Improving the identification and management of Binge Eating Disorder and Bulimia Nervosa in adults aged 16 and over in primary care in the United Kingdom

Background: Recent empirical research suggests that binge eating disorder (BED) and bulimia nervosa (BN) may not be appropriately identified and managed in primary care, despite available practical support (Chapter 2). Aim: To improve the identification and management of BED and BN in adults aged 16 and over in primary care in the UK. Methods: This programme of research comprised three main studies. A systematic review of qualitative research was conducted to describe perceptions about the identification and management of BED and BN in primary care settings (Chapter 3). Findings from the review informed a national survey to map current practice in UK primary care (Chapter 4). A qualitative study consisting of interviews and focus groups with healthcare professionals (HCP) and people with lived experience was then conducted to develop recommendations for improving the identification and management of BED and BN in UK primary care (Chapter 5). All studies integrated perspectives from healthcare professionals and people with lived experience and were designed and interpreted with the support of a patient and public advisory group. Results: The review critically appraised and synthesised evidence from 25 qualitative studies, which highlighted that knowledge and understanding, HCP-patient interactions, attitudes and emotions, and treatment and referral pathways are key factors that independently, yet interrelatedly, impact the identification and management of BED and BN in primary care. The national survey indicated variations in practice across the country and among healthcare professionals (n=347) and in patients’ lived experiences (n=251), such as the use of self-referral to eating disorder services or access to different disorder-specific self-help tools. Respondents with BN were almost four times more likely to receive a clinical diagnosis than individuals with BED. This was also mirrored in management practices, such that individuals with BED relied on self-help, while those with BN were referred to eating disorder services. Interviews and focus groups with 26 participants (14 HCPs, 12 people with LE) suggested that to improve the identification and management of BED and BN in primary care, (1) relevant education needs to be provided to HCPs, patients, their families and the public, (2) functional screening pathways embedding suitable and accurate screening tools need to be developed, (3) current referral and treatment pathways must be improved to simplify referral processes and provide interim management options for patients, and (4) guidelines must be clear, specific, and co-designed to support implementation of the aforementioned suggestions. Conclusions: This thesis provides a state-of-the-art picture of the perceptions of healthcare professionals and patients towards the identification and management of BED and BN in primary care and of current primary care practice. It develops evidence-informed recommendations for change and suggests next steps for research, integrating both healthcare professional and patient perspectives, and drawing on good practice seen in other countries or in other health conditions within the UK.<p></p>

Author dc:creator

• Stella Kozmér (21052616)

• primary care
• eating disorders
• binge eating disorder
• bulimia nervosa
• mixed-methods
• identification
• management

Statement dc:rights

• All rights reserved
• Open Access after 2027-09-15

Identifier

10779/exe.31742734.v1

OAI identifier oai:identifier

oai:figshare.com:article/31742734