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Monitoring the quality of care for patients with eating disorders in North-Portugal

Monitoring the quality of care for patients with eating disorders in North-Portugal. P.P.Machado (U. Minho) B. C. Machado (U. Minho) I. Soares (U. Minho) I. Brandão (H.S.J.) A. Roma-Torres (H.S.J.). Introduction.

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Monitoring the quality of care for patients with eating disorders in North-Portugal

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  1. Monitoring the quality of care for patients with eating disorders in North-Portugal P.P.Machado (U. Minho) B. C. Machado (U. Minho) I. Soares (U. Minho) I. Brandão (H.S.J.) A. Roma-Torres (H.S.J.)

  2. Introduction • The current project is a development of the previous collaboration between the Psychotherapy Research Group and the St. John’s Hospital in Porto under the COST B6 ACTION - the effectiveness of psychotherapy in the treatment of eating disorders - funded by the European Community. • After the COST collaborative experience the site showed interest in continued collaboration with our research center and desire to monitor their treatment services

  3. In September 2001 we started monitoring all incoming patients to the eating disorder unit, using the AKQUASI protocol • Up to now we screened 89 female patients diagnosed with eating disorders (DSM IV) who initiated treatment • 57 diagnosed with anorexia nervosa • 26 diagnosed with bulimia nervosa • 6 EDNOS

  4. Instruments • Eating Disorders Inventory - EDI (Garner, 1984) • Symptom checklist (SCL-90R, Derrogatis) • Brief monthly evaluations (COST-B6, 1994) • Screening Sheet (COST-B6, 1994) • (IIP – Inventory of Interpersonal problems) • (OQ-45)

  5. Specific characteristics of the clinical site • Mostly an out-patient unit, although some patients have short-term inpatient treatment (emergencies) • During the COST project we lost a substantial amount of data at end-of-treatment, because the site tends to treat patients long and doesn’t define end-of-treatment status • A substantial number of “drop-outs” could be successfully treated patients

  6. Possible solutions • We evaluate patients at beginning of treatment, 6 months after BOT, 1 year after BOT, at End-of-treatment when possible, and follow-up my mail/phone (very successful strategy under COST project) • Additionally we monitor core Eating Disorder symptoms monthly

  7. Design Intake 6 month 1 year End / FU • SCL-90 • EDI • (IIP) • (OQ-45) • Therapeutic Alliance * • Satisfaction w/ treatment • SCL-90 • EDI • (IIP) • (OQ-45) • Therapeutic Alliance • Satisfaction w/ treatment • SCL-90 • EDI • (IIP) • (OQ-45) • Satisfaction w/ treatment • SCL-90 • EDI • (IIP) • (OQ-45) • Demographics • Diagnosis Monthly short evaluations until end-of-treatment or last contact *Early therapeutic alliance is also evaluated with the 1 month short evaluation

  8. Data analysis Intake 6 month 1 year End FU Intake 6 month 1 year End FU Intake 6 month 1 year End FU

  9. EDI scores at intake

  10. EDI scores at 6 months

  11. Pre to 6-month change

  12. Pre to 6-month change

  13. SCL-90-RGSI scores

  14. Body Mass Index (BMI) at intake

  15. Short Evaluation Severity Scores for AN+BN symptoms • 0 = symptom not present, • 1 = symptom is mild, • 2 = symptom meets criteria for diagnosis, • 3 = symptom is extreme

  16. AN severity score • AN-Symptoms :Rating: • degree of underweight 0 2 4 6 • fear of gaining weight 0 1 2 3 • distortion of body perception 0 1 2 3 --------------- • Severity score 4+1+1 = 6 / 3 = 2

  17. BN severity score • BN-Symptoms :Rating: • amount of binge eating 0 2 4 6 • amount of compensatory behavior 0 1 2 3 • over concern with body shape/weight 0 1 2 3 --------------- • Severity Score 0+1+2 = 3 / 3 = 1  

  18. Frequency AN Severity Score by time wave

  19. Frequency BN Severity Score by time wave

  20. Discussion • The strategy of implementing intermediate (every 6 month) evaluations seems to generate useful data. The frequency of these evaluations was negotiated with the clinical staff, and reflect usual points of end of treatment • Evaluated patients present much higher scores on EDI’s sub-scales than the Portuguese normal female sample. Bulimic patients score higher than anorectic patients on all subscales, this pattern was already identified in the COST data

  21. Discussion • Bulimic patients scored highest on the SCL90R as well • It is possible that some patients are misdiagnosed (corroborates some COST data) • Short evaluations seem to be an easy and economic tool to track patient change and hopefully will allow us to identify patterns of symptomatic change

  22. Discussion • In the future, and based on ongoing data collection will try to identify rules to help deciding when to end treatment, and when to continue it. • And, try to identify patients at a high risk of not responding to treatment as usual. • Test the effects of feeding the information back to therapists and patients • Particularly interested in studying patterns of symptomatic change

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