The development of an ICP for adults with an eating disorder in rural Scotland. Dr Shiona Macdonald Consultant Psychiatrist Scotland

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1 The development of an ICP for adults with an eating disorder in rural Scotland Dr Shiona Macdonald Consultant Psychiatrist Scotland

2 Talk Background info Set the scene Developing the ICP Outcomes

3 Background Eating Disorders Severe and complex mental illness Severe disturbances in eating behavior Driven by over-evaluation of the benefits of being thin Causes harm to physical health Anorexia Nervosa (AN), Bulimia Nervosa (BN), EDNOS

4 Background Anorexic thinking Anorexic voice Fear of fatness Strong dissatisfaction with body Pre-occupation with food, weight, shape Salience of shape and weight

5 Background Epidemiology Incidence of AN is 8 per 100,000 50% of new cases present in under 19s Prognosis for AN 30% remain unwell, 30% switch to BN, 30% recover, 10% die Average length of treatment 7 years!

6 Background Dumfries and Galloway

7 Dumfries and Galloway

8 Pre- 2007: Setting the scene No specialist ED service one dietitian Treated by sector CMHT - variable Inpatient treatment in Glasgow patients dislocated from home Costing HB 106,000/year ED Strategy developed

9 ED Strategy Two main developments: Set up a day hospital based intensive service Develop an Integrated Care Pathway Started in Spring 2007

10 ICP Why? EDs are relatively rare Multiple risk issues High mortality rate Treatment requires good M/D working

11 How did we develop ICP? Started from scratch Small working group plus reference group Reviewed other ICPs Worked from May September 2007 Acknowledgement from beginning that it was part of something bigger

12 What did service look like? Based in an existing day hospital - Dumfries Three new posts 0.3 Consultant Psychiatrist, 0.2 Consultant Psychologist, 0.6 Dietitian 5 day/week treatment Meal support, medical monitoring, mental health monitoring, nutritional rehab, carer support, social and occupational rehab

13 ICP for Intensive ED service Criteria for referral Referral process Assessment process Risk assessment Treatment plan Criteria for discharge Standard was set MDT review every 8/52

14 Then Worked on the rest of ICP GP pathway, CMHT pathways, Inpatient psychiatric and medical Traffic light system Medically orientated 133 page document Finished in 2009

15 Objectives of ICP Improve access to specialist ED services locally to make it more equitable Improve choice of options available Improve outcomes locally Reduce reliance on ECRs

16 Outcomes - satisfaction Patient satisfaction study after 1 year Questionnaire to 8 patients, 3 Carers and 18 staff Overall satisfaction scale 1-5 Patients 4.3, Carers 4.0, Staff 4.7 really helped a desperate patient we have been waiting years for such a comprehensive service

17 Outcomes - general Four year outcome audit in 2011 Retrospective data collection on 23 attendances (3 patients attended twice) 12 had AN, 9 BN Main outcome measures BMI, EAT score, I/P bed days, ECR spend

18 Outcomes BMI in AN BMI/Duration of illness Pre-treatment < 10 years > 10years Post-treatment

19 Outcomes EAT in AN EAT score/duration of illness Pre-treatment < 10 years > 10 years Post-treatment

20 Outcomes Impact on I/P services ECR spend (average) Local I/P bed days Local average length of stay ,000 zero 749 bed days 653 bed days 152 days 41 days

21 Outcomes - Standard Eight weekly MDT review held at day hospital Met in 100% of cases

22 Outcomes - Equity Patients attended from all areas across the region Better outcomes were also distributed across the region

23 Conclusions Achieved our objectives to provide more choice, to develop specialist services, to ensure equity and to eliminate reliance on ECRs

24 My own conclusions on ICP Lucky timing Too prescriptive in parts Increased confidence of staff Became the focus for disseminating information and training A work in progress

25

26 European Care Pathways conference Supporting safe, effective, person centred care, through the use of care pathways Grand Central Hotel, Glasgow 20 th and 21 st June 2013 Follow the conference on twitter at #ecpc13

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