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Article Title

Factors Associated With Time to Diagnosis in Fibromyalgia

Publication Date

4-30-2015

Keywords

fibromyalgia, health care services

Abstract

Background/Aims: The diagnosis of fibromyalgia, a chronic debilitating disorder, is complicated and affected by various factors of the patient and the caregiver. The objectives of this study were to investigate the time passing from initial complaints to diagnosis and to delineate the patient and physician characteristics affecting that time.

Methods: For this retrospective cohort study we used the datasets of Maccabi Health Services (MHS), the second largest health maintenance organization in Israel. We identified all confirmed cases of fibromyalgia that were diagnosed by specialists in the community or hospital during 1/2008–12/2011. These patients were compared to sex- and-age-matched fibromyalgia-free members. Different complaint patterns were examined to ascertain time of initial complaints. The pattern with the best validity was applied on nonvalidated cases that were diagnosed with fibromyalgia by primary physician, rheumatologist or at release from hospitalization during the same period. Patient and primary physician factors associated with time between initial complaints and fibromyalgia diagnosis were assessed. A multilevel generalized mixed linear model with a log-linked gamma distribution was used to account for clustering of patients associated with the same primary physician.

Results: Our study included 2,656 confirmed cases of fibromyalgia (91% women, mean age: 51.1 years, standard deviation [SD]: 11.3 years). The most valid initial complaints pattern included 4 or more complaints within 6 months, found in 73% of the cases. These results indicated that the mean duration between initial fibromyalgia-related complaints to final diagnosis was 4.7 years with SD of 3.6 years. In a multivariable model, shorter time to diagnosis was associated with patients of young age, male gender and higher socio-economic status, and with primary physicians of young age, family/pediatric/internal specialty versus general, and medical studies in Eastern or Western Europe versus other continents.

Discussion: The mean time to diagnosis of fibromyalgia is very long and is significantly influenced by patient and physician characteristics. Better patient and physician education, and increased awareness to the disease and its early complaints, can be a key for improving the diagnosis of fibromyalgia.

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