Abstract：
BACKGROUND: Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. Given the significant disease burden associated with EDs, it is imperative that current implementation research is summarised to identify gaps in care and enable refinement for optimal patient outcomes. This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems.
METHODS: This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs.
RESULTS: Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services.
CONCLUSIONS: Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter \'hospitalisations\' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia\'s National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed.
METHODS: This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs.
RESULTS: Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services.
CONCLUSIONS: Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter \'hospitalisations\' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia\'s National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed.
摘要：
背景：诊断延迟，服务的差距以及随后的专科护理和治疗延误导致饮食失调（ED）患者的健康状况较差，并推动政府的重大医疗支出。鉴于与ED相关的重大疾病负担，必须总结当前的实施研究，以确定护理方面的差距，并优化患者预后。这篇综述旨在提供有关已开发医疗保健系统中ED护理模型的最新综合。
方法：本文是一系列快速评论（RRs）的一部分，该系列将在《饮食失调杂志》上发表。提供当前和严格的审查，在2009年至2021年之间，在三个数据库中以英语发表的同行评审文章(ScienceDirect，PubMed和Ovid/Medline)进行了搜索，优先考虑更高级别的证据(例如，荟萃分析，大型人口研究，随机对照试验（RCT））。当前的评论综合了来自调查ED患者护理模型的研究的数据。
结果：确定了63项研究（原始RR的4.5％），其中包括几个诊断人群，最常见的是神经性厌食症(AN)(30.51%)。在整个ED中，发现专科护理可以改善患者的预后，许多患者在门诊或日间项目中得到了多学科团队的有效治疗，无需长期住院。很少有研究调查不同ED服务的相互作用(例如，住院,社区服务,初级保健)，然而，阶梯式护理模式作为一种有前景的方法出现了，可以有针对性和具有成本效益的方式整合ED服务。围绕低治疗摄取的问题，诊断不足,在所有服务中，漫长的等候名单和有限的病床也很明显。
结论：研究结果表明，需要进一步研究替代传统住院护理的方法，部分和较短的“住院治疗”成为有希望的途径。此外,为了解决持续的资源问题，并确保及时发现和治疗ED，进一步研究新的替代品，例如需要积极的候诊名单或初级保健临床医生发挥更大的作用.本文是为指导澳大利亚2021-2031年国家饮食失调研究和翻译战略而开展的大型快速审查系列的一部分。快速审查旨在在短时间内彻底总结研究领域，通常是为了帮助这方面的政策制定。这份快速审查总结了有关我们如何照顾西方医疗保健系统中饮食失调的人的证据。承保的主题包括住院/医院照护,寄宿护理,dayprograms,门诊/社区护理，和转诊途径。研究结果表明，专家饮食失调服务可能会增强检测，转介,和病人护理。步进护理模式是一种具有成本效益的方法，可能有助于将不同的饮食失调服务联系起来。有一种趋势是缩短住院时间和方法，可以与社区建立更大的联系，比如日间节目。还发现了治疗延误的证据，由于系统问题(漫长的等待名单，缺乏准确的评估和诊断)和与患者相关的障碍(污名，recognition).作为阶梯式护理模式的一部分，提高技能并让初级保健临床医生参与诊断和转诊可能有助于解决其中一些问题。需要进一步努力提高心理健康素养和消除对饮食失调的污名化帮助。
方法：本文是一系列快速评论（RRs）的一部分，该系列将在《饮食失调杂志》上发表。提供当前和严格的审查，在2009年至2021年之间，在三个数据库中以英语发表的同行评审文章(ScienceDirect，PubMed和Ovid/Medline)进行了搜索，优先考虑更高级别的证据(例如，荟萃分析，大型人口研究，随机对照试验（RCT））。当前的评论综合了来自调查ED患者护理模型的研究的数据。
结果：确定了63项研究（原始RR的4.5％），其中包括几个诊断人群，最常见的是神经性厌食症(AN)(30.51%)。在整个ED中，发现专科护理可以改善患者的预后，许多患者在门诊或日间项目中得到了多学科团队的有效治疗，无需长期住院。很少有研究调查不同ED服务的相互作用(例如，住院,社区服务,初级保健)，然而，阶梯式护理模式作为一种有前景的方法出现了，可以有针对性和具有成本效益的方式整合ED服务。围绕低治疗摄取的问题，诊断不足,在所有服务中，漫长的等候名单和有限的病床也很明显。
结论：研究结果表明，需要进一步研究替代传统住院护理的方法，部分和较短的“住院治疗”成为有希望的途径。此外,为了解决持续的资源问题，并确保及时发现和治疗ED，进一步研究新的替代品，例如需要积极的候诊名单或初级保健临床医生发挥更大的作用.本文是为指导澳大利亚2021-2031年国家饮食失调研究和翻译战略而开展的大型快速审查系列的一部分。快速审查旨在在短时间内彻底总结研究领域，通常是为了帮助这方面的政策制定。这份快速审查总结了有关我们如何照顾西方医疗保健系统中饮食失调的人的证据。承保的主题包括住院/医院照护,寄宿护理,dayprograms,门诊/社区护理，和转诊途径。研究结果表明，专家饮食失调服务可能会增强检测，转介,和病人护理。步进护理模式是一种具有成本效益的方法，可能有助于将不同的饮食失调服务联系起来。有一种趋势是缩短住院时间和方法，可以与社区建立更大的联系，比如日间节目。还发现了治疗延误的证据，由于系统问题(漫长的等待名单，缺乏准确的评估和诊断)和与患者相关的障碍(污名，recognition).作为阶梯式护理模式的一部分，提高技能并让初级保健临床医生参与诊断和转诊可能有助于解决其中一些问题。需要进一步努力提高心理健康素养和消除对饮食失调的污名化帮助。
