{"doi":"10.1002/msc.1935","title":"The Development and Implementation of a Rheumatology Referral‐Based, General Internal Medicine‐Led Fibromyalgia Clinic and Preliminary Patient Outcomes","abstract":"Fibromyalgia is a debilitating pain syndrome affecting 2%–10% of Americans (Gota 2021). Patients with fibromyalgia frequently seek care from their primary care physician (PCP) or rheumatologist; however, patients encounter several barriers to finding high-quality care. Challenges include inadequate fibromyalgia knowledge among PCPs, difficulty accessing rheumatology speciality care and negative provider perceptions towards patients with fibromyalgia (Battafarano et al. 2018; Byrne et al. 2023; Pang et al. 2021; Van Wilgen et al. 2024). We created a rheumatology referral-based general internal medicine-led fibromyalgia clinic. The goals of the clinic were multifactorial. The clinic aimed to provide patients with fibromyalgia compassionate, evidence-based care and to shift the care of patients with fibromyalgia from rheumatology to general internal medicine. We conducted a quality improvement study to assess the short-term and long-term impacts of our fibromyalgia clinic on patients' symptom control. The fibromyalgia clinic was created via an institutional collaboration between the division of rheumatology and the division of general internal medicine and was supported by the department of medicine. The division of rheumatology was struggling with two issues that prompted the creation of the fibromyalgia clinic: (1) local rheumatology practices were receiving many referrals to aid in the diagnosis and management of fibromyalgia and (2) the burden of increased referrals led to long wait times for new patient appointments. By creating a specific fibromyalgia clinic, we aimed to provide timely, high-quality care and increased access to the rheumatology department for patients with autoimmune/inflammatory conditions. Patients had an initial evaluation with a rheumatologist to ensure no concomitant autoimmune/inflammatory condition was present and then were referred to the fibromyalgia clinic for fibromyalgia specific care and ongoing management needs. The initial rheumatology evaluation was conducted in various ways based on patient needs and degree of suspicion for autoimmune/inflammatory disease. Some patients were referred after a brief telemedicine appointment, whereas others were referred after a longer evaluation necessitating several in-person appointments. Although fibromyalgia and autoimmune/inflammatory conditions frequently co-occur, the fibromyalgia clinic targeted patients with only fibromyalgia. The division of rheumatology continued to manage patients with fibromyalgia and concurrent autoimmune/inflammatory conditions, but the fibromyalgia clinic was available to these patients if the fibromyalgia care team could offer additional services (e.g., medical marijuana certification) that were not readily available through rheumatology. The care team at the fibromyalgia clinic consisted of two pharmacists, two physicians, one behavioural health therapist and nurses. The initial visit included a 30-min pharmacist visit and a 1-h physician visit. The pharmacist performed a medication reconciliation, reviewed prior pharmacological therapies and discussed additional pharmacological options. The pharmacist also made a recommendation to the physician regarding pharmacologic options and was available to help with medication changes or cross tapers (e.g., changing gabapentin to pregabalin or selective serotonin reuptake inhibitors [SSRIs] to selective norepinephrine reuptake inhibitors [SNRIs]). The goals of the initial physician visit were to confirm the diagnosis of fibromyalgia; identify other pain generators (e.g., osteoarthritis) or concurrent chronic pain conditions (e.g., migraines and irritable bowel syndrome), provide empathetic listening, validation and education about fibromyalgia; review prior treatment modalities and create a new treatment plan involving pharmacologic, non-pharmacologic and behavioural health interventions. Pharmacologic management options offered included SNRIs (e.g., duloxetine and milnacipran), tric","journal":"Musculoskeletal Care","year":2024,"id":503227,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9517,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":530047,"name":"Katherine Lane","orcid":"0000-0003-0884-6257","position":1,"is_corresponding":false},{"id":341543,"name":"Kristine Ruppert","orcid":"0000-0002-3008-6584","position":2,"is_corresponding":false},{"id":1352826,"name":"Trisha A. Miller","orcid":"0000-0001-6008-8735","position":3,"is_corresponding":false},{"id":1353158,"name":"Carly Gabriel","orcid":null,"position":4,"is_corresponding":false},{"id":1353159,"name":"Jillian Kyle","orcid":null,"position":5,"is_corresponding":false},{"id":1352827,"name":"Rachel Vanderberg","orcid":"0000-0002-1491-9937","position":6,"is_corresponding":false},{"id":768607,"name":"Catherine A. Pressimone","orcid":null,"position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-19T02:10:27.781502Z","pmid":"39261292","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}