Juvenile Fibromyalgia Syndrome and Improved Recognition by Pediatric Primary Care Providers

Judith D. McLeod, DNP, RN, CPNP

Disclosures

J Pediatr Health Care. 2014;28(2):e9-e18. 

In This Article

Results

Provider Results

Demographics. Thirteen pediatricians, 14 residents, and all five nurse practitioners attended the educational sessions. Most of the attendees had fewer than 5 years of experience (n = 14), with the next largest group having more than 10 years of experience (n = 11). Eight pediatricians, seven residents, and all five nurse practitioners completed the satisfaction survey. Table 1 shows the demographics for the providers.

SORE Scoresheet Pilot Study. The SORE Scoresheet was developed and validated by the rheumatologist and two nurse practitioners as a screening tool in the first aim of the project. All five of the patients who were evaluated were White girls, with a mean age of 14.23 years (SD 2.77). The goal of this aim was to have the symptoms identified by the nurse practitioners match the symptoms identified by the pediatric rheumatologist 80% of the time. Both of the nurse practitioners matched the rheumatologist by more than 80% in symptom identification with the SORE Scoresheet, as seen in Figure 3. The two nurse practitioners also recommended that all of the patients should be referred to the pediatric rheumatologist from the pediatric clinic if this was their first visit.

Figure 3.

Percentage of symptoms identified correctly by cumulative score on the SORE Scoresheet (N = 5). NP = nurse practitioner. This figure appears in color online at www.jpedhc.org.

Provider Educational Sessions. Attitude about pain is important when evaluating children with JFS. Table 2 illustrates the scores for the questions most often missed on the true and false assessment of attitudes about childhood pain. The goal for the case study during the presentation was that learners would achieve a score of 80% or greater. In the case study, pediatric care providers were able to correctly list symptoms on average 86% of the time. The goal for the test was that learners would achieve a score of 80% or greater. The mean score on the test was 93% (SD 4.83).

SORE Scoresheet Comparison Between Pediatric Care Providers and the Rheumatologist. A significant correlation was found in total scores on the SORE Scoresheet between the rheumatologist and the pediatric providers after the educational presentation and after introduction of the SORE Scoresheet in the clinic (r = .645, p = .001). Pediatric primary care providers' recognition of JFS symptoms on the SORE Scoresheet equated with the history and diagnosis of the rheumatologist 93.4% of the time (Aim 4).

Pediatric Provider Satisfaction Survey. A satisfaction survey was conducted at the conclusion of the project. Twenty out of 55 pediatric providers (36%) responded to the survey (Aim 5). Overall satisfaction with the use of the SORE Scoresheet was found, with 95% of all providers indicating they would use the SORE Scoresheet with a patient who had chronic pain symptoms. Results of the satisfaction survey are presented in Table 3.

Patient Results

Demographics. Table 4 provides the demographics of the baseline patients with juvenile fibromyalgia from 2010 and the patients from 2011 who were assessed with the SORE Scoresheet and referred to rheumatology for evaluation for JFS. Patients in the 2011 sample were slightly older, with a mean age of 15.6 years compared with 13.8 years in 2010. The 2010 sample included more Hispanic than White patients (55% vs. 33%) and the 2011 sample included more White than Hispanic patients (54% vs. 36%). There was not a significant difference in gender.

Referral of Patients. During this project, 100% of the patients referred to the pediatric rheumatologist for evaluation for possible JFS had a SORE Scoresheet completed by the pediatric providers (Aim 3). During the fourth quarter of 2010 and January 2011, nine patients were referred and diagnosed with JFS, compared with 22 patients who were referred and 19 who were diagnosed with JFS in the fourth quarter of 2011 and January of 2012. There was an increase in total referrals of 13 patients in 2011 with use of the SORE Scoresheet (Aim 4).

Number of Visits. This improved recognition of symptoms of JFS and increase in referrals was also reflected by a decrease in the number of visits during the previous year before referral to the rheumatologist from a mean of 9.67 visits in 2010 to 5.09 visits in 2011, for an overall percentage decrease of 48%. The goal for a decrease in visits was 10%, and thus this result was clinically significant for this sample. These results are illustrated in Figure 4.

Figure 4.

Patient visits 1 year before referral in 2010 and 2011. This figure appears in color online at www.jpedhc.org.

Weeks to Referral. The number of weeks to referral was also decreased from a mean of 60.11 in 2010 to 43.35 in 2011, with an overall decrease of 28%. The goal for a decrease in weeks to referral was 5%. This result was also clinically significant for this sample (Aim 2). These results are illustrated in Figure 5.

Figure 5.

Number of weeks to referral in 2010 and 2011. This figure appears in color online at www.jpedhc.org.

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