Integration of specialised services for eating disorders and functional symptom disorders in children and young people: discrete choice experiments and qualitative study.
Stephen Morris, Efthalia Massou, Josefine Magnusson, Saheli Gandhi, Pei Li Ng, Angus Ig Ramsay, Naomi J Fulop
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引用次数: 0
Abstract
Background: Evidence suggests that centralising specialist healthcare services can improve outcomes for patients but increase travel distances and times. Traditionally, people requiring specialist health care were cared for by a single specialist, with mental and physical health care delivered by separate services. Recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, including shared access to medical records and multidisciplinary care.
Objectives: To investigate how centralisation of specialised healthcare services can be characterised. To examine the proposed integration between physical and mental health services in the care of children and young people with eating disorders and functional symptom disorders in one region of England.
Design: Mixed-methods study comprising: a scoping review (conducted in November 2020) of four databases to characterise centralisation of specialised healthcare services; a systematic literature review (conducted in August 2022, updated in July 2024) of three databases to evaluate integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders; an interview study of parents (n = 10 participants), healthcare professionals (n = 14 participants) and a project lead (n = 1 participants) to understand perspectives on integration, which analysed data in themes organised within the Consolidated Framework for Implementation Research; and two discrete choice experiments of preferences using online surveys (n = 400 participants).
Results: The scoping review (n = 93 studies) found that definitions of centralisation commonly lacked detail but, where available, covered centralisation's form, objectives, mechanisms and drivers. Limited evidence suggests centralisation could be linked to better outcomes, but many important outcomes were rarely examined. The systematic review of integration found one low-quality (uncontrolled) pre-post study of eating disorders in Australia. Findings from the interviews suggest that service redesign should ensure the concept of 'integration' has shared meaning among professionals, and that agreement is reached over roles and responsibilities. From the discrete choice experiments, the main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders and time to diagnosis for functional symptom disorders.
Limitations: Limited, poor-quality literature in the reviews; small numbers of interview participants; difficulties engaging parents, carers and healthcare professionals for the discrete choice experiment.
Conclusions: There is a lack of evidence around integrated care for children and young people affected by eating disorders and functional symptom disorders. Implementation of integrated services needs to address concerns regarding roles, responsibilities and leadership. Future evaluations should measure impact in terms of the factors found to matter most to participants in this study.
Future work: Mixed-methods studies to evaluate integrated pathways.
Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.
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