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

Gea A Holtman; Huibert Burger; Robert A Verheij; Hans Wouters; Marjolein Y Berger; Judith Gm Rosmalen; Peter Fm Verhaak

doi:10.1136/bmjopen-2020-040730

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

Gea A Holtman^*, Huibert Burger, Robert A Verheij, Hans Wouters, Marjolein Y Berger, Judith Gm Rosmalen, Peter Fm Verhaak

^*Corresponding author for this work

Tranzo

Research output: Contribution to journal › Article › Scientific › peer-review

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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.

Original language	English
Article number	e040730
Journal	BMJ Open
Volume	11
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2020-040730
Publication status	Published - 2021

Keywords

EVENTS
GENERAL-PRACTICE
ISSUES
LIST
MEDICALLY UNEXPLAINED SYMPTOMS
MODELS
THREATENING EXPERIENCES
VALIDITY
epidemiology
general medicine (see internal medicine)
primary care

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10.1136/bmjopen-2020-040730Licence: CC BY

Tranzo Verheij developing a clinical prediction rule BMJ Open 2021Final published version, 321 KBLicence: CC BY

Cite this

@article{f3c49e6d605a4b0aa99c88882cb9f931,

title = "Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: A cohort study",

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 ({\textquoteleft}Lifelines{\textquoteright}) 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.",

keywords = "EVENTS, GENERAL-PRACTICE, ISSUES, LIST, MEDICALLY UNEXPLAINED SYMPTOMS, MODELS, THREATENING EXPERIENCES, VALIDITY, epidemiology, general medicine (see internal medicine), primary care",

author = "Holtman, {Gea A} and Huibert Burger and Verheij, {Robert A} and Hans Wouters and Berger, {Marjolein Y} and Rosmalen, {Judith Gm} and Verhaak, {Peter Fm}",

note = "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).",

year = "2021",

doi = "10.1136/bmjopen-2020-040730",

language = "English",

volume = "11",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "1",

}

TY - JOUR

T1 - Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care

T2 - A cohort study

AU - Holtman, Gea A

AU - Burger, Huibert

AU - Verheij, Robert A

AU - Wouters, Hans

AU - Berger, Marjolein Y

AU - Rosmalen, Judith Gm

AU - Verhaak, Peter Fm

N1 - 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).

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - EVENTS

KW - GENERAL-PRACTICE

KW - ISSUES

KW - LIST

KW - MEDICALLY UNEXPLAINED SYMPTOMS

KW - MODELS

KW - THREATENING EXPERIENCES

KW - VALIDITY

KW - epidemiology

KW - general medicine (see internal medicine)

KW - primary care

U2 - 10.1136/bmjopen-2020-040730

DO - 10.1136/bmjopen-2020-040730

M3 - Article

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e040730

ER -

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

Abstract

Keywords

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