Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

Abstract

Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives

“…Cachelin & Striegel-Moore, 2006;Cachelin et al, 2001;Cavazos-Rehg et al, 2020;Chowbey et al, 2012;Ciao et al, 2020;Coelho et al, 2021;Couturier et al, 2013;Dayal et al, 2015;Dearden & Mulgrew, 2013;Del Valle et al, 2017;Elran-Barak et al, 2018;Escobar-Koch et al, 2010;Evans et al, 2011;Fitzsimmons-Craft, Balantekin, et al, 2020;Fitzsimmons-Craft, Eichen, et al, 2020;Fitzsimmons-Craft, Krauss, et al, 2020;Forrest et al, 2017;Goodwin & Fitzgibbon, 2002;Gorse et al, 2013;Grammer et al, 2022;Griffiths et al, 2015;Griffiths et al, 2018;Grillot & Keel, 2018;Gulliksen et al, 2015;Hamilton et al, 2022;Hartman-Munick et al, 2021;Hepworth & Paxton, 2007;Herman et al, 2014;Javier & Belgrave, 2019;Kanakam, 2021;Kästner et al, 2021;Lazare et al, 2021;Leavey et al, 2011;Lebow et al, 2021;Linardon, Shatte, et al, 2020;Linardon, Rosato, et al, 2020;Linardon et al, 2021;Lipson et al, 2017;…”

Evaluation of a one‐hour asynchronous video training for eating disorder screening and referral in U.S. Pediatric Primary Care: A pilot study

“…We also identified significant improvements in participating PCPs' comfort screening and making referrals for each of AN, BN, BED, ARFID, and OSFED in pediatric patients. Previous studies have demonstrated that physicians have generally low levels of comfort in diagnosing or treating EDs (Anderson et al, 2017; Davidson et al, 2019) but are open to referring patients to other services and working in multidisciplinary teams with ED specialists (Davidson et al, 2019; Lebow et al, 2021). Exposure to the present study's brief video training bolstered PCPs’ comfort in screening and referral for all EDs, which emphasizes that even minimal training can produce change.…”

“…Low rates of screening and referral may result in youth with EDs being underdiagnosed into late adolescence and young adulthood (Hornberger & Lane, 2021; Kalindjian et al, 2022). Pediatric primary care providers (PCPs) can play an important role in early detection of symptoms and referral to specialized treatment (Currin et al, 2009; Hornberger & Lane, 2021); however, many PCPs lack training in screening and are unaware of existing referral resources (Banas et al, 2013; Currin et al, 2009; Higgins & Cahn, 2018; Lebow et al, 2021). This gap in training is especially concerning given the rise in youth seeking services for EDs during the COVID‐19 pandemic (Lin et al, 2021; Radhakrishnan et al, 2022).…”

A framework for conceptualising early intervention for eating disorders

“…Specialised ED services, when available, are often concentrated in intensive settings in major urban cities, leading to limited treatment spaces and long waitlists. Youth in Canada with mild or early‐stage EDs, and those living outside major cities, often lack access to specialised care (Lebow et al., 2021 ) and any possibility for early detection and intervention. One solution being considered is the spreading of ED services into the community via primary mental health care settings.…”