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

Natalie Edelman, Jackie A. Cassell, C.H. Mercer, Stephen Bremner, C.I. Jones, A. Gersten, R.O. deVisser

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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, binge-drinking 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.
Original languageEnglish
Pages (from-to)185-192
Number of pages8
JournalPreventive Medicine
Volume112
DOIs
Publication statusPublished - 30 Apr 2018

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Decision Support Techniques
General Practice
Delivery of Health Care
Psychology
Sensitivity and Specificity
Pregnancy
Postcoital Contraception
Binge Drinking
High-Risk Pregnancy
Sexual Partners
Reproductive Health
Sexually Transmitted Diseases
England
Referral and Consultation
Cross-Sectional Studies
Logistic Models
Smoking
Research

Bibliographical note

© 2018 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/)

Keywords

  • Primary care
  • Sexually transmitted infections
  • Women
  • Contraception
  • Sexual behaviour
  • Primary prevention
  • Sexual healthcare
  • Reproductive healthcare

Cite this

Edelman, Natalie ; Cassell, Jackie A. ; Mercer, C.H. ; Bremner, Stephen ; Jones, C.I. ; Gersten, A. ; deVisser, R.O. / Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. In: Preventive Medicine. 2018 ; Vol. 112. pp. 185-192.
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Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. / Edelman, Natalie; Cassell, Jackie A.; Mercer, C.H.; Bremner, Stephen; Jones, C.I.; Gersten, A.; deVisser, R.O.

In: Preventive Medicine, Vol. 112, 30.04.2018, p. 185-192.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Cassell, Jackie A.

AU - Mercer, C.H.

AU - Bremner, Stephen

AU - Jones, C.I.

AU - Gersten, A.

AU - deVisser, R.O.

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KW - Sexually transmitted infections

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