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首页> 外文期刊>BMC Family Practice >Identifying patients with medically unexplained physical symptoms in electronic medical records in primary care: a validation study
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Identifying patients with medically unexplained physical symptoms in electronic medical records in primary care: a validation study

机译：识别初级医疗电子病历中具有无法解释的身体症状的患者：一项验证研究

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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.
机译：背景技术当医学上无法解释的身体症状（MUPS）持续存在时，可能对患者，全科医生（GP）和社会产生重大影响。在电子病历（EMR）中早期识别患有MUPS的患者可能会通过在全科医生中建立意识并提供开始逐步护理管理的机会而有助于预防持续性MUPS。然而，鉴定EMR中的MUPS患者的程序尚不完善。在这项验证研究中，我们探索了一种EMR筛查方法的测试特征，以识别患有MUPS的患者。方法EMR筛选方法包括三个步骤。首先，在过去的12个月中有五次或以上接触的所有≥18岁的患者都包括在内。第二，排除患有已知慢性病的患者。最后，患者被纳入MUPS综合征，或者当他们有三个或三个以上暗示MUPS的主诉时。我们将EMR筛查方法的结果与患者健康问卷15（PHQ-15）上的分数进行了比较，我们将其用作参考测试。我们计算了各个截止点的测试特性。结果在我们的数据集中完成PHQ-15的1223名患者中，有609名（49/8％）在PHQ-15中得分≥5。 EMR筛查方法检测出131/1223（10.7％）为MUPS患者。其中，在PHQ-15上得分≥5的有102名（77.9％），并且在得分≥10的有53名（40.5％）。与PHQ-15截止点≥10相比，敏感性和特异性分别为0.30和0.93，阳性和阴性预测值分别为0.40和0.89。结论EMR筛查MUPS患者具有很高的特异性。但是，许多潜在的MUPS患者将被错过。在将这种方法用作筛选可能会从结构性治疗中受益的患者的筛查工具之前，需要提高其敏感性，同时保持其特异性。

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