Self-Reported Quality of Life, Treatment Effectiveness, Attitudes and Perceptions of Fibromyalgia Patients

OBJECTIVES: To assess FMS patients\u27 quality of life (QoL) and pain based on: patient perceptions of physicians\u27 attitudes, trust in physicians, invalidation, treatment type, and demographics. METHODS: An on-line survey was conducted via the National Fibromyalgia and Chronic Pain Association. Descriptive and inferential statistics were performed. OUTCOMES: The survey resulted in 670 (70.5%) usable responses. Invalidation, use of complementary and alternative medicine (CAM), income, age, and education were significant predictors of QoL. Trust in physician, income, education, and number of referrals were significant predictors of pain. Use of CAM only was associated with lower pain, while use of pharmacologic medications and CAM was associated with higher QoL. CONCLUSIONS: Invalidation and trust in physicians may impact pain and QoL in FMS. The use of CAM or CAM with medications may improve pain and QoL

Prescription opioid epidemic in Pennsylvania: lessons from Medicare and Medicaid

This dissertation seeks to provide evidence for interventions that large health systems can utilize to help mitigate the prescription opioid epidemic in Pennsylvania. Chapter one introduces the research problem. Chapter two examines the potential for machine-learning approaches to better understand the heterogeneity of opioid use in Medicare. What constitutes potentially high-risk use of prescription opioids in Medicare is not clearly known. Using novel techniques of machine-learning, we identify five groups of Medicare beneficiaries with potentially high-risk opioid use patterns. We observe that these groups differ not only on measures of opioid use but also on important demographic characteristics, clinical characteristics and mortality. Chapter three examines the associations between physician prescribing specialties and opioid-related outcomes of opioid-use disorder (OUD), misuse, and overdose. Little is known about the variations in risk of OUD, misuse, and overdose by type of opioid prescribing specialties. Using data from Pennsylvania Medicaid, we examine the associations between the index and dominant opioid prescribing specialty and OUD, misuse, and overdose. We observe that Medicaid enrollees who receive their index opioid prescription or a majority of their prescriptions from specialties that treat chronic pain -pain medicine and physical medicine and rehabilitation- are at higher risk for OUD and misuse compared to primary care. Chapter four examines the associations between adherence to antidepressant medications among individuals with mood disorders and opioid use. Literature shows that antidepressants have anti-nociceptive effects in mitigating pain among individuals with mood disorders. Using Pennsylvania Medicaid data, we examine whether adherence to antidepressants among individuals with major depressive disorders (MDD) or anxiety disorders is associated with reduced opioid use. We observe that enrollees with MDD and no cancer, who achieve ≥ 20% adherence have significantly lower hazards ratios for opioid use than those who achieve <20% adherence. This dissertation has important implications for public health. Our findings provide evidence for interventions that health-systems can use to: (i) identify high-risk beneficiaries who use opioids, (ii) support evidence-based prescribing in settings where patients are at an elevated risk for adverse outcomes of opioid use, and (iii) increase adherence to antidepressant medications among individuals with MDD

The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity

**Background:** Research on employee care partners of patients with multiple sclerosis (MS) is limited. **Objectives:** The clinical and economic impact on employee care partners was evaluated by MS disease severity. **Methods:** Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010–Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners’ demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. **Results:** Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (_P_<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (_P_<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (_P_<.05). **Discussion:** Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. **Conclusions:** Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity

Use of Complementary and Alternative Medicine in Fibromyalgia: Results of an Online Survey

Background: Fibromyalgia is a chronic condition which may negatively impact various aspects of patients\u27 lives. Many people with fibromyalgia look to complementary and alternative medicine treatments for symptom relief. Aims: The three main objectives of this study were to examine self-reported complementary and alternative medicine use in patients with fibromyalgia, to determine associations between the use of complementary and alternative medicine treatments and patients’ self-reported quality of live and self-reported pain levels. Design: Cross-sectional survey. Setting: Web-based. Participants/Subjects: Adults over the age of 18 years who had been diagnosed with fibromyalgia. Methods: Patients with fibromyalgia responded to an online questionnaire regarding the following: treatments (complementary and alternative medicine, prescription and over-the-counter medications), quality of life (Quality of Life Scale-16), assessment of current pain (visual analog scale), and demographic information. Results: Approximately 66% of the respondents used complementary and alternative treatments. Vitamins, massage therapy, and meditation were the most commonly used complementary and alternative therapies. Results indicated respondents using a combination of complementary and alternative medicine and pharmacologic treatments (prescription or over-the-counter) had significantly higher quality of life versus those using pharmacologic treatments alone, p = .011. Similarly, respondents using only complementary and alternative medicine treatment reported significantly lower pain levels versus those using pharmacologic treatment alone, p = .046. Conclusions: The study suggests that a large proportion of fibromyalgia patients use complementary and alternative medicine, and these treatments may offer beneficial effects to these patients. Integration of complementary and alternative medicine into conventional treatment regimens may provide opportunities for a holistic treatment approach and greater symptom relief for fibromyalgia patients. This approach is timely, as controlled substances are increasingly difficult for patients with fibromyalgia to access