Identification and Management of Bulimia Nervosa & Binge Eating Disorder in Primary Care: a systematic review of qualitative research

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

10C.3

Presenter:

Stella Kozmér

Twitter:

@kozmer_stella

Co-authors:

Christopher O’Rouke, Dr Samantha van Beurden, Dr Natalia Lawrence, Dr Jane Smith

Author institutions:

University of Exeter, Dorset Healthcare NHS University Foundation Trust

Problem

Binge eating disorder (BED) and Bulimia Nervosa (BN) are the most common eating disorders in the UK. Despite this, their identification is overlooked, and support for the management of these conditions is lacking in primary care. Research on patients’ and healthcare professionals’ perspectives could shed light on issues surrounding the identification and management of BED and BN and areas where this might be improved.

Approach

A systematic review of qualitative research was conducted to explore the perceptions of patients and healthcare professionals in relation to the identification and management of BED and BN in primary care (PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394919). Searches of peer-reviewed literature were completed in Medline, Embase, PsycINFO, Global Health (all via OVID) and CINAHL (via EBSCO host) from database inception to February 2023. The quality of articles was assessed using the Critical Appraisal Skills Programme checklist for qualitative research. Data was extracted on methods of data collection and analysis, country of origin, date of publication, eating disorders focused on, type of healthcare professional and gender of patients. Thematic synthesis was used to synthesise the data. Patient and healthcare professional advisors were involved in interpreting results, shaping the presentation of findings and supporting the integration of both patient and healthcare professional perspectives into themes and a subsequent model.

Findings

2043 articles were identified and screened for inclusion by two reviewers independently and checked by a third reviewer where necessary, with 17 studies ultimately included. 3 studies were of high quality with a low risk of bias; the rest were medium quality and risk of bias. 7 studies were from the UK, 4 from the US, and the rest were from Canada, Norway, France, Australia, and New Zealand. Ten articles focused on healthcare professionals’ perspectives, and seven on patients’ views. Five themes were generated, highlighting that several factors influence healthcare professionals' management of eating disorders. These included a “lack of knowledge” about the definition and presentation of BED/BN; “communication” issues due to a lack of confidence in addressing eating disorders during consultations whether it is a known diagnosis or only suspected; overwhelmingly negative and unhelpful “attitudes” about eating disorders, such as weight bias; “barriers to identification”, such as comorbidities; and ”barriers to management” for example, due to lack of resources. Patient perspectives supported these views in some areas, such as in relation to there being a lack of resources or showcased negative impacts on their experience, for example, related to the “communication” theme. A model was generated to highlight the relationship between the themes.

Consequences

This review has identified factors that could be addressed to better equip healthcare professionals to identify and manage BED and BN in primary care.

Submitted by:

Stella Kozmer

Funding acknowledgement:

This project is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference C062). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.