Healthcare use and its variation in people with fibromyalgia: a systematic review protocol.

Aim: A crucial step towards improving the care of people with fibromyalgia is understanding current practice. Our systematic review aims to address this by synthesising the global evidence around healthcare use in people with fibromyalgia, including its variation across groups of people, geographical locations, and over time.

Background: Fibromyalgia is a chronic condition characterized by widespread pain alongside a broad range of non-pain symptoms. Its substantial impact on peoples' lives and high prevalence mean that ensuring people with fibromyalgia receive evidence-based and appropriate care is a clinical and research priority. Whilst guidelines recommend that people with fibromyalgia receive a prompt diagnosis, care that focuses on non-pharmacological interventions, and in many countries should be predominantly managed in the community, existing evidence indicates they often wait many years for a diagnosis, commonly receive long-term opioid medicines, and see multiple hospital specialists.

Methods: Relevant databases will be searched, with 25% of screening, data extraction, and quality appraisal conducted by two reviewers. Eligible studies will have evaluated healthcare use in adults with fibromyalgia using data obtained from electronic health record, registry, or insurance databases (providing generalizable findings in large, representative datasets). Data will be synthesized using meta-analysis and/or synthesis without meta-analysis where possible.

Results: By providing an in-depth analysis of healthcare use and its variation in people with fibromyalgia, the results from this systematic review could be used to benchmark practice, inform targeted management strategies to those with the highest levels of healthcare use (and therefore care need), and provide insight into whether certain countries require specific guideline/policy changes.