InsideOut Institute, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.
Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2021 Nov;55(11):1089-1100. doi: 10.1177/0004867421998752. Epub 2021 Mar 15.
Primary care practitioners are well placed to support diagnosis and appropriate treatment of eating disorders as they are often the first point of contact with the health care system. However, little is known about management of eating disorders in primary care. We aimed to estimate the prevalence of management of eating disorders in primary care and identify how these disorders are managed.
This study used data from the Bettering the Evaluation of Care of Health programme, which annually surveys 1000 randomly sampled general practitioners in Australia who each record details of 100 successive patient encounters. In total, data were utilised from 1,568,100 primary care encounters between 2000/2001 and 2015/2016.
Eating disorders were managed in less than 1% of primary care encounters between 2000/2001 and 2015/2016. When extrapolated to the Australian population, up to 0.32% of the population were managed in primary care for a primary or probable eating disorder. In the majority of encounters where an eating disorder was managed (58.5%), the encounter was initiated for reasons other than the eating disorder itself. Of a group of patients identified with a clinically significant low body mass index ( = 5917), a small number ( = 118) had either no other diagnosis or a related condition that may be indicative of an eating disorder. In encounters where an eating disorder was managed, referrals to a mental health specialist/service, medical specialist and nutritionist/dietician were provided in 20%, 8% and 6% of encounters, respectively. Mental health treatment plans, which provide subsidised access to mental health services, were ascribed in approximately 7.7% of encounters where an eating disorder was managed.
Primary care provides an opportunity to improve detection and management of eating disorders, particularly when patients present for 'other' issues or with unexplained low body mass index and one or more symptoms related to an eating disorder.
初级保健医生是支持饮食障碍诊断和适当治疗的合适人选，因为他们通常是与医疗保健系统的第一联系点。然而，对于初级保健中饮食障碍的管理知之甚少。我们旨在评估初级保健中饮食障碍管理的流行率，并确定如何管理这些障碍。
本研究使用了 Bettering the Evaluation of Care of Health 计划的数据，该计划每年调查澳大利亚 1000 名随机抽样的全科医生，每位医生记录 100 次连续患者就诊的详细信息。总共利用了 2000/2001 年至 2015/2016 年期间 1568100 次初级保健就诊的数据。
在 2000/2001 年至 2015/2016 年期间，不到 1%的初级保健就诊涉及饮食障碍管理。如果推断到澳大利亚人口，那么多达 0.32%的人口在初级保健中接受原发性或可能的饮食障碍管理。在大多数管理饮食障碍的就诊中（58.5%），就诊的原因不是饮食障碍本身。在一组被确定为临床显著低体重指数的患者中（ = 5917），少数患者（ = 118）没有其他诊断或相关疾病，这可能表明存在饮食障碍。在管理饮食障碍的就诊中，分别有 20%、8%和 6%的就诊向心理健康专家/服务、医学专家和营养师/饮食学家提供转介。大约 7.7%的管理饮食障碍的就诊中，开了心理健康治疗计划，该计划提供了获得心理健康服务的补贴。
初级保健为改善饮食障碍的发现和管理提供了机会，特别是当患者因“其他”问题就诊或出现不明原因的低体重指数和一个或多个与饮食障碍相关的症状时。
