title: Identifying patients with medically unexplained physical symptoms in electronic medical records in primary care: a validation study.
abstract: 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.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. m.denboeft@vumc.nl.
authors.forename: Madelon
authors.initials: M
authors.lastname: den Boeft
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.forename: Trudie R
authors.initials: TR
authors.lastname: Rydell-Lexmond
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
mesh_terms: D000328:Adult; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires