Article

Little is known regarding fibromyalgia syndrome (FMS) care among Operation Iraqi
Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) Veterans.
Current recommendations include interdisciplinary, team-based combined care
approaches and limited opioid use. In this study of OIF/OEF/OND Veterans who
accessed Veterans Health Administration services between 2002 and 2012, we
hypothesized that combined care (defined as at least 4 primary care visits/yr
with visits to mental health and/or rheumatology) versus <4 primary care
visits/yr only would be associated with lower risk of at least 2 opioid
prescriptions 12 mo following an FMS diagnosis. Using generalized linear models
with a log-link, the Poisson family, and robust standard errors, we estimated
risk ratios (RRs) and 95% confidence intervals (CIs). We found that 1% of
Veterans had at least 2 FMS diagnoses (International Classification of
Diseases-9th Revision-Clinical Modification code 729.1) or at least 1 FMS
diagnosis by rheumatology. Veterans with (vs without) FMS were more likely to be
female, older, Hispanic, and never/currently married. Combined primary, mental
health, and rheumatology care was associated with at least 2 opioid prescriptions
(RR [95% CI] for males 2.2 [1.1-4.4] and females 2.8 [0.4-18.6]). Also, combined
care was associated with at least 2 nonopioid pain-related prescriptions, a
practice supported by evidence-based clinical practice guidelines. In tandem,
these results provide mixed evidence of benefit of combined care for FMS. Future
studies of healthcare encounter characteristics, care coordination, and benefits
for Veterans with FMS are needed.

Langue : ANGLAIS