Richards Katie L, Flynn Michaela, Austin Amelia, Lang Katie, Allen Karina L, Bassi Ranjeet, Brady Gabrielle, Brown Amy, Connan Frances, Franklin-Smith Mary, Glennon Danielle, Grant Nina, Jones William Rhys, Kali Kuda, Koskina Antonia, Mahony Kate, Mountford Victoria A, Nunes Nicole, Schelhase Monique, Serpell Lucy, Schmidt Ulrike
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Eating Disorder Outpatient Service, South London and Maudsley NHS Foundation Trust, UK.
BJPsych Open. 2021 May 7;7(3):e98. doi: 10.1192/bjo.2021.51.
The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package.
This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study.
Participants were 259 emerging adults (aged 16-25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined.
There were significant increases (16-40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used.
This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.
饮食失调首次发作快速早期干预（FREED）服务模式与缩短等待时间以及改善近期发病的饮食失调的新兴成年人的临床结局相关。了解FREED如何实施是将这些结果归因于该模式的关键组成部分（即等待时间目标和护理套餐）的必要前提。
本研究在多中心FREED-Up研究期间评估了对FREED服务模式的依从性。
参与者为259名患有病程小于3年的饮食失调的新兴成年人（年龄在16 - 25岁之间），通过FREED护理途径接受治疗。患者就医记录记录了从筛查到治疗结束的患者护理情况。检查了对等待时间目标（48小时内进行参与电话沟通、2周内进行评估、4周内进行治疗）和护理套餐的依从性，以及不同诊断和治疗组之间依从性的差异。
引入FREED后，无论诊断如何，对等待时间目标的依从性都有显著提高（16% - 40%）。在最佳条件下接受FREED也提高了对目标的依从性。护理套餐的使用因组成部分和诊断而异。最常用的护理套餐活动是心理教育和饮食改变。对过渡阶段的关注使用较少。
本研究表明了对FREED模式关键组成部分的依从水平。这些依从率可初步视为具有临床意义的阈值。结果突出了该模式及其实施中值得未来研究的方面。
