Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 1, 2016
   Pages 45 — 58

Abstract — Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration

April F. Mohanty, MPH, PhD;1* Drew A. Helmer, MD, MS;2–3 Anusha Muthukutty, MS;1 Lisa M. McAndrew, PhD;2–4 Marjorie E. Carter, MSPH;1 Joshua Judd, MBA;1 Jennifer H. Garvin, PhD, MBA, RHIA, CTR, CPHQ, CCS, FAHIMA;1,5 Matthew H. Samore, MD;1,5 Adi V. Gundlapalli, MD, PhD, MS1,5

1Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, Department of Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, UT; and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; 2War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ; 3New Jersey Medical School, Rutgers University, Newark, NJ; 4Department of Educational and Counseling Psychology, University of Albany, Albany, NY; 5Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT

Abstract — 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.

Key words: Afghanistan, fibromyalgia syndrome, healthcare setting, healthcare utilization, Iraq, OIF/OEF/OND, opioid, primary care, PTSD, rheumatology, Veteran.


View HTML ¦ View PDF ¦ Contents Vol. 53, No.1

This article and any supplementary material should be cited as follows:
Mohanty AF, Helmer DA, Muthukutty A, McAndrew LM, Carter ME, Judd J, Garvin JH, Samore MH, Gundlapalli AV. Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration. J Rehabil Res Dev. 2016;53(1):45–58.
http://dx.doi.org/10.1682/JRRD.2014.10.0265
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