GPs are dissatisfied with the care they are giving patients with eatin
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《英国医生杂志》
Few GPs adhere to primary care guidelines and protocols on the management of eating disorders, and many feel dissatisfied with the treatment they are providing, according to a British study presented at the seventh international eating disorders conference, held in London last week.
Researchers at the Institute of Psychiatry sent questionnaires to all GPs and university counsellors in south London, Surrey, Sussex, and Kent, who together serve a population of 6.4 million.
Half of the GPs who responded had had at least one new case of an eating disorder during the previous year. Overall, around a quarter of these patients were managed exclusively in primary care. However, individual GPs tended to refer either all or none of the affected patients, a practice that is unlikely to result in smooth service delivery, the researchers say.
Three quarters of the responding university counsellors had at least one new case, and about three quarters of these patients were managed exclusively in student health services.
In the second stage of the study, clinicians volunteered to answer questionnaires that reviewed their treatment practices and assessed their satisfaction with the care they were providing. The researchers compared clinicians?practice with that recommended by the National Institute for Clinical Excellence and the Royal College of Psychiatrists, both of which recommend the provision of information and education. Around two thirds of GPs said they recommend self help materials and give information to some patients. However, only a quarter do this routinely, and one in five GPs never recommend self help material.
The Royal College of Psychiatrists advises measuring weight and height and referring all patients with a body mass index (BMI) of less than 17 to specialists, with urgent referral in the case of patients with a BMI less than 15. Most GPs said they measured weight and height in at least some patients with an eating disorder, but only two thirds said they did this in every case. Many GPs do not adhere to guidelines on referral. Less than half said they would definitely refer a patient with a BMI of less than 17. Most would refer those with a BMI of less than 15, but less than half said they would do so urgently.
A small proportion of university counsellors and GPs use published guidelines or protocols to help manage patients with eating disorders, said the study抯 lead researcher, Laura Currin. "Many GPs were unhappy about the treatment they were providing. Nearly half were 憂ot at all?or 憂ot very?satisfied. However, this could be due to the service constrictions of primary care," she added.
In the conference抯 final session, Professor Christopher Fairburn of the Department of Psychiatry at Oxford University called for reclassification of eating disorders according to their clinical implications.
"The current scheme for classifying eating disorders is a historical accident that is a poor reflection of clinical reality," he said. Around 60% of patients do not meet the strict criteria of the revised, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders for anorexia nervosa or bulimia nervosa so are classified as having an "eating disorder not otherwise specified" (EDNOS).
"The label carries with it the connotation that these patients are 憀eftovers?with an unusual and mild illness," he said. "In fact they constitute the biggest group of patients referred to outpatient clinics, they have many of the same symptoms as AN and BN , and their illness can be just as severe. However, there has been virtually no research on EDNOS and not a single treatment study to guide its management. These patients are truly marginalised. In some countries, including Germany and the USA, these patients can抰 even get reimbursed for medical care."(Jill Graham)
Researchers at the Institute of Psychiatry sent questionnaires to all GPs and university counsellors in south London, Surrey, Sussex, and Kent, who together serve a population of 6.4 million.
Half of the GPs who responded had had at least one new case of an eating disorder during the previous year. Overall, around a quarter of these patients were managed exclusively in primary care. However, individual GPs tended to refer either all or none of the affected patients, a practice that is unlikely to result in smooth service delivery, the researchers say.
Three quarters of the responding university counsellors had at least one new case, and about three quarters of these patients were managed exclusively in student health services.
In the second stage of the study, clinicians volunteered to answer questionnaires that reviewed their treatment practices and assessed their satisfaction with the care they were providing. The researchers compared clinicians?practice with that recommended by the National Institute for Clinical Excellence and the Royal College of Psychiatrists, both of which recommend the provision of information and education. Around two thirds of GPs said they recommend self help materials and give information to some patients. However, only a quarter do this routinely, and one in five GPs never recommend self help material.
The Royal College of Psychiatrists advises measuring weight and height and referring all patients with a body mass index (BMI) of less than 17 to specialists, with urgent referral in the case of patients with a BMI less than 15. Most GPs said they measured weight and height in at least some patients with an eating disorder, but only two thirds said they did this in every case. Many GPs do not adhere to guidelines on referral. Less than half said they would definitely refer a patient with a BMI of less than 17. Most would refer those with a BMI of less than 15, but less than half said they would do so urgently.
A small proportion of university counsellors and GPs use published guidelines or protocols to help manage patients with eating disorders, said the study抯 lead researcher, Laura Currin. "Many GPs were unhappy about the treatment they were providing. Nearly half were 憂ot at all?or 憂ot very?satisfied. However, this could be due to the service constrictions of primary care," she added.
In the conference抯 final session, Professor Christopher Fairburn of the Department of Psychiatry at Oxford University called for reclassification of eating disorders according to their clinical implications.
"The current scheme for classifying eating disorders is a historical accident that is a poor reflection of clinical reality," he said. Around 60% of patients do not meet the strict criteria of the revised, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders for anorexia nervosa or bulimia nervosa so are classified as having an "eating disorder not otherwise specified" (EDNOS).
"The label carries with it the connotation that these patients are 憀eftovers?with an unusual and mild illness," he said. "In fact they constitute the biggest group of patients referred to outpatient clinics, they have many of the same symptoms as AN and BN , and their illness can be just as severe. However, there has been virtually no research on EDNOS and not a single treatment study to guide its management. These patients are truly marginalised. In some countries, including Germany and the USA, these patients can抰 even get reimbursed for medical care."(Jill Graham)