3 Implementation of Family-based Treatment Principles in the Primary Care Management of Paediatric Anorexia Nervosa
Authors: Ramini Mehrieh , Leitner Maya , Agostino Holly 
Published: September 2023

Abstract

Background
Anorexia nervosa (AN) is a complex illness frequently beginning in adolescence and often associated with significant medical complications. In Canada, youth with AN typically first present to a primary care provider. Currently, the standard of care for paediatric restrictive eating disorders is Family Based Treatment (FBT). However, access to this modality remains limited. Numerous principles of FBT, including behavioural approaches to treatment, could be applied in a community setting. However, little is known regarding the awareness and uptake of FBT principles by primary care providers.

Objectives
To identify the extent to which FBT principles are understood and implemented by community providers (family physicians and community paediatricians) in treating paediatric patients with anorexia nervosa.

Design/Methods
We undertook a cross-sectional survey among family physicians and community paediatricians from 5 paediatric, urban, community clinics in Montreal, Quebec. Participants completed a standardized, self-administered electronic questionnaire to characterize their knowledge and degree of implementation of FBT principles in the treatment of adolescent AN. All practicing physicians who evaluated paediatric patients (age 5-18 years) were recruited to participate. Physicians were excluded if they self-reported spending less than 50% of their clinical practice in community care or were not involved in the assessment of eating disorder patients. Chi-square testing was used to compare frequency data between family physicians and community paediatricians.

Results
Survey response rate was 65% (n=36/55; 16/20 family physicians and 16/32 paediatricians, 4/55 other). Half of respondents had been in practice for over 10 years. Overall, 56% of respondents reported referring all their paediatric AN patients to tertiary services. Less than half of respondents (31.3%) reported following these patients weekly or biweekly once a referral was sent. Frequency of follow up did not vary for paediatricians and family physicians (37.5% vs. 25% p=0.45). Across both groups, 50% reported good knowledge of FBT principles, yet 47% reported using or expecting a nutritionist to use strict meal plans during treatment. There was no significant difference between family physicians and paediatricians in their reported awareness of FBT principles (43.8% vs. 56.3% p=0.48), and knowledge of behavioural management techniques in the treatment of paediatric AN (31.3% vs. 37.5% p=0.71). Overall, only a small percentage felt comfortable in applying FBT principles in the community (12.5% of family physicians vs. 6.3% of paediatricians, p=0.54) and 63% felt unaware of existing resources to assist physicians in implementing the tenets of FBT in a community practice.

Conclusion
Survey results suggest poor awareness and implementation of FBT principles in the community medical management of adolescent AN. FBT-specific education likely represents an important intervention to optimize physician comfort and improve the early delivery of appropriate care for adolescents with eating disorders.