title: Efficient practices associated with diagnosis, treatment and management of fibromyalgia among primary care physicians.
abstract: OBJECTIVE
  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.
authors.affiliation: United BioSource Corporation, Lexington, MA, USA.
authors.forename: Nandini
authors.initials: N
authors.lastname: Hadker
authors.forename: Suchita
authors.initials: S
authors.lastname: Garg
authors.forename: Arthi B
authors.initials: AB
authors.lastname: Chandran
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Crean
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNett
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Silverman
mesh_terms: D001291:Attitude of Health Personnel; D019468:Disease Management; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D058007:Physicians, Primary Care / Q000523:psychology; D011788:Quality of Life; D014481:United States