Mind the Gap! An examination of the interface between primary and secondary healthcare for eating disorders

Overarching Aim:

To examine the primary and secondary care interface for the treatment of eating disorders in Wales through the lens of Prudent Healthcare, in order to provide policy and practice recommendations for improvement of existing services.

Subsidiary Aims

1. To examine the primary and secondary care interface for the treatment of eating disorders through the accounts of people with eating disorders, carers, primary healthcare and secondary healthcare professionals;

2. To examine the primary and secondary care interface for the treatment of eating disorders through analysis of routine clinical care records using retrospective cohort and multivariate generalised linear mixed model analytical methods;

3. To explore the feasibility of estimating from routine clinical data the excess cost to the healthcare system in Wales at primary and secondary care due to eating disorders;

4. To provide policy and practice recommendations based on the findings to improve the patient and carer experience and efficiency of the primary and secondary care interface for eating disorders.

Research hypotheses:

A. That people with eating disorders, their carers, primary healthcare and secondary healthcare practitioners have differing perspectives of the primary and secondary care interface for eating disorders;

B. That these categories of people will provide some accounts of difficulties but also good practice at the interface;

C. That routine clinical data will identify significant differences in GP contacts and investigations in the 5 years prior to first diagnosis of an eating disorder (using a retrospective cohort analysis);

D. That routine clinical data will identify significant differences in psychiatric and physical status between people diagnosed with eating disorders and controls (using multivariate generalised linear mixed model analysis);

E. That it will be methodologically feasible to estimate excess costs to the healthcare system related to eating disorders;

F. That there can be improvements in policy and practice, as well as examples of good policy and practice, with respect to the primary and secondary care interface for eating disorders.

Research objectives
Work package 1:

a. To obtain the different perspectives of people with eating disorders, their carers, primary healthcare and secondary healthcare practitioners of the primary and secondary care interface for eating disorders;

b. To integrate these different perspectives into a well-rounded account of the primary and secondary care interface for eating disorders;

Work package 2:

c. To identify and characterize any significant differences in general practice contacts and investigations in the 5 years prior to first diagnosis of an eating disorder for a period (using a retrospective cohort analysis);

d. To identify and characterize any significant differences in psychiatric and physical status between people diagnosed with eating disorders and controls (using multivariate generalised linear mixed model analysis);

e. To explore methods to estimate from routine clinical data the excess cost to the healthcare system in Wales at primary and secondary care due to eating disorders;

Work package 3:

f. To provide policy and practice recommendations based on the findings to improve the patient and carer experience and efficiency of the primary and secondary care interface for eating disorders;

g. To produce, in partnership with co-applicants who are users, carers, and third sector mental health charities, a public report detailing the issues being studied, the research and its findings in user-friendly and accessible terms;

h. To produce a digital story which will encapsulate the issues being studied, the research and its findings in a user-friendly and accessible format and engage the public;

i. To give presentations at conferences and publish in academic journals.