van den Eijnde-Damen Ilona M C, Maas Joyce, Burger Pia, Bodde Nynke M G, Simeunovic-Ostojic Mladena
Center for Eating Disorders Helmond, Mental Health Center Region Oost-Brabant, Wesselmanlaan 25a, Helmond, 5707 HA, The Netherlands.
Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, Tilburg, 5037 AB, The Netherlands.
J Eat Disord. 2024 Aug 26;12(1):124. doi: 10.1186/s40337-024-01091-z.
Severe and Enduring Eating Disorders (SEED), in particular SEED-Anorexia Nervosa (SE-AN), may represent the most difficult disorder to treat in psychiatry. Furthermore, the lack of empirical research in this patient group, and, consequently the lack of guidelines, call for an urgent increase in research and discussion within this field. Meanwhile experts concur that effective care should be structured in a collaborative manner.
To identify the challenges in providing care to patients with SE-AN in the Dutch healthcare context, and propose a collaborative care treatment model to address these issues.
A pragmatic mixed-method approach was used, structured as follows: (1) Identifying perceived barriers and treatment needs from the viewpoint of both patients and eating disorder healthcare professionals through an evaluation questionnaire; (2) Investigating current treatment practices for SEED/SE-AN via benchmarking; (3) Gaining insight into the optimal structure and content of care by interviewing network partners and experts-by-experience. Based on these findings, and drawing from literature on severe and enduring disorders, a treatment model for SE-AN was proposed and implemented.
The key challenges identified included a lack of knowledge about eating disorders among network partners, treatment ambivalence among patients and poor collaboration between professionals. The proposed model enhances self-management and collaborative relationships with healthcare providers, offers user-friendly and practical guidance, and aims at stabilization, reducing relapses, deterioration, and readmissions, thereby being cost-effective. Importantly, the model operates across levels of care (primary, secondary, tertiary).
This study, describing a collaborative care program for SE-AN, developed and implemented in a highly specialized treatment center for eating disorders, sets the stage for further explanatory/efficacy research to build on the findings in this study, with the following aims: addressing the critical gap in care for SEED/SE-AN, improving better healthcare organization, reducing relapse rates, and lowering costs for this often overlooked patient group.
严重且持久的饮食失调症（SEED），尤其是SEED - 神经性厌食症（SE - AN），可能是精神病学中最难治疗的疾病。此外，该患者群体缺乏实证研究，因此也缺乏相关指南，这就迫切需要在该领域加强研究和讨论。同时，专家们一致认为，有效的护理应以协作的方式构建。
确定在荷兰医疗环境中为SE - AN患者提供护理时所面临的挑战，并提出一种协作式护理治疗模式来解决这些问题。
采用了一种务实的混合方法，具体如下：（1）通过评估问卷从患者和饮食失调症医疗专业人员的角度确定感知到的障碍和治疗需求；（2）通过基准测试调查SEED/SE - AN的当前治疗实践；（3）通过采访网络合作伙伴和有经验的专家深入了解护理的最佳结构和内容。基于这些发现，并借鉴关于严重且持久疾病的文献，提出并实施了一种SE - AN的治疗模式。
确定的关键挑战包括网络合作伙伴对饮食失调症缺乏了解、患者的治疗矛盾心理以及专业人员之间协作不佳。所提出的模式增强了自我管理以及与医疗服务提供者的协作关系，提供了用户友好且实用的指导，旨在实现病情稳定，减少复发、病情恶化和再入院情况，从而具有成本效益。重要的是，该模式在各级护理（初级、二级、三级）中都能发挥作用。
本研究描述了在一家高度专业化的饮食失调症治疗中心开发并实施的针对SE - AN的协作式护理项目，为基于本研究结果开展进一步的解释性/疗效研究奠定了基础，目标如下：填补SEED/SE - AN护理方面的关键空白、改善医疗组织、降低复发率以及降低这个常被忽视的患者群体的治疗成本。
