title: Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care.
abstract: OBJECTIVE
  To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments.
  
  
  METHODS
  Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher's exact tests, and Student'st-tests.
  
  
  RESULTS
  Physician specialist cohorts included rheumatologists (n=54), primary care physicians (n=25), and a heterogeneous group of physicians practicing pain or physical medicine, psychiatry, neurology, obstetrics and gynecology, osteopathy, or an unspecified specialty (n=12). The rheumatologists expressed higher confidence diagnosing FM (4.5 on a five-point scale) than primary care physicians (4.1) (P=0.037). All cohorts strongly agreed that recognizing FM is their responsibility. They agreed that psychological aspects of FM are important, but disagreed that symptoms are psychosomatic. All physician cohorts agreed with a multidisciplinary approach including nonpharmacological and pharmacological treatments, although physicians were more confident prescribing medications than alternative therapies. Most patients reported moderate to severe pain, multiple comorbidities, and treatment with several medications and nonpharmacologic therapies.
  
  
  CONCLUSIONS
  Physician practice characteristics, physician attitudes, and FM patient profiles were broadly similar across specialties. The small but significant differences reported by physicians and patients across physician cohorts suggest that despite published guidelines, treatment of FM still contains important variance across specialties.
authors: US Health Outcomes and Technology Assessment, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA.
authors: Stephen L
authors: SL
authors: Able
authors: Lilly Research Labs, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA.
authors: Rebecca L
authors: RL
authors: Robinson
authors: Department of Medicine, Indiana University; VA Health Services Research and Development Center for Health Information and Communication, Regenstrief Institute, Indianapolis, IN, USA.
authors: Kurt
authors: K
authors: Kroenke
authors: Rheumatology Associates, Division of Rheumatology Clinical Research, Swedish Medical Center; University of Washington School of Medicine, Seattle, WA, USA.
authors: Philip
authors: P
authors: Mease
authors: Chronic Pain and Fatigue Research Center, Michigan Institute for Clinical and Health Research, University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors: David A
authors: DA
authors: Williams
authors: inVentiv Health Clinical, Indianapolis, IN, USA.
authors: Yi
authors: Y
authors: Chen
authors: USMD Neuroscience, Lilly USA LLC, Eli Lilly and Company, Indianapolis, IN, USA.
authors: Madelaine
authors: M
authors: Wohlreich
authors: Department of Family Medicine, University of California at San Diego School of Medicine, San Diego, CA, USA.
authors: Bill H
authors: BH
authors: McCarberg
keywords: medical specialty; prospective observational study; treatment