Johnson Catherine, Cook Lesley, Cadman Kath, Andersen Thu, Williamson Paul, Wade Tracey D
Blackbird Initiative, Flinders University, Adelaide, SA, Australia.
Partners in Practice, Sydney, Australia.
J Eat Disord. 2022 Nov 17;10(1):170. doi: 10.1186/s40337-022-00695-7.
Many people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting.
In an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20-40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion); Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions); Adoption (drop-out and predictors); Implementation (barriers encountered); Maintenance (subsequent activity designed to embed new practices).
Treatment was completed by 71%; significant large decreases in eating disorder cognitions were achieved; remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing.
Implementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment.
This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).
许多饮食失调患者要么无法获得治疗，要么在症状首次出现后很久才获得治疗，要么中途退出治疗。本研究评估了在非专科社区环境中改善饮食失调患者早期获得循证干预措施的方法。
在澳大利亚一个地区社区，全科医生与治疗提供者（心理学家、心理健康社会工作者和营养师）建立了联系，这些治疗提供者接受持续培训、反馈和支持。服务使用者可获得20至40次补贴治疗课程。在18个月内从143名患者中收集了数据。我们根据RE-AIM实施框架报告结果：覆盖范围（我们衡量了接受率和治疗完成情况）；有效性（对饮食失调认知、体重指数、缓解情况的影响，以及有效性的调节因素，包括病程、既往治疗、合并症的存在、饮食失调规范水平的存在、任何饮食失调行为的存在、治疗期间称重、多学科病例讨论会、营养治疗课程数量）；采用情况（退出率及预测因素）；实施情况（遇到的障碍）；维持情况（为嵌入新实践而设计的后续活动）。
71%的患者完成了治疗；饮食失调认知显著大幅下降；37%（意向性分析）的患者实现了缓解。饮食失调基线水平较低、接受≥3次营养治疗课程以及≥2次团队病例讨论会可预测治疗完成情况。定期病例讨论会和治疗期间称重可预测随时间推移有更大改善。
在地区社区环境中实施该模式产生的完成率和结果与饮食失调治疗的专科临床试验中的结果相当。服务提供者认为护理协调是将使用者与服务联系起来并帮助克服持续治疗障碍的最重要因素。
本研究是对澳大利亚卫生部实施的一个项目的受邀评估。该项目未引入任何新的临床实践，而是试图通过消除四个已知的系统性障碍来改善饮食失调患者获得循证多学科治疗的机会：获得准确诊断、多学科治疗的可及性、治疗费用以及治疗强度。因此，该项目无需试验注册。尽管如此，本评估获得了伦理批准（贝尔贝里人类研究伦理委员会，申请编号：2018 - 09 - 728 - FR - 1）。
