背景:门诊家庭式治疗(FBT)可有效治疗青少年限制性进食障碍。然而,对于FBT是否会降低更高水平的护理(HLOC)利用率,或者HLOC的利用率是否与患者特征相关,人们知之甚少.这项研究调查了在大型综合卫生系统中,饮食失调相关护理(HLOC和门诊治疗)的利用与FBT的依从性和患者特征之间的关系。
方法:这项回顾性队列研究调查了在北加州KaiserPermanente接受限制性饮食失调治疗的4101名青少年。向每个医疗中心发送了一项调查,以确定治疗团队为高FBT依从性(hFBT)和低FBT依从性(lFBT)。门诊医疗和精神病学的遭遇和HLOC,我们从EHR中提取患者特征,包括内科住院和更高级别的精神病治疗,并在指数后12个月内进行检查.
结果:2111和1990青少年在hFBT和lFBT治疗,分别。在调整了年龄之后,性别,种族/民族,初始百分比中位数BMI,和精神健康诊断合并症,hFBT和lFBT之间的HLOC或门诊使用没有差异。与男性相比,女性有更高的利用几率。与白人青少年相比,拉丁美洲人/西班牙裔人使用HLOC的几率较低。亚洲人,黑色,与白人相比,拉丁裔/西班牙裔青少年接受精神病门诊治疗的几率较低.
结论:报告的FBT依从性与该样本的HLOC利用率无关。然而,在使用精神病治疗饮食失调方面,发现患者特征之间存在显着差异。需要更多的努力来了解所有饮食失调人群都可以获得和有效的治疗途径。
通过家庭治疗(FBT)团队进行限制性饮食治疗的青少年早期体重增加较好,但在使用强化门诊治疗方面没有差异,住宅,与坚持FBT方法的团队治疗相比,部分医院计划或住院精神病治疗。诸如性别等因素,种族,种族,情绪障碍,自杀与使用精神科服务有关。这些发现与先前记录的在患者人口统计学中获得精神科服务的系统差异一致,应用于为所有患者更具包容性和可访问性的拟议护理模式的发展提供信息。
BACKGROUND: Outpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system.
METHODS: This retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index.
RESULTS: 2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites.
CONCLUSIONS: Reported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders.
Adolescents with restrictive eating treated by Family-Based Treatment (FBT) teams had better early weight gain but no differences in the use of intensive outpatient, residential, partial hospital programs or inpatient psychiatry care when compared to those treated by teams with a low adherence to the FBT approach. Factors such as sex, race, ethnicity, mood disorders, and suicidality were associated with the use of psychiatric services. These findings are consistent with previously documented systematic disparities in accessing psychiatric services across patient demographics and should be used to inform the development of proposed care models that are more inclusive and accessible to all patients.