Identification of patients with moderate medically unexplained physical symptoms in primary care with a five years follow-up

Abstract

Background Patients with medically unexplained physical symptoms (MUPS) are common in primary care, with a spectrum from mild to moderate and chronic MUPS. The burden of chronic MUPS is high, and early identification of moderate MUPS patients is important to prevent chronicity. The PRESUME screening method to identify moderate MUPS patients in primary care was developed, but insight in prognostic accuracy is needed. Therefore, our objective is to determine the prognostic accuracy for identification of moderate MUPS patients using the screening method with 5 year follow-up. Methods The PRESUME screening method consists of three subsequent steps based on consultation frequency, exclusion of medical/psychiatric diagnosis and identification of MUPS. In a random 10% sample of patients from the Julius General Practitioners Network ( n = 114.185), patients were identified with mild, moderate or chronic MUPS in 2008 (index year), using routine care data. In 5 years follow-up we calculated predictive values and odds ratio’s for sustained MUPS related symptoms. Results In 2008, 789 patients (6.9% of the patient population) were identified as having mild, moderate or chronic MUPS. On average 55.5% of the moderate MUPS patients in 2008, still had MUPS related symptoms or developed chronic MUPS in 5 year follow-up. Positive predictive values for maintaining MUPS related symptoms or worsening was 67% after 1 year, and 48.7% after 5 years for moderate MUPS patients. Conclusion The prognostic accuracy of the PRESUME screening method using electronic medical record data for identification of moderate MUPS patients is moderate. However, it might be a useful method to identify patients at increased risk of moderate MUPS, if combined with a validity check by the GP. Electronic supplementary material The online version of this article (10.1186/s12875-019-0950-7) contains supplementary material, which is available to authorized users.

Effectiveness of a Blended Multidisciplinary Intervention for Patients with Moderate Medically Unexplained Physical Symptoms (PARASOL): Protocol for a Cluster Randomized Clinical Trial

“…All patients in the routine care database of a GP are anonymously screened in a stepwise selection, based on a consultation frequency above five, with exclusion of chronic diseases (eg, chronic obstructive pulmonary disease, hypertension or diabetes mellitus) and psychiatric diagnoses (eg, schizophrenia, anxiety disorder or depressive disorder) and the presence of any of the 104 MUPS related International Classification of Primary Care codes. The prognostic accuracy of this PRESUME screening method for identification of moderate MUPS patients is moderate [ 19 ].…”

“…Since the PRESUME screening method is over inclusive and not meant to set an accurate diagnosis of MUPS in individual patients, all identified patients with moderate MUPS will be screened by their GP for eligibility [ 19 ]. As a consequence, the expected prevalence of patients with moderate MUPS is less than the 2.4% according to the PRESUME screening method [ 19 ].…”

“…Since the PRESUME screening method is over inclusive and not meant to set an accurate diagnosis of MUPS in individual patients, all identified patients with moderate MUPS will be screened by their GP for eligibility [ 19 ]. As a consequence, the expected prevalence of patients with moderate MUPS is less than the 2.4% according to the PRESUME screening method [ 19 ]. The GP will exclude patients based on the following criteria: (1) having another chronic somatic or psychiatric disease, (2) receiving a medically explained diagnosis between identification using the PRESUME screening method and the time of inclusion, (3) having complaints with a duration of less than 1 month, in which case further diagnostic evaluation of the symptoms is needed, and (4) unable to participate as determined by the GP, due to a life-threatening condition, a shortened life expectancy, a major life event in the past month or a MUPS targeted multidisciplinary intervention in the past 12 months.…”

“…Recently, a screening method (PRESUME; preventive screening of medically unexplained physical symptoms) has been developed to identify patients with moderate MUPS using data from the electronic medical record of the patient’s GP as shown in Figure 1 [ 19 ]. The PRESUME screening method showed acceptable prognostic accuracy over a five-year follow-up [ 19 ]. For patients with moderate MUPS, we developed a proactive, blended, and integrated mental health and physical therapy care program to prevent chronicity.…”

Barriers and facilitators in the usability of an integrated blended care program in patients with medically unexplained physical symptoms from the healthcare professionals’ perspective; a qualitative study

“…Patients were selected through a proactive approach. An electronic screening method using data from the electronic medical record of the patients' GP was used (29). All eligible patients who were at risk for chronicity of complaints were proactively approached by their GP via an invitation letter explaining the study.…”