Abstract
BackgroundAnorexia nervosa (AN) is a mental disorder with grave burdens for affected individuals as well as for the healthcare system. One of the strongest predictors of a poor outcome is a long Duration of Untreated Illness (DUI), which is defined as the time between the onset of the disease and treatment initiation. Reducing the DUI is an important step to optimize care of individuals with AN. In order to achieve this aim, systemic public health interventions are necessary. Objective of this study is to evaluate a systemic public health intervention at Community level aiming to reduce the DUI in individuals with AN.Methods/designThe intervention includes the establishment of a network of health care professionals within the area of eating disorders (EDs), the development of an internet-based treatment guide, the presentation of informative short-films about EDs in cinemas and a corresponding poster campaign as well as a special outpatient clinic. For the evaluating study a pre-post between-subject design is chosen. The DUI, and the duration until first contact (DUC) with a health care professional, ED pathology as well as comorbidity are assessed before and after the systemic intervention is carried out.DiscussionThe study attempts to provide evidence of the effectiveness of an ED-related systematic public health intervention. Additionally, the study will lead to a better understanding of the DUI, which is essential in order to improve care of individuals with AN.Trial registrationCurrent Controlled Trials ISRCTN44979231; Registered 11 November 2011.
Highlights
Anorexia nervosa (AN) is a mental disorder with grave burdens for affected individuals as well as for the healthcare system
Sample size/power calculation Based on former international studies [25] with an average Duration of Untreated Illness (DUI) of 19 months and an effect size of 0.4, we considered a DUI reduction of 4.8 months or 25% as clinically relevant
The systemic intervention contains the establishment of a network of health care professionals within the area of eating disorders (EDs), the publication of a treatment guide for patients, Figure 2 Expected impact of the systemic intervention on the primary and secondary outcome parameters
Summary
Assessing the DUI and the DUC may lead to a better understanding of the period during the time until the first ED-specific treatment is initiated. In spite of the huge demand for such evaluated interventions, some limitations to this study have to be mentioned: Since this project is a systemic public health intervention, the implementation of a Randomized Controlled Trial (RCT) is not feasible. This makes it necessary to develop a new measure for the purposes of the study. The successful implementation of a systemic intervention in this area will improve the networking of different health care professionals and facilitate patients’ flow into specialist care. AG and AW participated in the design of the study as well as its coordination and drafted the manuscript.
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