Ibrahim Ali, Ryan Sharon, Viljoen David, Tutisani Ellen, Gardner Lucy, Collins Lorna, Ayton Agnes
Oxford Health NHS Foundation Trust, Oxford, UK.
Arts and Sciences, University College London, London, UK.
J Eat Disord. 2022 Jul 8;10(1):98. doi: 10.1186/s40337-022-00620-y.
Inpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice.
This is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6-8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay.
212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18-60) years, mean admission BMI was 14.1 (10-18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU.
Our main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.
神经性厌食症的住院治疗可能挽救生命，但与高复发率和不良预后相关。为解决这一问题，牛津服务机构对强化认知行为疗法（CBTE）模型进行了调整，该模型最初是为意大利的住院患者开发的，以适应英国国家医疗服务体系（NHS）的环境。在本研究中，我们比较了常规治疗（TAU）、综合CBTE（I-CBTE）以及英国常规临床实践中其他替代治疗模式的疗效。
这是一项纵向队列研究，使用2017年至2020年期间常规收集的数据，涉及英格兰一个地理区域内所有因神经性厌食症入住专科病房的成年人，该区域总人口为350万。我们将TAU与以下治疗方法进行比较：（1）I-CBTE（13周住院CBTE，恢复到健康体重，再加上7周日间治疗，随后20周门诊CBTE）；（2）独立住院CBTE（由于疫情后资源不足）；（3）作为危机管理的6 - 8周住院及部分体重恢复。主要结局指标（出院后至少1年）定义为：（1）良好结局：体重指数（BMI）> 19.5且无异常饮食或代偿行为；（2）不良结局：BMI < 19.5和/或持续的饮食障碍行为；（3）再次入院；或（4）死亡。次要结局指标为出院时的BMI和住院时间。
根据床位情况，212名患者入住了英国的15个专科病房。平均年龄为28.9岁（18 - 60岁），平均入院BMI为14.1（10 - 18.3），80%为自愿入院。出院后至少1年的随访中，接受I-CBTE治疗的患者中有70%保持良好结局，独立住院CBTE治疗的患者中有29%保持良好结局，相比之下，TAU组和危机管理住院组的这一比例均小于5%。I-CBTE的再次入院率为14.3%，而其他组约为50%（χ < 0.0001）。良好结局的主要预测因素是出院时达到健康BMI、I-CBTE治疗和自愿入院状态。年龄、精神疾病共病情况和住院时间并不能预测结局。CBTE组出院时的BMI和住院时间显著优于TAU组。
我们的主要发现是，在现实生活环境中，与其他住院治疗模式相比，I-CBTE在短期和至少1年的结局方面具有优势。在整个护理路径中推广I-CBTE有可能改变这一高风险患者群体的住院治疗结局，并降低个人和社会成本。
