Adolescent anorexia nervosa treated in primary care with a family-based method - long-term outcomes.

Background: Anorexia nervosa is a potentially lethal psychiatric disorder characterised by restrictive eating and weight loss. Adolescent patients were treated as outpatients using a novel method which involved coaching the parents to take full responsibility for their child's nutrition. In this follow-up cohort study, we compared the long-term outcomes of patients treated in primary care using the family-based coaching method (FBcM-PC) with those treated in tertiary care using traditional treatment.

Methods: The cohort included all adolescent patients with a restrictive eating disorder treated initially in Oulu University Hospital and/or Oulu Primary Health Care centre between 2013 and 2019. Patients (n = 168) were contacted and asked to fill out a health questionnaire. Altogether 73 (43%) responded (30 from the FBcM-PC and 43 from the traditional treatment group). The outcome variables - depression, anxiety, eating disorder symptoms and need for medical appointments - were compared between the treatment groups.

Results: Upon follow-up after a mean of 6.6 years, 77% of the FBcM-PC and 54% of the traditional treatment groups did not need medical appointments (p = 0.052). No differences were found in self-reported health, depression or anxiety between the study groups. Concerns about weight and shape were reported by 40% of both groups. 87% of the FBcM-PC and 9% of the traditional treatment group received outpatient treatment only (p < 0.001).

Conclusion: Adolescent anorexia nervosa patients treated mainly in primary care had at least as favourable long-term outcomes as those treated in tertiary care. The results of this study encourage further development of outpatient treatment methods in primary care.