3 Implementation of Family-based Treatment Principles in the Primary Care Management of Paediatric Anorexia Nervosa
Notice bibliographique
Résumé
Abstract Background Anorexia nervosa (AN) is a complex illness frequently beginning in adolescence and often associated with significant medical complications. In Canada, youth with AN typically first present to a primary care provider. Currently, the standard of care for paediatric restrictive eating disorders is Family Based Treatment (FBT). However, access to this modality remains limited. Numerous principles of FBT, including behavioural approaches to treatment, could be applied in a community setting. However, little is known regarding the awareness and uptake of FBT principles by primary care providers. Objectives To identify the extent to which FBT principles are understood and implemented by community providers (family physicians and community paediatricians) in treating paediatric patients with anorexia nervosa. Design/Methods We undertook a cross-sectional survey among family physicians and community paediatricians from 5 paediatric, urban, community clinics in Montreal, Quebec. Participants completed a standardized, self-administered electronic questionnaire to characterize their knowledge and degree of implementation of FBT principles in the treatment of adolescent AN. All practicing physicians who evaluated paediatric patients (age 5-18 years) were recruited to participate. Physicians were excluded if they self-reported spending less than 50% of their clinical practice in community care or were not involved in the assessment of eating disorder patients. Chi-square testing was used to compare frequency data between family physicians and community paediatricians. Results Survey response rate was 65% (n=36/55; 16/20 family physicians and 16/32 paediatricians, 4/55 other). Half of respondents had been in practice for over 10 years. Overall, 56% of respondents reported referring all their paediatric AN patients to tertiary services. Less than half of respondents (31.3%) reported following these patients weekly or biweekly once a referral was sent. Frequency of follow up did not vary for paediatricians and family physicians (37.5% vs. 25% p=0.45). Across both groups, 50% reported good knowledge of FBT principles, yet 47% reported using or expecting a nutritionist to use strict meal plans during treatment. There was no significant difference between family physicians and paediatricians in their reported awareness of FBT principles (43.8% vs. 56.3% p=0.48), and knowledge of behavioural management techniques in the treatment of paediatric AN (31.3% vs. 37.5% p=0.71). Overall, only a small percentage felt comfortable in applying FBT principles in the community (12.5% of family physicians vs. 6.3% of paediatricians, p=0.54) and 63% felt unaware of existing resources to assist physicians in implementing the tenets of FBT in a community practice. Conclusion Survey results suggest poor awareness and implementation of FBT principles in the community medical management of adolescent AN. FBT-specific education likely represents an important intervention to optimize physician comfort and improve the early delivery of appropriate care for adolescents with eating disorders.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».