Matthews Kylie, Gordon Leanne, van Beusekom John, Sheffield Jeanie, Patterson Susan
1Royal Brisbane and Women's Hospital, Nutrition and Dietetics, Level 2 James Mayne Building, RBWH, Herston, 4006 Australia.
2Psychology, University of Queensland, St Lucia, 4067 Australia.
J Eat Disord. 2019 Jul 1;7:21. doi: 10.1186/s40337-019-0252-4. eCollection 2019.
Eating disorders are serious conditions which are increasing in prevalence internationally. The causes of these conditions are complex and incompletely understood, and clinical presentations can vary over time. The complexity of these conditions can also complicate treatment. Therefore, stepped care treatment comprising a hierarchy of interventions, including access to day treatment programs (DTPs), is recommended. While studies have examined patient outcomes and provided narrative accounts of these programs, no published studies describe DTP development. This study aims to address this gap by examining development and implementation of a DTP from service providers and patients' perspectives.
This study utilised a mixed-methods design to examine the design and implementation of a publicly funded, closed group DTP in Australia. Data from service records and documents were analysed, alongside interviews with patients and interview and focus groups with service providers conducted between June 2016 and July 2017. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using the Framework Approach.
Seventeen service providers ( = 4 in managerial and = 13 clinical positions, with clinical experience of 3 months to 20 years) and 11 patients (100% F, 17-33 years) were interviewed. The service providers reported that implementation was a stressful undertaking due to tight timeframes to achieve multiple tasks. Patients had diverse opinions regarding the DTP content and the group treatment experience. Despite this, all patients reported benefits from attending the DTP, varying from improvements in mood, weight gain, development of personal skills and strengths, to living independently. For further benefit, patients suggested that programs could be shaped and targets towards differing patient groups, with fewer breaks throughout treatment.
Designing and implementing a DTP is a challenge and can be a time-intensive undertaking, however the result can be beneficial for both service providers and patients. The closed group format was beneficial in creating a supportive environment, though may have led to increases in additional eating disordered behaviours. While the current structure of this DTP may require reconsideration, organisations considering implementing a new DTP may find usefulness in the overall design described in this study, alongside learning from the issues experienced.
饮食失调是严重的疾病，在国际上的患病率正在上升。这些疾病的病因复杂且尚未完全了解，临床表现会随时间变化。这些疾病的复杂性也会使治疗变得复杂。因此，建议采用分级护理治疗，包括一系列干预措施，其中包括日间治疗项目（DTPs）。虽然已有研究考察了患者的治疗效果并对这些项目进行了叙述性描述，但尚无已发表的研究描述DTP的发展情况。本研究旨在从服务提供者和患者的角度考察DTP的发展与实施情况，以填补这一空白。
本研究采用混合方法设计，考察澳大利亚一个由公共资金资助的封闭式团体DTP的设计与实施情况。分析了服务记录和文件中的数据，并结合2016年6月至2017年7月期间对患者的访谈以及对服务提供者的访谈和焦点小组讨论。定量数据采用描述性统计进行分析。定性数据采用框架法进行分析。
访谈了17名服务提供者（管理岗位4名，临床岗位13名，临床经验3个月至20年）和11名患者（100%为女性，年龄17 - 33岁）。服务提供者报告称，由于要在紧迫的时间内完成多项任务，实施工作压力很大。患者对DTP的内容和团体治疗体验有不同的看法。尽管如此，所有患者都报告称参加DTP有好处，从情绪改善、体重增加、个人技能和优势的发展到独立生活等方面。为了获得更多益处，患者建议项目可以根据不同患者群体进行调整和设定目标，治疗过程中的休息时间可以减少。
设计和实施DTP是一项挑战，可能需要耗费大量时间，但结果对服务提供者和患者都有益。封闭式团体形式有利于营造一个支持性的环境，不过可能导致额外的饮食失调行为增加。虽然目前这个DTP的结构可能需要重新考虑，但考虑实施新DTP的机构可能会从本研究描述的总体设计中找到有用之处，并从所经历的问题中吸取经验教训。
