Hughes Gwenda, Martinez Carlos, Myon Eric, Taïeb Charles, Wessely Simon
Medicines and Healthcare Products Regulatory Agency, Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK.
Arthritis Rheum. 2006 Jan;54(1):177-83. doi: 10.1002/art.21545.
To investigate the impact of a diagnosis of fibromyalgia (FM) in clinical practice on health care resource use in the UK.
Rates of visits, prescriptions, referral, and diagnostic testing were estimated in patients who had been diagnosed as having FM between 1998 and March 2003 in UK primary care and compared with those in matched controls. Rates were calculated in 6-month intervals from 10 years before until 4 years after the FM diagnosis.
Patients (2260) were newly diagnosed as having FM; 81.3% were women. Their mean age was 49 years. FM patients had considerably higher rates of visits, prescriptions, and testing from at least 10 years prior to diagnosis compared with controls. By the time of diagnosis, FM patients had 25 visits and 11 prescriptions per year compared with 12 visits and 4.5 prescriptions per year in controls. Visit rates were highest for depression, followed by fatigue, chest pain, headache, and sleep disturbance. Following diagnosis, visits for most symptoms and health care use markers declined, but within 2-3 years, most visits rose to levels at or higher than those at diagnosis.
Primary care patients who had been diagnosed as having FM reported higher rates of illness and health care resource use for at least 10 years prior to their diagnosis, which suggests that illness behavior may play a role. Being diagnosed as having FM may help patients cope with some symptoms, but the diagnosis has a limited impact on health care resource use in the longer term, possibly because there is little effective treatment.
调查在英国临床实践中纤维肌痛(FM)诊断对医疗资源使用的影响。
对1998年至2003年3月期间在英国初级医疗中被诊断为患有FM的患者的就诊率、处方率、转诊率和诊断测试率进行估算,并与匹配的对照组进行比较。从FM诊断前10年到诊断后4年,每6个月计算一次比率。
2260例患者被新诊断为患有FM;81.3%为女性。他们的平均年龄为49岁。与对照组相比,FM患者在诊断前至少10年的就诊率、处方率和测试率要高得多。到诊断时,FM患者每年有25次就诊和11张处方,而对照组每年有12次就诊和4.5张处方。抑郁症的就诊率最高,其次是疲劳、胸痛、头痛和睡眠障碍。诊断后,大多数症状和医疗资源使用指标的就诊率下降,但在2至3年内,大多数就诊率又升至诊断时或高于诊断时的水平。
被诊断为患有FM的初级医疗患者在诊断前至少10年报告的疾病发生率和医疗资源使用率较高,这表明疾病行为可能起了作用。被诊断为患有FM可能有助于患者应对一些症状,但从长远来看,该诊断对医疗资源使用的影响有限,可能是因为有效治疗很少。