Characteristics and patterns of healthcare utilization of patients with fibromyalgia in general practitioner settings in Germany

Objective: To examine characteristics and patterns of healthcare utilization of patients with fibromyalgia (FM) under the care of general practitioners (GPs) in Germany. Research design and methods: Retrospective cohort study, using a large electronic database with information on GP encounters in Germany (IMS MediPlus). We identified all patients, aged >= 18 years, with any encounters for FM (ICD-10 diagnosis code M79.7) between February 1, 2004 and January 31, 2007. We also constituted a comparison group consisting of randomly selected patients with one or more GP encounters - but none for FM - during this period, who we matched to FM patients based on age and sex. Characteristics and healthcare utilization of patients in the FM and comparison groups were then examined over the 1-year period, February 1, 2006-January 31, 2007. Main outcome measures: Prevalence of co-morbidities; use of pain-related pharmacotherapy; number of GP office visits; number of specialist referrals; and number of sick notes (physician-excused absences from work). Results: The study sample consisted of 4983 FM patients and an identical number in the comparison group. Mean age was 58 years; 87% were women. The prevalence of various co-morbidities was greater among FM patients, including painful neuropathies (33% vs. 18% for comparison group) and depression (20% vs. 5%) (both p < 0.01); more FM patients also received pain-related pharmacotherapy (67% vs. 28%; p < 0.01). Compared with patients in the comparison group, FM patients averaged approximately twice as many GP visits (11.4 [SD = 10.1] vs. 5.8 [7.5]), referrals (4.5 [5.21 vs. 2.2 [3.6]), and sick notes (0.6 [1.8] vs. 0.3 [1.1]) (all p < 0.01). Limitations: Information in the study database is limited to GP encounters, and the sensitivity and specificity of our case-finding methods are unknown. Conclusions: Patients with FM under the care of GPs in Germany have comparatively more co-morbidities and higher levels of healthcare utilization.