Massou Efthalia, Magnusson Josefine, Fulop Naomi J, Gandhi Saheli, Ramsay Angus Ig, Heyman Isobel, O'Curry Sara, Bennett Sophie, Ford Tamsin, Morris Stephen
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
Department of Behavioural Science and Health, University College London, UK.
Health Soc Care Deliv Res. 2025 Jan 8:1-24. doi: 10.3310/ELPT1245.
Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms).
The present review is part of a larger study that will inform the development of a new children's hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care.
We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English.
We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased.
The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders.
The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care, integration of physical and mental health services for children and young people with eating disorders or functional symptom disorders is underexplored and the limited available evidence is of weak quality.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.
有证据表明，认识到疾病的社会心理成分与生物学成分同样重要，医疗会变得更加全面，患者也能从中受益。提供这类医疗服务需要卫生专业人员之间的协作，而不是孤立地工作，以取得更好的效果。然而，关于综合医疗保健实施情况的证据不足。本综述聚焦于患有饮食失调（即与进食和喂养相关的失调）或功能性症状障碍（即医学上无法解释的症状）的儿童和青少年。
本综述是一项更大规模研究的一部分，该研究将为英格兰一家新儿童医院的建设提供参考。饮食失调和功能性症状障碍这两种病症可能特别适合采用综合医疗保健方法，本综述旨在调查采用了哪些服务模式来整合医疗服务，哪些因素影响其实施，以及这些综合模式对医疗服务的可及性和治疗效果有何影响。
我们对基于患有饮食失调或功能性症状障碍的儿童和青少年的研究进行了系统综述，调查综合心理健康和身体健康服务与这些人群所提供的任何其他类型服务相比的有效性。我们于2024年7月搜索了MEDLINE、EMBASE和PsycInfo®（美国心理学会，华盛顿特区，美国）电子文献数据库，对出版日期或感兴趣的国家没有限制。我们只审查用英文撰写的研究。
我们识别出2668条引文，从中筛选出1939篇符合标题筛选条件的论文。我们的综述仅纳入了一项20多年前澳大利亚对综合护理模式的单中心评估。该研究报告称，综合方法的总入院人数和总住院天数显著增加。然而，护理负担从精神科病房转移到了内科病房，结果是每次入院成本和每位住院患者成本下降。
综合护理定义缺乏概念一致性可能导致错误筛选和一些证据丢失。在功能性症状障碍的定义方面也存在同样的局限性。
该综述发现，与一般服务相比，针对患有饮食失调或功能性症状障碍的儿童和青少年的综合二级服务的证据基础存在差距。未找到针对患有功能性症状障碍的儿童和青少年的类似研究。我们的研究结果与先前的证据一致，表明尽管存在描述综合护理各个方面的研究，但针对患有饮食失调或功能性症状障碍的儿童和青少年的身心健康服务整合仍未得到充分探索，现有有限证据质量也很薄弱。
本文介绍了由英国国家卫生与保健研究所（NIHR）卫生和社会保健交付研究计划资助的独立研究，资助编号为NIHR133613。
