Supporting healthcare professionals systematically to improve the quality and person-centeredness of fibromyalgia management in primary healthcare

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Yvonne van Eijk-Hustings
Mariëlle Kroese
Monique Bessems-Beks
Robert Landewé
Bert Vrijhoef


Objective: To improve the quality and person-centeredness of primary healthcare for fibromyalgia patients by supporting healthcare professionals.Methods: The Chronic Care Model was used as a framework to develop combined interventions: an educational program, a multidisciplinary guideline and a checklist for referral, for general practitioners and physical therapists in two regions in the South of the Netherlands. After the educational program, the guideline and the checklist for referral were tested in daily practice during 6 months. A pre-post design was used to measure changes in fibromyalgia care as perceived by the healthcare professionals. Changes were measured by the “Assessment Chronic Illness Care” (ACIC) questionnaire. The questionnaire evaluates team opinions about the level and nature of improvements in response to interventions. Feasibility of the guideline and the checklist for referral was asked for in interviews.Results: Guideline and checklist for referral were tested by 12 general practitioners and 23 physical therapists, forming 12 “practice teams”. After the 6 month test period, the ACIC showed statistically significant improvements in all elements of care. Guideline and checklist for referral were found feasible.Conclusions: Healthcare professionals in primary care reported improvements in fibromyalgia care, but also faced difficulties in changing daily practice. Additional activities are needed for further care improvement. Future research should examine the generalisibility of findings and whether and how an improved quality of care is perceived by fibromyalgia patients.

Article Details

Regular Articles
Author Biography

Robert Landewé

Department of Internal Medicine, Division of Rheumatology, Academic Medical Centre / University of Amsterdam & Atrium Medical Centre Heerlen,


Arnold, L.M., Crofford, L.J., Mease, P.J., Burgess, S.M., Palmer, S.C., Abetz, L. & Martin, S.A. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counselling 73 (1) 114-120.

Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Katz, R.S., Mease, P., Russell, A.S., Russell, I.J., Winfield, J.B. & Yunus, M.B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research (Hoboken) 62 (5) 600-610.

Boonen, A., van den Heuvel, R., van Tubergen, A., Goossens, M., Severens, J.L., van der Heijde, D. & van der Linden, S. (2005). Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Annals of the Rheumatic Diseases 64 (3) 396-402.

White, L.A., Birnbaum, H.G., Kaltenboeck, A., Tang, J., Mallett, D. & Robinson, R.L. (2008). Employees with fibromyalgia: medical comorbidity, healthcare costs, and work loss. Journal of Occupational and Environmental Medicine 50 (1) 13-24.

Kroese, M.E., Schulpen, G.J., Sonneveld, H.M. & Vrijhoef, H.J. (2008). Therapeutic approaches to fibromyalgia in the Netherlands: a comparison between 1998 and 2005. Journal of Evaluation in Clinical Practice 14 (2) 321-325.

Clauw, D.J. (2007). Fibromyalgia: update on mechanisms and management. Journal of Clinical Rheumatolology 13 (2) 102-109.

Bennett, R. (1998). Fibromyalgia, chronic fatigue syndrome, and myofascial pain. Current Opinion in Rheumatology 10 (2) 95-103.

Goldenberg, D.L., Burckhardt, C. & Crofford, L. (2004). Management of fibromyalgia syndrome. Journal of the American Medical Association 292 (19) 2388-2395.

White, K.P., Nielson, W.R., Harth, M., Ostbye, T. & Speechley, M. (2002). Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain. Arthritis & Rheumatism 47 (3) 260-265.

Wagner, E.H., Austin, B.T. & Von Korff, M. (1996). Improving outcomes in chronic illness. Managed Care Quarterly 4 (2) 12-25.

Joosten, E.A., DeFuentes Merillas, L., de Weert, G.H., Sensky, T., van der Staak, C.P. & de Jong, C.A. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics 77 (4) 219-226.

Kroese, M.E.A.L., Schulpen, G.J.C., Bessems, M.C.M., Severens, J.L., Nijhuis, F.J., Geusens, P.P. & Landewé, R.B. (2008). Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: a randomized controlled trial. Arthritis Care & Research 59 (9) 1299-1305.

Kroese, M., Severens. J., Schulpen, G., Bessems, M., Nijhuis, F. & Landewe, R. (2011). Specialized Rheumatology Nurse Substitutes for Rheumatologists in the Diagnostic Process of Fibromyalgia: A Cost-Consequence Analysis and a Randomized Controlled Trial. Journal of Rheumatology 38(7) 1413-1422.

Kroese, M., Schulpen, G., Bessems, M., Nijhuis, F., Severens, J. & Landewe, R. (2009). The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia. Clinical Rheumatology 28 (8) 923-929.

van Eijk-Hustings, Y., Kroese, M., Bessems-Beks, M., Boonen, A. & Landewé, R. (2008). Multidisciplinary treatment with aftercare meetings compared to aerobic exercise and usual care in fibromyalgia. First results of a randomised controlled trial. Annals of Rheumatic Diseases 67 (Supplement 11) 262. cited 2011 (in Dutch)

Carville, S.F., Arendt-Nielsen, S., Bliddal, H., blotman, F., Branco, J.C., Buskila, D., DaSilva, J.A., Danneskiold-Samsøe, B., Dincer, F., Henriksson, C., Henriksson, K.G., Kosek, E., Longley, K., McCarthy, G.M., Perrot, S., Puszczewicz, M., Sarzi-Puttini, P., Silman, A., Späth, M., Choy, E.H. & EULAR. (2008). EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Annals of Rheumatic Diseases 67 (4) 536-541.

Hauser, W., Arnold, B., Eich, W., Felde, E., Flügge, C., Hennigsen, P., Herrmann, M., Köllner, V., Kühn, E., Nutzinger, D., Offenbächer, M., Schiltenwolf, M., Sommer, C., Thieme, K. & Kopp, I. (2008). Management of fibromyalgia syndrome - an interdisciplinary evidence-based guideline. German Medical Science 6, Doc14.

Terluin, B., Van Heest, F.B., Van der Meer, K., Neomagus, G.J.H., Hekman, J., Aulbers, L.P.J., Starreveld, J.S. & Grol, M.H. (2004). NHG-Standaard Angststoornissen. Huisarts en Wetenschap 47 (1) 26-37.

Van Marwijk, H.W.J., Grundmeijer, H.G.L.M., Bijl, D.V.G.M., De Haan, M., Van Weel- Baumgarten, E.M., Burgers, J.S., Boukes, F.S. & Romeijnders, A.C.M. (2003). NHG- Standaard Depressieve stoornis (depressie) (eerste herziening). Huisarts en Wetenschap 46 (11) 614-633.

Lemmens, K., Strating, M., Huijsman, R. & Nieboer, A. (2009). Professional commitment to changing chronic illness care: results from disease management programmes. International Journal of Quality in Health Care 21 (4) 233-242.

Boyer, A.M.M., Calatayud, N., Roig, S. & Cantero, C. (2009). Comparing fibromyalgia patients from primary care and rheumatology settings: clinical and psychosocial features. Rheumatology International 29, 1151-1160.

Hauser, W., Thieme, K. & Turk, D.C. (2010). Guidelines on the management of fibromyalgia syndrome - A systematic review. European Journal of Pain 14 (1) 5-10.

Ryan, S., Hassell, A., Thwaites, C., Manley, K. & Home, D. (2007). Developing a new model of care for patients with chronic musculoskeletal pain. Journal of Nursing Management 15 (8) 825-829.

Schulte, E., Hermann, K., Berghöfer, A., Hagmeister, H., Schuh-Hofer, S., Schenk, M., Kopf, A., Vilain, M., Martus, P., Willich, S.N. & Boemke, W. (2010). Referral practices in patients suffering from non-malignant pain. European Journal of Pain 14 (3) 308e1– e10.