Performance Optimization Solutions, AXDEV Group Inc, Brossard, Quebec.
Pain Res Manag. 2010 Nov-Dec;15(6):385-91. doi: 10.1155/2010/354868.
Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care.
A mixed-methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five-point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings.
GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty-three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree - "We are not trained to treat distress and suffering" (Specialist). Attitudinal issues centred around frustration (mean 3.91⁄5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5).
Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"
纤维肌痛症在加拿大的发病率估计为 3.3%，尽管如此，这种疾病的诊断率仍然很低，治疗效果也不理想。本研究旨在探讨影响最佳治疗效果的知识和态度方面的挑战。
采用混合方法。于 2007 年 6 月至 2008 年 1 月期间，进行了小组讨论、半结构化访谈和在线定量调查（五分制）。参与者包括分布在加拿大各地的 189 名全科医生（GP）和 139 名专科医生（麻醉师、神经科医生、理疗师、精神科医生和风湿病医生）。另外还纳入了 18 名患者，以丰富研究结果的范围。
GP 报告称，他们在诊断纤维肌痛症方面的知识和技能不足，并非所有人都认为纤维肌痛症是一种可诊断的疾病（平均得分为 3.74/5）。23%的 GP 和 12%的专科医生将纤维肌痛症患者描述为装病者。他们还报告称，他们在治疗纤维肌痛症方面的知识和技能不足（平均得分为 2.73/5），包括与该疾病相关的疼痛、睡眠障碍和情绪障碍（平均得分为 3.32/5）。专科医生也面临着这些挑战，尽管程度较轻——“我们没有接受过治疗痛苦和苦难的培训”（专科医生）。态度问题主要集中在沮丧（平均得分为 3.91⁄5）和对纤维肌痛症患者的负面印象（平均得分为 3.06/5 和 1.99/5）。
研究结果显示，GP 在照顾纤维肌痛症患者时存在态度和信心方面的挑战。随着纤维肌痛症患者的治疗转向全科医生，必须解决这些基本能力问题，以确保所有患者都能获得管理疾病所需的护理质量，并使医生更专业地发挥作用。正如一位患者所说，“为什么我们因为这种残疾而受到惩罚？”
