School of Health Sciences, University of Brighton, Brighton & Hove, UK
Department of Primary Care & Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK.
BMJ Sex Reprod Health. 2021 Apr;47(2):117-128. doi: 10.1136/bmjsrh-2019-200482. Epub 2020 Jun 4.
A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic.
Female patients aged 16-44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity.
The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%-60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%-91.8%) and specificity of 43.7% (95% CI 39.0%-48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%-86.0%) and specificity of 48.3% (95% CI 43.4%-53.1%).
The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
之前已经开发出一种使用心理社会问题的临床预测规则（CPR），通过识别有意外怀孕（UIP）和性传播感染（STI）风险的女性，在一般实践中针对性保健。这种心理社会 CPR 可以帮助在避孕和性健康（CASH）服务中定位资源。本研究调查了它在预测在 CASH 诊所就诊的女性中最近报告的 UIP 和 STI 感染风险方面的表现。
在英格兰东南部的一家 CASH 诊所就诊的 16-44 岁女性患者在就诊时提供了一份关于心理社会问题的问卷，以及其他三个性风险问题：（1）过去一年中与两个或更多男性发生性关系（2+P），（2）通过最近的伴侣感染 STI 的风险，以及（3）过去 6 个月内 UIP 的风险。为每位参与者计算 CPR 评分，并与每个性风险的自我报告进行交叉制表，以估计 CPR 的敏感性和特异性。
预测 2+P 的心理社会问题的敏感性为 83.2%（95%CI 79.3%-86.5%），特异性为 56.1%（95%CI 51.3%-60.6%）。预测 2+P 和/或通过最近的伴侣感染 STI 的风险的问题的敏感性为 89.1%（95%CI 85.7%-91.8%），特异性为 43.7%（95%CI 39.0%-48.5%）。预测过去 6 个月内 UIP 风险的问题的敏感性为 82.5%（95%CI 78.6%-86.0%），特异性为 48.3%（95%CI 43.4%-53.1%）。
CPR 表现出良好的敏感性但特异性低，因此可能适合对 CASH 患者进行分诊或分层，以确定提供哪些干预措施以及通过哪种模式（例如，在线与面对面）。需要进一步研究心理社会因素与性风险之间的因果关系，以支持为该患者群体开发心理社会干预措施。
