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The aim of this study was to compare clinical symptoms, perceived health status, health resource use and psychosocial features in fibromyalgia (FM) patients at different health care levels. A total of 315 participants were recruited from primary care (PC) (n = 101) and rheumatology settings (RS) (n = 214). Subjects completed a protocol of clinical features and health resource use, hospital anxiety and depression scale, sickness impact profile, chronic pain self-efficacy scale, multidimensional pain locus of control scale, perceived health competence scale and chronic pain coping inventory. Student’s t test, effect size, and contrast and power test were performed to examine differences between samples. FM patients treated in PC and RS were similar in most variables assessed and only differed significantly in tender points, sleep disturbance, wellness-focused coping strategies and in self-efficacy beliefs. The similarities do not support patient selection through care levels and thus, in the Spanish health care system at least, endorse PC as a reference unit for treatment and questioning the benefits of referring patients to RS.

Studies on the socioeconomic impact of fibromyalgia (FM) have shown the high health services use done by these patients. These data indicate the challenge of dealing with these people, their treatment and rehabilitation, as well as the need of changes in actions and implementation of cost-effective approaches. In this study we reviewed the literature on the health care use behavior in FM. The data shows that the emotional state and catastrophizing are relevant factors in the onset of seeking health care, and within the system, higher self-efficacy, attributions of symptoms to external factors, the perception of good health and lower comorbidity is associated with less use. Estudios sobre el impacto socioeconómico de la Fibromialgia (FM) han evidenciado el alto uso de los servicios sanitarios por parte de estos pacientes. Estos datos expresan el reto que supone el abordaje de estas personas, su tratamient o y rehabilitación, y la necesidad de cambios de actuación coste-efectivas. En este estudio revisamos la literatura existente sobre la conducta de uso de servicios médicos en la FM. Los datos muestran que el estado emocional y el catastrofismo son factores relevantes en el inicio de la búsqueda de asistencia sanitaria; dentro del sistema, mayor autoeficacia, la atribución de los síntomas a factores externos, la percepción de un buen estado de salud y la menor comorbilidad se asocia a un menor uso del mismo.

This work identifies which psychosocial, clinical and perceived health status factors predict health-resource use in Fibromyalgia (FM), considering the patients' assistance level. Participants were 315 FM patients from Primary Care (PC: n=101) and Rheumatology Services (RS: n=214). Stepwise regression analysis showed that self-efficacy variables were significant predictors of medication intake in PC, and, along with Illness-focused coping, of the health service use. In RS, perceived health status was the best predictor of medication intake. In any case, Pain intensity significantly predicted the use of health resources. These data offer a new perspective for intervention in these patients, taking into account the level of assistance.