e22 Do patients with fibromyalgia place increased demands on healthcare resources?

Abstract

Background: Fibromyalgia is a common chronic disease, with prevalence rates of 2-18% in the adult population. The diagnostic criteria for fibromyalgia is based largely on subjective symptoms and examination findings, which can lead to extensive investigations and referrals. Management of this condition and its comorbidities is widely varied. We aimed to explore the health care utilization of patients with fibromyalgia at one general practitioner (GP) practice in Greater Manchester. Methods: All 49 patients with a coded diagnosis of fibromyalgia at Bowland Medical Practice were included in the fibromyalgia patient group. 49 age/sex matched controls were identified through eMIS electronic records. All GP consultations in the practice are recorded with a problem code, which summarises the purpose of the visit. All consultations within a 12 month period from 1 August 2016 to 1 July 2017 were categorised according to the problem code as fibromyalgia, fibromyalgia-related or other. Fibromyalgia related visits included those with a problem code of chronic fatigue syndrome, irritable bowel syndrome, chronic pelvic pain syndrome/primary dysmenorrhea, temporomandibular joint pain, tension-type headaches/migraine, post-traumatic stress disorder, multiple chemical sensitivity, periodic limb movement disorder/restless legs syndrome, interstitial cystitis). Any contact with the emergency department (ED) or secondary care within the same time-period was also categorised under the headings rheumatology, pain clinic, orthopaedic, radiology, psychiatry, other. Differences in healthcare utilisation between the fibromyalgia and control groups were assessed by Mann-Whitney U tests. Results: The total number of GP consultations over the 12-month period was significantly higher in the fibromyalgia group (563) compared to controls (281) (p<0.05). The median (interquartile range) number of consultations/person/year was 10 (7, 16) in the fibromyalgia group and 4 (2, 7) in the control group. The number of fibromyalgia-related consultations was significantly greater in the fibromyalgia group (123) than in controls (31) (p<0.05), and also in the subcategories of rheumatology (26 c.f. 8 (p<0.05)), psychiatry (14 c.f. 11 (p<0.05)), radiology (40 c.f. 35 (p<0.05)) and ED (36 c.f. 30 (p<0.05)) contacts. The opposite was true for orthopaedic contacts which were found to be significantly greater in the control group (11 c.f. 23 (p<0.05)). Conclusion: We have found significantly greater use of healthcare resources amongst fibromyalgia patients compared to age/sex matched controls at one GP practice in Greater Manchester. Future work looking at other GP practices and using hospital records should be considered to greater understand the extent of this difference. Methods to address this issue are being considered, including the introduction of a specialised multidisciplinary fibromyalgia clinic to provide better support and information to patients and healthcare providers. Such a service should lead to better understanding of the condition, earlier diagnosis, patient empowerment and a reduction in health-care burden.