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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Identifying patients with medically unexplained physical symptoms in electronic medical records in primary care: a validation study

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Madelon den Boeft, Johannes C van der Wouden, Trudie R Rydell-Lexmond, Niek J de Wit, Henriëtte E van der Horst, Mattijs E Numans
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-109) contains supplementary material, which is available to authorized users.

Competing interests

All authors declare that they have no competing interests.

Authors’ contributions

All authors made contributions to the research and writing of the manuscript. MB was responsible for planning the study. She also collected, analysed and interpreted the data and wrote the manuscript. TRL and NW developed the EMR screening method. JW, HH and MN were all involved in the conception and design of the study, data analysis and interpretation. All authors supported MB in drafting and revising the manuscript. They all gave their final approval for submission of this version.

Abstract

Background

When medically unexplained physical symptoms (MUPS) become persistent, it may have major implications for the patient, the general practitioner (GP) and for society.
Early identification of patients with MUPS in electronic medical records (EMRs) might contribute to prevention of persistent MUPS by creating awareness among GPs and providing an opportunity to start stepped care management. However, procedures for identification of patients with MUPS in EMRs are not well established yet. In this validation study we explore the test characteristics of an EMR screening method to identify patients with MUPS.

Methods

The EMR screening method consists of three steps. First, all patients ≥18 years were included when they had five or more contacts in the last 12 months. Second, patients with known chronic conditions were excluded. Finally, patients were included with a MUPS syndrome or when they had three or more complaints suggestive for MUPS. We compared the results of the EMR screening method with scores on the Patient Health Questionnaire-15 (PHQ-15), which we used as reference test. We calculated test characteristics for various cut-off points.

Results

From the 1223 patients in our dataset who completed the PHQ-15, 609 (49/8%) scored ≥5 on the PHQ-15. The EMR screening method detected 131/1223 (10.7%) as patients with MUPS. Of those, 102 (77.9%) scored ≥5 on the PHQ-15 and 53 (40.5%) scored ≥10. When compared with the PHQ-15 cut-off point ≥10, sensitivity and specificity were 0.30 and 0.93 and positive and negative predictive values were 0.40 and 0.89, respectively.

Conclusions

The EMR screening method to identify patients with MUPS has a high specificity. However, many potential MUPS patients will be missed. Before using this method as a screening instrument for selecting patients who might benefit from structured care, its sensitivity needs to be improved while maintaining its specificity.
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