Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders

Department of Psychology, Section of Family Therapy, Institute of Psychiatry, King's College London, London, United Kingdom.
International Journal of Eating Disorders (Impact Factor: 3.13). 12/2012; 45(8). DOI: 10.1002/eat.22065
Source: PubMed


To explore the role of specialist outpatient eating disorders services and investigate how direct access to these affects rates of referral, admissions for inpatient treatment, and continuity of care.
Services beyond primary care in Greater London retrospectively identified adolescents who presented with an eating disorder over a 2-year period. Data concerning service use were collected from clinical casenotes.
In areas where specialist outpatient services were available, 2–3 times more cases were identified than in areas without such services. Where initial outpatient treatment was in specialist rather than nonspecialist services, there was a significantly lower rate of admission for inpatient treatment and considerably higher consistency of care.
Developing specialist outpatient services with direct access from primary care is likely to lead to improvements in treatment and reduce overall costs. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)

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    • "GPs are referral “gatekeepers” (whether intended or otherwise), and ED clinicians have a role in supporting and educating their colleagues about frontline assessment practices and referral thresholds. In the regions where there are specialist services, GPs are likely to have greater awareness of eating disorders and in turn refer to specialist services more frequently [6]. In any event, presentation to primary care or emergency services should always be used as an opportunity to introduce, or re-engage with an ED clinician or ED service if one is available. "
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    ABSTRACT: Aim Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines. Method We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans. Results In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment. Conclusion Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice.
    International Journal of Eating Disorders 08/2013; 1(1):29. DOI:10.1186/2050-2974-1-29 · 3.13 Impact Factor
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    ABSTRACT: The conceptualization of anorexia nervosa (AN) depends on the diagnostic criteria. Most patients with teenage onset AN seem to remit within 3-10 years depending on the definitions of recovery. The mortality of adolescent onset anorexia nervosa (AN) has fortunately decreased over the last two decades. Based on randomized controlled trials, we review different treatments including individual and group psychotherapy, family therapy, psychopharmacology, and hormone therapy. Treatment settings vary over time for any individual patient. Despite high rates of inpatient treatment, the respective evidence for effectiveness is meager. In underage patients with severe AN clinical, ethical and legal aspects need to be dealt with systematically if intermittent compulsory treatment is deemed necessary. The prolonged and frequently chronic course of AN often entails therapeutic discontinuity; the transition into adulthood requires a graded therapeutic concept that considers the severity of the disorder, developmental and chronological age, and parental involvement. Finally, we consider future clinical and research options to improve treatment and outcome of this eating disorder.
    Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 11/2013; 41(6):433-46. DOI:10.1024/1422-4917/a000259 · 0.99 Impact Factor
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    ABSTRACT: Background: Eating disorders (EDs) show a varying course and outcome. Within 10 years, between half and three-quarters of patients recover from their disorder. There is, however, a lack of consensus in how to define recovery. Aims: The aim of the present naturalistic study was to assess clinical and full recovery in ED patients 5 years after initiated treatment at a specialized outpatient unit for EDs. Methods: Data was collected at three time points: after the investigation period (T1), at the end of treatment (T2) and 5 years after the beginning of treatment (T3). Data at T1 and T2 were collected from patient records, and at T3 using a questionnaire. The number of participants was 71 and response rate 78%. Results: At T3, the proportion in clinical recovery was 83.1%, with no significant differences between diagnostic groups. The proportion in full recovery, i.e. in addition to a subjective account of being fully recovered, presenting no physical, behavioural or psychological ED symptoms, was 40.8%. Conclusions: For most ED patients, outpatient treatment is sufficient to enable recovery. How to define and measure recovery still warrants discussion.
    Nordic journal of psychiatry 03/2014; 68(8). DOI:10.3109/08039488.2014.892152 · 1.34 Impact Factor
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