Multidisciplinary treatment approach for patients with fibromyalgia: are general practitioners referring patients to physical and mental health care?

Objective: Fibromyalgia is a disease constituted of both somatic and psychological symptoms. Prior research found that multidisciplinary treatment approaches are the most effective. The present study wants to elaborate whether general practitioners apply a multidisciplinary approach when referring patients with fibromyalgia to health care professionals. Design: An observational between-subject study has been conducted. The data used is taken from routine primary care databases of 82 general practices longitudinally. A patient group with depression acts as a control group to whom referral behaviour of general practices is compared. Participants: Patients who were older than 18, have had either a diagnosis of fibromyalgia or depression, and who were registered at their general practice at least one year were included (N=2443). Measures: Three outcome measures have been used: type of registration consisting of the two possible levels of fibromyalgia or depression, type of referral...Show moreObjective: Fibromyalgia is a disease constituted of both somatic and psychological symptoms. Prior research found that multidisciplinary treatment approaches are the most effective. The present study wants to elaborate whether general practitioners apply a multidisciplinary approach when referring patients with fibromyalgia to health care professionals. Design: An observational between-subject study has been conducted. The data used is taken from routine primary care databases of 82 general practices longitudinally. A patient group with depression acts as a control group to whom referral behaviour of general practices is compared. Participants: Patients who were older than 18, have had either a diagnosis of fibromyalgia or depression, and who were registered at their general practice at least one year were included (N=2443). Measures: Three outcome measures have been used: type of registration consisting of the two possible levels of fibromyalgia or depression, type of referral consisting of the three levels of mental health care, physical health care or both, and type of general practice consisting of 82 levels. Statistics: Descriptive and frequency tables have been evaluated regarding case numbers per type of registration, type of referral and general practice. Further, chi-square tests with Monte Carlo’s estimation of significance have been computed to analyse (in)dependence between registration type and referral type, and to analyse general practice-specific referral behaviour. Results: Of the fibromyalgia patient group, 2.6% received multidisciplinary referrals. Patients were referred to MHC less than to PHC. Patients with depression were referred to MHC in the majority of cases. Further, statistical significance has been found for a dependence between registration and referral type (p=<.001). Taking the different general practices into account, statistical significance has been found for a dependence between type of registration and general practice within the PHC referral sample (p=.01). Conclusion and implication: Multidisciplinary treatment seems to not always be facilitated by general practitioners even though previous research showed that it seems to be the best treatment option. Thus, a change in general practitioner’s referral behaviour might be needed. Future research should repeat the study with larger sample sizes per registration type to investigate general practices’ specific referral behaviour more in depth.Show less

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Multidisciplinary treatment approach for patients with fibromyalgia: are general practitioners referring patients to physical and mental health care?