Kaplan Amy, Hutchinson Anastasia, Hooper Suzie, Gwee Karen, Khaw Damien, Valent Lola, Willcox Jane C
Epworth HealthCare Rehabilitation and Mental Health, Camberwell, Australia.
School of Nursing and Midwifery, Centre for Quality and Patient Safety Research (QPS), Institute for Health Transformation, Deakin University, Geelong, Australia.
J Eat Disord. 2024 Aug 19;12(1):119. doi: 10.1186/s40337-024-01077-x.
General mental health inpatient units hold a valuable place in the stepped system of care, and for identification and treatment of people with eating disorders (EDs) or disordered eating behaviours (DEBs). This study aimed to pragmatically evaluate an evidence-informed screening and care pathway, alongside a staff education program, implemented to improve identification and treatment access for consumers with EDs and DEBs, with co-occurring psychiatric conditions, on a general mental health ward.
A mixed methodology design was mapped to the RE-AIM implementation framework. It encompassed medical record audits across two 3-month time points pre and post implementation of the pathway, and key informant consumer and health professional interviews.
Process and implementation data were compared for three-month periods pre (2019, n = 348) and post-implementation (2021, n = 284). Post-implementation, intake SCOFF screening occurred in 94.7% of admissions. People with ED/DEBs diagnoses were 35 times more likely to have a SCOFF score ≥ 2 (OR = 35.2, p < .001) with the odds of identifying previously undiagnosed DEBs 3.3 times greater (p = .002). Post-implementation, for those with an ED/DEB, dietitian referrals (p < .001) and micronutrient supplementation (p = .013) were more likely. For those with weight and height data, both absolute (-1.1 kg ± 2.2 vs. 1.3 kg ± 2.3; p < .001) and percentage weight change were significantly higher post-implementation with similarities across BMI categories. Universally, consumers and health professionals expressed that the service had "changed care for the better" encouraging therapeutic relationships, mediated by trust, that resulted in better consumer outcomes. 50 health professionals undertook tailored ED and meal support therapy education. They noted that their knowledge and confidence improved allowing value to be seen in understanding EDs and the role for care within general mental health.
This study demonstrated that an articulated screening and care pathway could be feasibly implemented in general mental health. The evaluation demonstrated advances in ED detection and management with noted improvements in management access, care planning, physical monitoring and weight gain outcomes. Understanding stakeholders' experiences of new care practices enabled the identification of enablers and barriers for implementation, and avenues to optimise care for consumers with EDs in the general mental health setting.
综合精神科住院单元在分级护理体系中占有重要地位，对于识别和治疗饮食失调（ED）或饮食行为紊乱（DEB）患者具有重要意义。本研究旨在切实评估一种基于证据的筛查和护理路径，以及一项员工教育计划，该计划旨在改善综合精神科病房中患有ED和DEB且伴有精神疾病的患者的识别和治疗途径。
采用混合方法设计，并映射到RE-AIM实施框架。该设计包括在该路径实施前后的两个3个月时间点进行病历审核，以及对关键信息提供者（消费者和健康专业人员）进行访谈。
比较了实施前（2019年，n = 348）和实施后（2021年，n = 284）三个月期间的过程和实施数据。实施后，94.7%的入院患者进行了SCOFF筛查。被诊断为ED/DEB的患者SCOFF评分≥2的可能性是其他人的35倍（OR = 35.2，p <.001），识别先前未诊断出的DEB的几率高出3.3倍（p =.002）。实施后，对于患有ED/DEB的患者，营养师转诊（p <.001）和微量营养素补充（p =.013）的可能性更大。对于有体重和身高数据的患者，实施后体重的绝对变化（-1.1 kg±2.2 vs. 1.3 kg±2.3；p <.001）和体重变化百分比均显著更高，且在不同BMI类别中具有相似性。总体而言，消费者和健康专业人员都表示该服务“使护理得到了改善”，促进了由信任介导的治疗关系，从而带来了更好的消费者治疗效果。50名健康专业人员接受了量身定制的ED和膳食支持治疗教育。他们指出，自己的知识和信心得到了提高，从而在理解ED以及综合精神科护理中的作用方面看到了价值。
本研究表明，一种明确的筛查和护理路径可以在综合精神科切实实施。评估显示，在ED检测和管理方面取得了进展，在管理途径、护理计划、身体监测和体重增加结果方面有显著改善。了解利益相关者对新护理实践的体验有助于识别实施的促进因素和障碍，以及优化综合精神科环境中ED患者护理的途径。
