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

Edelman, NL; Cassell, JA; Mercer, CH; Bremner, SA; Jones, CI; Gersten, A; deVisser, RO; (2018) Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices. Preventive Medicine , 112 pp. 185-192. 10.1016/j.ypmed.2018.04.030. Green open access

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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.

Type: Article
Title: Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ypmed.2018.04.030
Publisher version: https://doi.org/10.1016/j.ypmed.2018.04.030
Language: English
Additional information: Copyright © 2018 The Authors. 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
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10049660
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