Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices

Edelman, N L, Cassell, J A, Mercer, C H, Bremner, S A, Jones, C I, Gersten, A and deVisser, R O (2018) Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. Preventive Medicine, 112. pp. 185-192. ISSN 0091-7435

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Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention.

Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16–44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff.

The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, bingedrinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut < 16 years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%).

2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
School of Psychology > Psychology
Depositing User: Rosie Harvey
Date Deposited: 14 May 2018 11:26
Last Modified: 14 May 2018 11:26

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