Feasibility and acceptability of screening for eating disorders in primary care

Department of Psychology, Institute of Psychiatry, King's College London, PO78, Addiction Sciences Building, London, UK.
Family Practice (Impact Factor: 1.84). 11/2007; 24(5):511-7. DOI: 10.1093/fampra/cmm029
Source: PubMed

ABSTRACT Earlier diagnosis of disordered eating is linked to improved prognosis, but detection in primary care is poor.
To assess the feasibility of screening for disordered eating within primary care, in terms of the proportion of patients accepting screening, yield of cases, action taken by staff and staff views on screening.
Data were collected in open GP surgeries, midwife (MW) antenatal clinics and health visitor (HV) child health surveillance clinics in two GP practices, using face-to-face surveys and semi-structured interviews. Female patients aged 16-35 were asked to complete the SCOFF questionnaire, which was scored by researchers and taken by the patient into their consultation. If the result indicated possible disturbed eating, the health professional (HP) running the surgery/clinic was asked to complete a questionnaire and interview. One hundred and eleven women were screened and 11 HPs (GPs, MWs, HVs) were interviewed.
Forty-six percent of patients agreed to be screened. Of these, 16% produced a positive result. The staff survey suggested that HPs found screening acceptable. However, concerns arose in the interviews, principally over what action to take in response to positive results. Positive results were rarely recorded in medical notes, and treatment was rarely offered.
In order for a screening programme for eating disorders to be implemented in primary care, HP concerns about options for dealing with positive results would need to be addressed. Feasibility of screening would be enhanced by production of a protocol to be followed in the case of positive results.

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    ABSTRACT: Background & aims More than half of individuals with eating disorders (ED) remain undetected in primary care, making a validated screening tool necessary. The aim of the study was to analyze the screening value of the SCOFF questionnaire for women in family practices. Methods 150 consecutive women attending their general practitioner (GP) in the south west of France were recruited. The written SCOFF questionnaire was completed, and then concealed in an envelope. The women were then assessed by a clinical interview for the diagnosis with ED DSM-IV criteria. Sensitivity and specificity were evaluated with a ROC curve. Results 143 women completed all the questionnaires and interviews. Sixteen % presented with some criteria of the DSM-IV TR ED, while 21 % of the group has a SCOFF score >1. A score > 2 had a sensitivity of 30%, and a specificity of 97%. A score > 1 had a sensitivity of 65%, and a specificity of 87%. Conclusion The prevalence of ED in a GP practice is relatively high and the SCOFF score is an easy and helpful screening tool increasing the identification of patients. A score equal to 2 or more has a sensitivity of 65,2% and a specificity of 87,5%. A few questions reflecting pragmatic clinical situations would improve the specificity of the screening.
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