Diagnosing Fibromyalgia: Using a Diagnostic Screening Tool in Primary Care

Diagnosing Fibromyalgia: Using a Diagnostic Screening Tool in Primary Care by Lilo Fink MSN, Grand Canyon University, 2010 BSN, Northeastern University, 1980 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 Abstract Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, andFibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient’s other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS. Diagnosing Fibromyalgia: Using a Diagnostic Screening Tool in Primary Care by Lilo Fink MSN, Grand Canyon University, 2010 BSN, Northeastern University, 1980 Project Submitted in Partial Fulfillment Of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 Dedication This project is dedicated to all those practitioners whose clinical expertise assisted in my treatment from my automobile accident to where I am today. I owe each and every one of you all my gratitude for the relentless motivation and fight you instilled in me and how hard you made me work even when I wanted to give up and throw in the towel. It has taught me to be a better practitioner and to see things from the eyes of the patient. Thank you! Acknowledgments Firstly, I want to thank my faculty committee members, Dr. Deborah Lewis, Committee Chair, and Dr. Faisal Aboul-Enein, Committee Member, and Dr. Mary Verklan, Committee URR. I want to also thank Dr. Wallace McLean for being my preceptor and Dr. James Worden, a pain management physician, for their expertise, guidance, words of encouragement, and support. All your collaboration and leadership were essential to my project’s completion. My husband, Richard, who is the wind beneath my wings, I thank you for your constant support and motivation to finish this journey. My grown children, Evan and Erika, have given their constant understanding and encouragement. My grandson, Aaron, thank you for letting me be your Nana, for inspiration, understanding, and knowing that your Nana preferred spending time with you rather than working on her schoolwork. To my furry friends, thank you for keeping my legs warm and the occasional lick I received. Lastly, my mother and father encouraged me to have a professional work ethic and to be a hard worker. My mother, Marion, was my inspiration in doing all of this. It was her love of medicine and dedication to women’s health care that made an everlasting difference in who I am as a student. I owe everything to her. I know she guides me and is so very proud of me. I know she is happy and smiling! Both my parents encouraged me to be all that I could be, and I am forever grateful. I thank each and every one of you for your support and understanding when I was too busy with my studies to be a wife, mom, nana, friend, or employee. You all loved and encouraged me to move forward. Thank you, I will make you all proud of me!