Day hospital programmes for eating disorders: A review of the similarities, differences and goals

Abstract

Day hospital (DH) treatments for eating disorders (EDs) provide intensive daily care and allow patients to maintain and test their social relations and coping skills at home and outside. Although widespread, their description is lacking. This review compares the different types of DH described in the literature and presents our DH experience in Turin, Italy. We searched Psychinfo and Pubmed with the following keywords: anorexia nervosa, bulimia nervosa, EDs, DH, day treatment and partial hospitalisation. We found and reviewed the DH programmes of eleven specialised centres, which have some shared features but also many differences, suggesting that DH treatments are still largely experimental. Briefly, the shared elements are: biopsychosocial model as reference frame; cognitive-behavioural model or techniques; behavioural contract; patients' selection; body image therapy; involvement of family; weight normalisation/weight gain and modification/normalisation of eating behaviour as objectives. Nonetheless, shared opinions concerning inclusion criteria are lacking; the duration of DH treatment is surprisingly different among centres (from 3 to 39 weeks); the approach to eating and compensation behaviours ranges from control to autonomy; followup and psychometric assessment can be either performed or not; psychological and behavioural objectives can be different. This review suggests the existence of two different DH models: the first has a shorter duration and is mainly symptom-focused; the second is more individual-focused, has a longer duration and is focused on patients' relational skills, psychodynamic understanding of symptoms and more gradual changes in body weight. Further investigation is required to make DH treatment programmes measurable and comparable.

Impact of process reengineering on technical efficiency of the health care provider

“…Consequently, medical staff could also spend less time monitoring the patients. The same conclusions have been made in several other studies (28)(29)(30)(31)(32)(33). This way, patients would not be required to needlessly wait for the morning rounds and their discharge.…”

“…The patient would thus avoid unnecessary waiting for the surgical block to become available, because the operation room of the day hospital would be intended only for patients who are scheduled for surgeries in a day hospital. Such a regime of the activities within this process is also proposed by other authors (32,33). In addition, patients would spend significantly less time in the hospital, as they would be discharged on the same day and would thus avoid being hospitalized overnight.…”

“…In addition, the majority of activities would be carried out in a newly-established department of a day hospital, which would be kept spatially separated from the surgical department. The usefulness of such a regime has been noted in almost all research in the field of day care (28)(29)(30)(31)(32)(33). In the renovated process laboratory and anesthesia departments would be excluded, compared to the existing process.…”

Trajectories of Eating and Clinical Symptoms Over the Course of a Day Hospital Program for Eating Disorders

“…Over the last 20 years, several DHPs for patients struggling with EDs have been described and evaluated worldwide (Abbate-Daga et al, 2009;Gerlinghoff, Bakmund, & Franzen, 1998;Gerlinghoff, Backmund, Franzen, Gorzewski, & Fenzel, 1997;Lammers, Exterkate, & De Jong, 2007;Piran, Langdon, Kaplan, & Garfinkel, 1989;Williamson & Duchmann, 1998;Zeeck, Herzog, & Hartmann, 2004). The most recent review identified 13 DHPs from various countries described in the literature (Canada, Germany, USA, United Kingdom, The Netherlands, South Korea, and Australia; Abbate-Daga et al, 2009). However, it is likely that DHPs are common in local clinical settings, especially in major cities and densely populated areas, even if they are not described in the literature.…”

Experience of an eating disorders out-patient program in an internal medicine hospital

“…Community-based facilities might prevent the adverse effects frequently associated with hospitalizations, particularly in these patients [10,11].…”