Catenacci Vanessa, Couturier Jennifer
DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
J Eat Disord. 2023 Aug 10;11(1):133. doi: 10.1186/s40337-023-00859-z.
Throughout the COVID-19 pandemic, there was a detrimental impact to the symptoms and treatment of eating disorders, causing an increase in medical admissions and visits. Day treatment programs (DTPs), often used to bridge the gap between inpatient and outpatient treatment, were converted to online formats. This study aims to explore the impact of the transition to virtual DTPs on eating disorder treatment from the perspective of adolescents, their caregivers, and program staff.
Twelve participants (3 adolescents, 4 caregivers, 5 healthcare providers) in a virtual day treatment program were interviewed using a semi-structured interview guide. Interviews were transcribed and managed with qualitative software NVivo 11.0. Conventional analysis was used to inductively identify pertinent themes related to patient, caregiver, and healthcare staff perceptions and experiences of the virtual day treatment. Summative content analysis provided counts of the barriers and benefits of virtual day treatment as identified by participants.
The majority of participants (10/12) had exposure to both virtual and in person settings, most participants (11/12) felt in-person day programs would be superior to virtual programs. Common limitations of the virtual format were feelings of isolation, less support from healthcare providers, parental burnout, and increased disordered eating. Common benefits were increased accessibility, parental involvement, improved communication with healthcare staff, and the ability for participants to be in their home environment and eat home food. Suggestions for improvement included designing a hybrid model of day treatment, increased family involvement, extending the day program to include dinners with family, and screening for patient appropriateness for the virtual setting.
This qualitative study suggests that there are many barriers to effective implementation of virtual day programs. However, the virtual DTP program offers increased accessibility to patients during a period of a health pandemic and to patients in rural/remote areas with limited treatment options. Suggestions provided by participants in this study, such as increased family involvement, frequency of in person check-ins and increased number of meals supported by the program, may help to improve outcomes in virtual day treatment programs.
在整个新冠疫情期间，饮食失调的症状和治疗受到了不利影响，导致住院和就诊人数增加。日间治疗项目（DTPs）常用于弥合住院治疗和门诊治疗之间的差距，现已转变为在线形式。本研究旨在从青少年、其照顾者和项目工作人员的角度，探讨向虚拟日间治疗项目转变对饮食失调治疗的影响。
使用半结构化访谈指南，对一个虚拟日间治疗项目中的12名参与者（3名青少年、4名照顾者、5名医疗服务提供者）进行访谈。访谈内容进行了转录，并使用定性软件NVivo 11.0进行管理。采用常规分析归纳确定与患者、照顾者以及医疗工作人员对虚拟日间治疗的认知和体验相关的主题。总结性内容分析统计了参与者所确定的虚拟日间治疗的障碍和益处。
大多数参与者（10/12）曾接触过虚拟和面对面两种治疗方式，大多数参与者（11/12）认为面对面的日间项目优于虚拟项目。虚拟形式的常见局限性包括孤独感、医疗服务提供者的支持减少、家长倦怠以及饮食失调加剧。常见益处包括可及性增加、家长参与度提高、与医疗工作人员的沟通改善，以及参与者能够在家中环境并食用家常食物。改进建议包括设计一种混合式日间治疗模式、增加家庭参与度、将日间项目扩展至包括与家人共进晚餐，以及筛查患者是否适合虚拟治疗环境。
这项定性研究表明，有效实施虚拟日间项目存在诸多障碍。然而，虚拟日间治疗项目在健康大流行期间为患者以及治疗选择有限的农村/偏远地区患者提供了更高的可及性。本研究中参与者提出的建议，如增加家庭参与度、增加面对面检查的频率以及增加项目支持的用餐次数，可能有助于改善虚拟日间治疗项目的效果。
