Objective Comorbid psychiatric and pain-related conditions are common in patients with fibromyalgia. Most studies in this area have used data from patients in specialty care and may not represent the characteristics of fibromyalgia in primary care patients. We sought to fill gaps in the literature by determining if the association between psychiatric diagnoses, conditions associated with chronic pain, and fibromyalgia differed by gender in a primary care patient population. Design Retrospective cohort. Setting and Subjects Medical record data obtained from 38,976 patients, ≥18 years of age with a primary care encounter between July 1, 2008, to June 30, 2016. Methods International Classification of Diseases–9 codes were used to define fibromyalgia, psychiatric diagnoses, and conditions associated with chronic pain. Unadjusted associations between patient demographics, comorbid conditions, and fibromyalgia were computed using binary logistic regression for the entire cohort and separately by gender. Results Overall, 4.6% of the sample had a fibromyalgia diagnosis, of whom 76.1% were women. Comorbid conditions were more prevalent among patients with vs without fibromyalgia. Depression and arthritis were more strongly related to fibromyalgia among women (odds ratio [OR] = 2.80, 95% confidence interval [CI] = 2.50–3.13; and OR = 5.19, 95% CI = 4.62–5.84) compared with men (OR = 2.16, 95% CI = 1.71–2.71; and (OR = 3.91, 95% CI = 3.22–4.75). The relationship of fibromyalgia and other diagnoses did not significantly differ by gender. Conclusions Except for depression and arthritis, the burden of comorbid conditions in patients with fibromyalgia is similar in women and men treated in primary care. Fibromyalgia comorbidities in primary care are similar to those found in specialty care.

Objective: Many ADMs can alter blood pressure (BP), but the research on the effect of antidepressant medication (ADMs) on incident hypertension is mixed. We investigated whether the use of ADMs was associated with the subsequent development of hypertension.Methods: A retrospective cohort study was conducted using electronic medical record data from 6224 patients with primary care visits from 2008 to 2015. Prescription orders were used to identify ADM use, and hypertension was defined by medical record diagnosis. Using package insert warnings, a 3-level ADM exposure variable was created: ADMs that increase BP (ADM BP؉), ADMs that do not increase BP, and no ADM. Unadjusted and adjusted Cox proportional hazard models were computed to estimate the association between the ADM exposure and incident hypertension.Results: Unadjusted results revealed that ADM BP؉ use compared with the no ADM group was significantly associated with incident hypertension (hazard ratio, 1.30; 95% confidence interval, 1.08 -1.57). After adjusting for covariates, ADM BP؉ use was no longer significantly associated with incident hypertension (hazard ratio, 1.20; 95% confidence interval, 0.97-1.49).Conclusions Primary care physicians manage hypertension and antidepressant medications (ADMs) almost every day. The age-adjusted prevalence of hypertension is 29.6% among the adult population in the United States. Of those with hypertension, only 48% achieve control of their blood pressure. Hypertension is directly related to both heart disease and stroke, which are counted as the first and fourth leading causes of death in the United States, respectively.1 Given the serious outcomes associated with hypertension, physicians must be mindful of iatrogenic causes of hypertension, which can include frequently prescribed medications. Recent data suggest that 10% to 11% of Americans age 6 years and older are treated with ADMs in a given year.2,3 Some concern has been expressed as to the safety of ADMs with regard to hypertension, especially when considering certain classes of ADMs. In a cohort of depressed participants with low rates of hypertension at baseline, treatment with ADMs was associated with an increased risk of developing hypertension. 4 The same study showed a stronger link between tricyclic antidepressants (TCAs) and hypertension than between selective serotonin reuptake inhibitors and hypertension. However, that study did not contrast ADMs known to increase blood pressure (BP) against those that do not, and the association of individual ADMs and incident hypertension was not studied. 5 A separate study showed an association between serotonin norepinephrine reuptake inhibitors (SNRIs), espeThis article was externally peer reviewed.

No abstract

Background: The literature on results from primary care-based opioid-prescribing protocols is small and results have been mixed. To advance this field, we evaluated whether opioid prescribing changed after a comprehensive protocol was implemented and whether change was associated with the number and type of risk reduction tools adopted. Methods: Electronic medical record data were obtained for 2607 patients. Demographics, Patient Health Questionnaire-9 scores, body mass index, and utilization levels of protocol elements were measured for 24 months prior and 18 months post implementation of an opioid-prescribing protocol within a federally qualified health center. 2 and t-tests were computed to estimate change in opioid prescribing, morphine-equivalent dose, comedication prescribing, and number and type of protocol elements utilized. Results: The opioid protocol was associated with an increase in urine drug screens from 18.3% to 26.8% from pre to postimplementation (P < .0001). There was no significant increase in opioid treatment agreements. Tramadol (21.4% to 16.8%, P ‫؍‬ .0006) and antidepressant (56.0% to 51.6%, P ‫؍‬ .012) prescribing significantly decreased. Total opioid prescriptions and maximum morphine-equivalent doses were similar from pre to postimplementation. Protocol elements were more often used when patients had a higher opioid dose and were receiving benzodiazepines. Conclusions: Implementing a multi-faceted opioid-prescribing protocol was not associated with change in number or dose of opioid prescriptions but was associated with greater use of urine drug screens, and risk reduction tools were used more often in high-risk patients. Implementation research is needed to identify barriers to maximizing adherence to opioid protocols.

No abstract