Eating Disorders: Identification and Management in General Medical and Psychiatric Settings

OBJECTIVE Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.

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Telemedicine in Cancer Care

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_200141 ◽

2018 ◽

pp. 540-545 ◽

Cited By ~ 64

Author(s):

S. Joseph Sirintrapun ◽

Ana Maria Lopez

Keyword(s):

Health Care ◽

Access To Care ◽

Cancer Care ◽

Symptom Management ◽

Lifestyle Modification ◽

Clinical Settings ◽

Home Based ◽

Home Based Care ◽

Care Costs ◽

Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

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The health service use and cost of eating disorders

Psychological Medicine ◽

10.1017/s0033291705004708 ◽

2005 ◽

Vol 35 (11) ◽

pp. 1543-1551 ◽

Cited By ~ 88

Author(s):

JUDIT SIMON ◽

ULRIKE SCHMIDT ◽

STEPHEN PILLING

Keyword(s):

Health Care ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Resource Use ◽

Service Use ◽

Health Care Cost ◽

Health Service Use ◽

The Uk ◽

Care Costs ◽

Cost Of Illness Studies

Background. The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders.Method. Relevant literature (1980–2002) was identified from searches of electronic databases and expert contacts.Results. Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be £4·2 million in 1990. In Germany, the health care cost was €65 million for anorexia nervosa and €10 million for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus$22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs.Conclusions. The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.

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Meal Supervision During Medical Hospitalization for Eating Disorders

Clinical Nursing Research ◽

10.1177/1054773816637598 ◽

2016 ◽

Vol 26 (4) ◽

pp. 525-537 ◽

Cited By ~ 2

Author(s):

Meredith Kells ◽

Pamela Schubert-Bob ◽

Katharine Nagle ◽

Louise Hitchko ◽

Kathleen O’Neil ◽

...

Keyword(s):

Health Care ◽

Eating Disorders ◽

Weight Gain ◽

Length Of Stay ◽

Chart Review ◽

Vital Signs ◽

Restrictive Eating ◽

Gain Length ◽

Care Costs ◽

Supportive Intervention

The focus of medical hospitalization for restrictive eating disorders is weight gain; however, no guidelines exist on how to achieve successful and safe weight gain. Meal supervision may be a supportive intervention to aid in meal completion and weight gain. The aim of this study was to examine the effect of standardized meal supervision on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders. A chart review compared patients who received meal supervision from admission through discharge to an earlier cohort who received meal supervision as needed. There were no differences in weight, electrolytes, or vital signs between the two cohorts. Length of stay for those who received meal supervision from admission was 3 days shorter than earlier cohort. Nursing supervised meals beginning at admission may shorten length of stay and decrease health care costs.

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Lowering Preventable Maternal Deaths in Rural Georgia

Journal of Science Policy & Governance ◽

10.38126/jspg170205 ◽

2020 ◽

Vol 17 (02) ◽

Author(s):

Gabrielle Delima ◽

Amanda Engstrom ◽

Emily Michels ◽

Jay Qiu

Keyword(s):

Health Care ◽

Rural Areas ◽

Routine Care ◽

Maternal Deaths ◽

Certified Nurse Midwives ◽

Individual Health ◽

Life Saving ◽

Nurse Midwives ◽

Care Costs ◽

The U.S

Georgia’s maternal mortality rate (MMR) is one of the highest in the U.S. and shows few signs of improvement, despite government intervention. Women living in rural areas are exposed to significantly higher risk than their urban counterparts and have reduced access to life-saving health care. 60% of Georgia’s maternal deaths are preventable, however the lack of available providers—especially in rural areas—makes it hard to address these avoidable issues. As such, we propose an amendment to the Georgia legal code that would allow Certified Nurse Midwives (CNM) to practice independently, removing unnecessary restrictions on the low-risk and routine care that they are trained to provide. This change could lower systemic and individual health care costs while allowing an existing workforce to augment preventive care efforts.

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