Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study

Objectives Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations wit...

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Autores principales:	Huibert Burger, Robert A Verheij, Gea A Holtman, Hans Wouters, Marjolein Y Berger, Judith GM Rosmalen, Peter FM Verhaak
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/6113ce42f3584c14b70df310e8cb73f8
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spelling	oai:doaj.org-article:6113ce42f3584c14b70df310e8cb73f82021-11-18T13:00:05ZDeveloping a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study10.1136/bmjopen-2020-0407302044-6055https://doaj.org/article/6113ce42f3584c14b70df310e8cb73f82021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e040730.fullhttps://doaj.org/toc/2044-6055Objectives Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.Design and setting Records from the longitudinal population-based (‘Lifelines’) cohort study were linked to electronic health records from general practitioners (GPs).Participants We included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.Outcome measures The outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.Results 18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29–0.47).Conclusions Several theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.Huibert BurgerRobert A VerheijGea A HoltmanHans WoutersMarjolein Y BergerJudith GM RosmalenPeter FM VerhaakBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Huibert Burger Robert A Verheij Gea A Holtman Hans Wouters Marjolein Y Berger Judith GM Rosmalen Peter FM Verhaak Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
description	Objectives Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.Design and setting Records from the longitudinal population-based (‘Lifelines’) cohort study were linked to electronic health records from general practitioners (GPs).Participants We included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.Outcome measures The outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.Results 18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29–0.47).Conclusions Several theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.
format	article
author	Huibert Burger Robert A Verheij Gea A Holtman Hans Wouters Marjolein Y Berger Judith GM Rosmalen Peter FM Verhaak
author_facet	Huibert Burger Robert A Verheij Gea A Holtman Hans Wouters Marjolein Y Berger Judith GM Rosmalen Peter FM Verhaak
author_sort	Huibert Burger
title	Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
title_short	Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
title_full	Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
title_fullStr	Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
title_full_unstemmed	Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
title_sort	developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/6113ce42f3584c14b70df310e8cb73f8
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Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study

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