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Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: A cohort study
Holtman,Gea A Burger,Huibert Verheij,Robert A Wouters,Hans Berger,Marjolein Y Rosmalen,Judith Gm Verhaak,Peter Fm
Holtman,Gea A
Burger,Huibert
Verheij,Robert A
Wouters,Hans
Berger,Marjolein Y
Rosmalen,Judith Gm
Verhaak,Peter Fm
Abstract
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.
Description
Funding This study was funded by a grant from the Healthy Ageing Pilot of the University Medical Center Groningen (CDO17.0002/2017-1/296). The Lifelines initiative has been made possible by support from the Dutch Ministry of Health, Welfare and Sport; the Dutch Ministry of Economic Affairs; University Medical Center Groningen; Groningen University; and the Provinces in the north of the Netherlands (Drenthe, Friesland, Groningen).
Date
2021
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Research Projects
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Keywords
EVENTS, GENERAL-PRACTICE, ISSUES, LIST, MEDICALLY UNEXPLAINED SYMPTOMS, MODELS, THREATENING EXPERIENCES, VALIDITY, epidemiology, general medicine (see internal medicine), primary care
Citation
Holtman, G A, Burger, H, Verheij, R A, Wouters, H, Berger, M Y, Rosmalen, J G & Verhaak, P F 2021, 'Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care : A cohort study', BMJ Open, vol. 11, no. 1, e040730. https://doi.org/10.1136/bmjopen-2020-040730