Turning eating disorders screening in primary practice into treatment: A clinical practice approach

Abstract

Objective: The rate of screening for eating disorders (EDs) by general practitioners (GPs) in primary health care is low. We examined an approach to increase screening and the impact on referrals.Method: Low cost assessment/treatment pathways were established in February 2019 for patients with an ED. Between October 2020 and June 2021 information was sent to GP practices about screening for EDs, along with provision of an online screening tool and training.Results: Of the 44 GP practices invited to participate in the screening initiative, 42 (95.5%) agreed. Only 12 (27%) had referred patients before the initiative, 53 patients over 19 months (2.8/month). Over the 10-month initiative 90 patients were referred and started treatment from 50% of the practices (8.2/month); 73 (81%) had an ED and six had disordered eating but not an ED. Qualitative feedback from GPs suggested they would not screen for a condition if there were no readily identifiable treatment pathway available.Discussion: Results suggest that the three elements of the initiative (provision of assessment and treatment pathways, access to a screening tool, provision of information on screening) increased the likelihood that GPs would use a screening tool, leading to an almost three-fold increase in referrals.Public Significance: An initiative used to translate screening for an eating disorder to treatment in primary health care had three components. First, provision of an easy referral process to assessment as well as treatment. Second, screening tools were made available on computer desktops. Third, information and training provided to GPs was used to support their clinical observation and increase confidence in initiating screening. Adoption of this initiative almost tripled referrals for assessment.

Toward a more comprehensive understanding and support of parents with a child experiencing an eating disorder

“…This is a current focus of the National Eating Disorder Collaboration (NEDC) in Australia who have developed an online training program for GPs. Evidence suggests that providing GPs with training and pragmatic tools (e.g., screening tools, referral pathways) can lead to a three‐fold increase of referrals to specialist care (Wade, Johnson, et al, 2022). While ideally all GPs should be skilled in this area, an appealing concept is to have a credentialing system where families can easily identify GPs who have completed training (e.g., a database).…”

40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling

“…It should be noted, however, that in clinical practice settings the use of instruments for the diagnosis and the different phases of the treatment process is not necessarily widespread [ 89 , 90 ]. To reduce this gap, some authors suggest to provide assessment training and/or assessment guidelines for mental health professionals and general practitioners in primary health care [ 91 , 92 ]. This can help obtain a comprehensive clinical assessment, particularly of individuals with higher risk such as young adolescents with restrictive Anorexia Nervosa [ 93 ].…”

Beyond screening in primary practice settings: Time to stop fiddling while Rome is burning

“…Even once the conversation about eating is conducted, general practitioners may still lack confidence to diagnose an eating disorder or may perceive that there are limited options for treatment available, and therefore not refer on to treatment (Wade, Johnson, Cadman & Cook, 2022, submitted). Alternatively, a referral for treatment may not be followed up by the patient, given the many barriers to treatment seeking noted in this population (Ali et al, 2017; Fitzsimmons‐Craft et al, 2020).…”

“…Care navigation support was provided by a coordinator with a nursing background who liaised between primary medical care and treatment providers. When online access to a screening tool (the SDE) and provision of information on screening was delivered to general practitioners, it increased the likelihood that general practitioners would use a screening tool for a suspected case, leading to an almost three‐fold increase in referrals to treatment providers (Wade et al, submitted). While an increase of referrals was only observed after provision of the screening access and training, qualitative feedback from general practitioners made it clear that they would not have referred if clear assessment and treatment pathways had not been available.…”