Evaluating increased resource use in fibromyalgia using electronic health records

Abstract

ObjectiveThe management of fibromyalgia (FM), a chronic musculoskeletal disease, remains challenging, and patients with FM are often characterized by high health care resource utilization. This study sought to explore potential drivers of all-cause health care resource utilization and other factors associated with high resource use, using a large electronic health records (EHR) database to explore data from patients diagnosed with FM.MethodsThis was a retrospective analysis of de-identified EHR data from the Humedica database. Adults (≥18 years) with FM were identified based on ≥2 International Classification of Diseases, Ninth Revision codes for FM (729.1) ≥30 days apart between January 1, 2008 and December 31, 2012 and were required to have evidence of ≥12 months continuous care pre- and post-index; first FM diagnosis was the index event; 12-month pre- and post-index reporting periods. Multivariable analysis evaluated relationships between variables and resource utilization.ResultsPatients were predominantly female (81.4%), Caucasian (87.7%), with a mean (standard deviation) age of 54.4 (14.8) years. The highest health care resource utilization was observed for the categories of “medication orders” and “physician office visits,” with 12-month post-index means of 21.2 (21.5) drug orders/patient and 15.1 (18.1) office visits/patient; the latter accounted for 73.3% of all health care visits. Opioids were the most common prescription medication, 44.3% of all patients. The chance of high resource use was significantly increased (P<0.001) 26% among African-Americans vs Caucasians and for patients with specific comorbid conditions ranging from 6% (musculoskeletal pain or depression/bipolar disorder) to 21% (congestive heart failure). Factors significantly associated with increased medications ordered included being female (P<0.001) and specific comorbid conditions (P<0.05).ConclusionPhysician office visits and pharmacotherapy orders were key drivers of all-cause health care utilization, with demographic factors, opioid use, and specific comorbidities associated with resource intensity. Health systems and providers may find their EHRs to be a useful tool for identifying and managing resource-intensive FM patients.

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

“…The majority of studies were from USA ( n = 28) , followed by UK ( n = 4 studies) , Spain ( n = 3 studies) and Canada ( n = 3 studies) , with single studies from Norway , Denmark , Australia and India . There were no studies that compared data from multiple countries.…”

“…There were 5 059 098 patients with chronic noncancer pain across the 42 studies. Twenty‐seven studies (64%) included specific subgroups of chronic noncancer pain such as chronic low back pain , osteoarthritis , rheumatoid arthritis and fibromyalgia . The mean age of participants was 58.6 years (SD 13.1, n = 29 studies).…”

Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients

“…The few studies on opioids for the treatment of FM have suggested that while responders to the weak opioid tramadol may have a reduction in pain but not in health‐related quality of life, opioids may have contributed to increased resource use and costs, or less favorable outcomes . The current study expands on the evaluated effectiveness of opioids for FM by showing that although opioids may provide benefits in pain and pain interference outcomes, treatment with pregabalin, which is approved for the treatment of FM, appeared to provide more favorable outcomes relative to opioids.…”

“…In the United States, the Food and Drug Administration (FDA) has approved 3 drugs for the treatment of FM: 2 antidepressants (duloxetine and milnacipran) and an anticonvulsant (pregabalin). However, treatment of FM remains challenging, and studies have shown low or ineffective use of approved or recommended therapies, with opioids consistently reported as the most frequently prescribed pharmacologic agent despite little evidence for their efficacy . Indeed, studies have suggested that opioid use may be associated with higher healthcare resource utilization and costs among patients with FM .…”

“…However, treatment of FM remains challenging, and studies have shown low or ineffective use of approved or recommended therapies, with opioids consistently reported as the most frequently prescribed pharmacologic agent despite little evidence for their efficacy . Indeed, studies have suggested that opioid use may be associated with higher healthcare resource utilization and costs among patients with FM . Nevertheless, an older survey among patients with FM found that these patients perceived opioids to be among the most effective therapies .…”