3 Implementation of Family-based Treatment Principles in the Primary Care Management of Paediatric Anorexia Nervosa
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".