Extrait

Background and study aims Anorexia nervosa is a serious mental health problem that can last for many years and carries a high risk of death from malnutrition. It is harmful for those affected and can place a considerable burden on families. Anorexia nervosa can be an expensive condition to treat, often involving lengthy admissions to hospital, which additionally has a negative impact on school and social life. Hospital admissions are not always helpful and readmission to hospital after discharge is common. In contrast, those who respond well to outpatient family therapy have lower rates of readmission to hospital inpatient care. There are two main community-based services available for young people with anorexia nervosa. The first is standard care provided by general Child and Adolescent Mental Health Services (CAMHS). The second is specialist eating disorder care provided by dedicated, multi-disciplinary teams. There is some evidence that these specialist services are better at preventing hospital admissions and may be more acceptable to patients and their families than general CAMHS teams. Even so, specialist community services for young people with eating disorders are still rare in the British Isles and vary depending on geographical location. One of the reasons why specialist services are rare is that they would require additional financial investment. Given the current financial difficulties facing the National Health Service, specialist services for anorexia nervosa are unlikely to be funded without clear evidence that savings will be made from this investment, alongside evidence that these services will have a positive effect on the health of patients and the quality of life of both patients and their families. This study will help to provide this evidence. Our plan is to study the cost and the effectiveness of existing models of community services for young people with anorexia nervosa (either specialist or general CAMHS models of service). This will help us to determine whether increasing investment in specialist CAMHS services will be beneficial to patients and their families and will also be good value for money. Who can participate? We will include in the study any young person aged between 8 and 18 seen by a child and adolescent psychiatrist in a community-based CAMHS team and diagnosed with anorexia nervosa. What does the study involve? The study will collect information about all new cases of young people with anorexia nervosa across the British Isles over a 12-month period. We will use a survey system called the Child and Adolescent Psychiatric Surveillance System (CAPSS), which asks all child and adolescent psychiatrists to report new cases of particular mental health diagnoses. Based on this information, we will study the different types of community-based care provided to each young person who enters the study and determine whether they are specialist services or general CAMHS services. This will enable us to classify all the different models of care available to young people with anorexia nervosa in the British Isles. Nine months and 18 months later, we will contact each referring psychiatrist again in order to collect information on the services each young person received and the outcomes for young people, in terms of their health status. We will calculate the cost of the care provided and explore the cost-effectiveness of the different models of care (the benefits generated by each model of care in relation to the amount of money spent). We will then look at the impact on cost and cost-effectiveness of possible changes to the provision of specialist services in the British Isles. In other words, we will look at the effect of increasing the provision of specialist services on the cost of services for child and adolescent anorexia nervosa and the benefits for young people of increased access to these services. What are the possible benefits and risks of participating? This study will help improve our understanding of the models of care currently available to young people with anorexia nervosa in the British Isles and help us to evaluate whether or not increased investment in specialist services is affordable to the NHS and would be of benefit to these young people. We will collect good quality, real-world evidence of the costs, cost-effectiveness and potential cost-savings associated with different models of community-based care. This should help the NHS to organise services for young people with anorexia nervosa in a way that maximises the benefits to patients and their families, given the funding currently available. The study aims to support improvements in the organisation of community-based services for anorexia nervosa that may lead to better use of NHS resources, better outcomes for young people, fewer hospital admissions, and less disruption to family, school and social life. The risks to patients and their families are minimal because they will not be directly involved in the study. Data will be collected from child and adolescent psychiatrists and the information they provide will be anonymised to ensure it is not possible to identify any particular young person. Where is the study run from? The study will be led by Professor Sarah Byford at the Institute of Psychiatry, King’s College London. This is a collaborative project involving 12 investigators from a range of organisations (including the NHS, universities and national charities) and covering the British Isles. When is the study starting and how long is it expected to run for? December 2013 to May 2016 Who is funding the study? The National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme and the Health and Social Care (Northern Ireland) Research & Development Division (UK) Who is the main contact? Professor Sarah Byford [email protected]

Critère d'inclusion

• Child and adolescent anorexia nervosa

Liens

• isrctn
• ictrp