Viljoen David, King Emily, Harris Sophie, Hollyman Jonathan, Costello Kate, Galvin Eimear, Stock Melissa, Schmidt Ulrike, Downs James, Sekar Murali, Newell Ciaran, Clark-Stone Sam, Wicksteed Amy, Foster Caroline, Battisti Francesca, Williams Laura, Jones Roshan, Beglin Sarah, Anderson Stephen, Jebarsan Thuthirna, Ghuys Viviane, Ayton Agnes
Oxford Health NHS Foundation Trust (OHFT), Oxford, UK.
Ellern Mede Ridgeway and Ellern Mede Barnet, London, UK.
BJPsych Bull. 2023 Aug 1;48(4):1-9. doi: 10.1192/bjb.2023.57.
AIMS/METHOD: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance.
Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS.
This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.
目的/方法：这项疫情前的全国性调查将成人社区饮食失调服务（ACEDS）的需求和能力与英国国家医疗服务体系（NHSE）的委托指南进行了比较。
英格兰和苏格兰的13项服务做出了回应（覆盖1070万人口）。在2016 - 2017年至2019 - 2020年期间，平均转诊率从每百万人口378例增加到449例，增长了18.8%。只有3.7%的转诊来自儿童和青少年饮食失调服务（CEDS - CYP），但46%的患者年龄在18 - 25岁之间，54%的患者年龄大于25岁。大多数ACEDS都有等候名单并限制服务获取。许多机构无法提供全面的医疗监测、针对合并症调整治疗、提供积极的外展服务或实现无缝过渡。就患者数量而言，ACEDS的劳动力预算为15%，而NHSE劳动力计算器针对CEDS - CYP的建议比例更高。要实现同等水平，ACEDS每百万人口需要700万英镑的投资。
本研究突出了ACEDS面临的巨大压力，自新冠疫情以来这种压力有所增加。需要大量投资以确保NHSE的ACEDS符合国家指南，提供循证治疗，降低风险和可预防的死亡，并与CEDS - CYP实现同等水平。
