107 providers (80.5%). Seventy six (57.1%) of the participants were aware of the 1990 American College of Rheumatology (ACR) criteria for fibromyalgia, including 16 NPs (50%), 8 PAs (50%), and 52 physicians (64.2%).12 Of the providers aware of the criteria, 45 (59.2%) regularly used the guidelines. Additional responses to questions related to fibromyalgia awareness are described in Table 2.
Forty three (32.8%) out of 131 participants stated they were completely or mostly confident in their ability to treat fibromyalgia. A total of 106 providers (79.7%) prescribed medications to treat fibromyalgia. The medication classes prescribed are shown in Figure 1. Figure 2 describes the non-drug therapies used to treat fibromyalgia. A quantitative pain scale to evaluate pain associated with fibromyalgia was used by 55 providers (45.1%, n=122); NPs used pain scales most often (53.1%), and physicians (34.8%) the least.