Janvier 2018
Summary
Title : ED-GP : General Practitioners management of patients with eating disorders in a primary care setting.
Keywords : Eating disorders, General Practice, Primary Care, screening, depression, temporality.
Background : People suffering from eating disorders (ED) may have a better prognosis if they benefit from an early management for their disease. GPs are often quoted in international guidelines as the main actors of screening and early management of ED patients. Prevalence studies in a primary care setting however find few ED patients and sometimes none. No study in GP has been done in France. Depressive disorders are often related as a comorbidity of ED.
Aim: to study the GP role of ED patients management. 1) To evaluate the efficacy of systematic screening of ED patients conducted by GPs on prognosis and recovery. 2) To describe the characteristics of ED patients followed by their GPs and study the temporality between depression management and ED management. 3) To describe GPs and patients' views of the role of GPs management of ED patients.
Methods 1)Systematic review according to PRISMA statement 2)Cohort study in a French GP setting of ED patients with analysis of different follow up groups comparing ED patients with depression to ED patients without depression. 3)Qualitative study of ED patients comparing GPs and patients' views selected in the cohort study, with a grounded theory approach and a phenomenological approach, double coding of semi directive interviews.
Results : the systematic review found no evidence of efficacy of systematic screening of ED patients by GPs. The literature is too heterogeneous and contains mainly opinion papers in primary care. 1310 patients (out of 350,000) had at least one consultation for ED by GPs in the French database between 1994 and 2007. 80 % were women, mean age of 35.19 years. Only 39 % benefited from a follow up for ED. 67.1 % were taken in charge for the first time. 32.3 % of ED patients had at least one consultation for depression, 62.41 % for the first time. ED patients with depression were older, followed longer for ED then the others. One fifth of patients had at least one prescription of antidepressants during their follow up period, half of them had anxiolytics. Depression management did not precede ED management. In the qualitative study, 24 GPs and 8 patients described the management as difficult and long. The key to a good management depended on trust, with a patient willing to talk about her disease; overcoming shame and denial, and a GP ready to listen, overcoming his helplessness feeling.
Discussion : it was the first study about this subject in France, using complementary methods. Management points are to be defined in primary care. Depression and ED are cofactors and should be managed in a global approach. This approach will have to take into account signs found in those two syndroms: low self esteem, negative body image, abuse background, pscyhiatric diseases in family (depression and ED) in first degree relatives.
Keywords : Eating disorders, General Practice, Primary Care, screening, depression, temporality.
Background : People suffering from eating disorders (ED) may have a better prognosis if they benefit from an early management for their disease. GPs are often quoted in international guidelines as the main actors of screening and early management of ED patients. Prevalence studies in a primary care setting however find few ED patients and sometimes none. No study in GP has been done in France. Depressive disorders are often related as a comorbidity of ED.
Aim: to study the GP role of ED patients management. 1) To evaluate the efficacy of systematic screening of ED patients conducted by GPs on prognosis and recovery. 2) To describe the characteristics of ED patients followed by their GPs and study the temporality between depression management and ED management. 3) To describe GPs and patients' views of the role of GPs management of ED patients.
Methods 1)Systematic review according to PRISMA statement 2)Cohort study in a French GP setting of ED patients with analysis of different follow up groups comparing ED patients with depression to ED patients without depression. 3)Qualitative study of ED patients comparing GPs and patients' views selected in the cohort study, with a grounded theory approach and a phenomenological approach, double coding of semi directive interviews.
Results : the systematic review found no evidence of efficacy of systematic screening of ED patients by GPs. The literature is too heterogeneous and contains mainly opinion papers in primary care. 1310 patients (out of 350,000) had at least one consultation for ED by GPs in the French database between 1994 and 2007. 80 % were women, mean age of 35.19 years. Only 39 % benefited from a follow up for ED. 67.1 % were taken in charge for the first time. 32.3 % of ED patients had at least one consultation for depression, 62.41 % for the first time. ED patients with depression were older, followed longer for ED then the others. One fifth of patients had at least one prescription of antidepressants during their follow up period, half of them had anxiolytics. Depression management did not precede ED management. In the qualitative study, 24 GPs and 8 patients described the management as difficult and long. The key to a good management depended on trust, with a patient willing to talk about her disease; overcoming shame and denial, and a GP ready to listen, overcoming his helplessness feeling.
Discussion : it was the first study about this subject in France, using complementary methods. Management points are to be defined in primary care. Depression and ED are cofactors and should be managed in a global approach. This approach will have to take into account signs found in those two syndroms: low self esteem, negative body image, abuse background, pscyhiatric diseases in family (depression and ED) in first degree relatives.
Conclusion
L’efficacité du dépistage des patients atteints de TCA par les MG en SP est à ce jour inconnue. Dans les études observationnelles, il y avait une augmentation quel que soit le type de TCA de la fréquence de consultations, du recours aux soins spécialisés et de prescription d’antidépresseurs. Une étude a répondu en partie à notre objectif. Elle retrouvait une guérison des patients atteints d’AM dans 57 % des cas et de BN dans 61 % des cas après 4,8 ans de suivi moyen. Un âge inférieur à 19 ans de détection du trouble était prédictif d’une guérison plus fréquente et plus rapide. Les patients atteints de BN semblaient guérir plus rapidement que les patients atteints d’AM.
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