Adherence of nutritional support prescriptions to clinical practice guidelines in patients with anorexia nervosa / Adecuación de la prescripción de soporte nutricional a las guías de práctica clínica en pacientes con anorexia nerviosa

Background: nutritional support (NS) is a core element in the treatment of underweight patients with anorexia nervosa (AN). Objective: to analyze the adherence of NS prescriptions to clinical practice guidelines (CPGs) for AN patients and to compare the effectiveness, safety, and cost of NS according to adherence. Methods: this retrospective observational study included AN patients admitted to an Eating Disorders Unit between January 2006 and December 2009 and followed until December 2014. NS prescriptions were compared with guidelines published by the American Psychiatric Association (APA), the National Institute for Clinical Excellence (NICE), and the Spanish Ministry of Health and Consumption (SMHC). Adherence was defined as percentage of hospitalizations that followed all recommendations. Results: adherence to APA and NICE/SMHC was observed in 10.2% and 73.4%, respectively, of the total of 177 hospitalizations. Body weight and body mass index were higher at admission in the NICE/SMHC adherence versus non-adherence group (p < 0.001). Weight gain rate during hospitalization was higher (p = 0.009) in "APA adherence" (135.5 g/day) versus "non-adherence" (92.1 g/day) group. Hospital stay was significantly shorter (p = 0.025) in "NICE/SMHC adherence" (39.5 days) versus "non-adherence" group (50.0 days). NICE/SMHC adherence was associated with lower costs (p = 0.006). Conclusions: NS prescriptions for anorexic patients more frequently followed NICE/SMHC than APA recommendations. Over the short-term, APA adherence was associated with improved weight gain. Patients adhering to NICE/SMHC recommendations had shorter hospital stay and reduced costs, likely due to their more favorable nutritional status at admission

Introducción: el soporte nutricional (SN) es un elemento clave en el tratamiento de la anorexia nerviosa (AN). Objetivo: analizar la adecuación de las prescripciones de SN en pacientes con AN a las guías de práctica clínica (GPC) y comparar la efectividad, seguridad y coste según la adecuación. Métodos: estudio observacional retrospectivo en pacientes con AN ingresados en una Unidad de Trastornos de Conducta Alimentaria entre enero de 2006 y diciembre de 2009. Se hizo seguimiento hasta diciembre de 2014. Se compararon las prescripciones de SN con las GPC publicadas por la Asociación Americana de Psiquiatría (APA), el Instituto Nacional de Excelencia Clínica (NICE) y el Ministerio Español de Sanidad y Consumo (MSC). Se definió adecuación como porcentaje de ingresos que cumplieron todas las recomendaciones. Resultados: el grado de adecuación a APA y NICE/MSC fue del 10,2% y 73,4%, respectivamente. El peso corporal y el índice de masa corporal al ingreso fueron mayores en el grupo "sí-adecuación" al NICE/MSC versus "no-adecuación" (p < 0,001). La tasa de ganancia ponderal fue superior (p = 0,009) en el grupo "sí-adecuación" a APA (135.5 g/día) versus "no-adecuación" (92,1 g/día). La estancia hospitalaria fue menor (p = 0,025) en "sí-adecuación" al NICE/MSC (39,5 días) versus "no-adecuación" (50,0 días). La adecuación al NICE/MSC fue asociada con menores costes (p = 0,006). Conclusiones: las prescripciones de SN se ajustaron en mayor grado al NICE/MSC que a la APA. La adecuación a APA parece relacionarse con mayor tasa de ganancia ponderal. Los pacientes que se adecuaron al NICE/MSC presentaron menores estancias hospitalarias y costes, probablemente relacionado con su estado nutricional más favorable al ingreso

Adherence of nutritional support prescriptions to clinical practice guidelines in patients with anorexia nervosa.

INTRODUCTION: Background: nutritional support (NS) is a core element in the treatment of underweight patients with anorexia nervosa (AN). Objective: to analyze the adherence of NS prescriptions to clinical practice guidelines (CPGs) for AN patients and to compare the effectiveness, safety, and cost of NS according to adherence. Methods: this retrospective observational study included AN patients admitted to an Eating Disorders Unit between January 2006 and December 2009 and followed until December 2014. NS prescriptions were compared with guidelines published by the American Psychiatric Association (APA), the National Institute for Clinical Excellence (NICE), and the Spanish Ministry of Health and Consumption (SMHC). Adherence was defined as percentage of hospitalizations that followed all recommendations. Results: adherence to APA and NICE/SMHC was observed in 10.2% and 73.4%, respectively, of the total of 177 hospitalizations. Body weight and body mass index were higher at admission in the NICE/SMHC adherence versus non-adherence group (p < 0.001). Weight gain rate during hospitalization was higher (p = 0.009) in "APA adherence" (135.5 g/day) versus "non-adherence" (92.1 g/day) group. Hospital stay was significantly shorter (p = 0.025) in "NICE/SMHC adherence" (39.5 days) versus "non-adherence" group (50.0 days). NICE/SMHC adherence was associated with lower costs (p = 0.006). Conclusions: NS prescriptions for anorexic patients more frequently followed NICE/SMHC than APA recommendations. Over the short-term, APA adherence was associated with improved weight gain. Patients adhering to NICE/SMHC recommendations had shorter hospital stay and reduced costs, likely due to their more favorable nutritional status at admission.

INTRODUCCIÓN: Introducción: el soporte nutricional (SN) es un elemento clave en el tratamiento de la anorexia nerviosa (AN). Objetivo: analizar la adecuación de las prescripciones de SN en pacientes con AN a las guías de práctica clínica (GPC) y comparar la efectividad, seguridad y coste según la adecuación. Métodos: estudio observacional retrospectivo en pacientes con AN ingresados en una Unidad de Trastornos de Conducta Alimentaria entre enero de 2006 y diciembre de 2009. Se hizo seguimiento hasta diciembre de 2014. Se compararon las prescripciones de SN con las GPC publicadas por la Asociación Americana de Psiquiatría (APA), el Instituto Nacional de Excelencia Clínica (NICE) y el Ministerio Español de Sanidad y Consumo (MSC). Se definió adecuación como porcentaje de ingresos que cumplieron todas las recomendaciones. Resultados: el grado de adecuación a APA y NICE/MSC fue del 10,2% y 73,4%, respectivamente. El peso corporal y el índice de masa corporal al ingreso fueron mayores en el grupo "sí-adecuación" al NICE/MSC versus "no-adecuación" (p < 0,001). La tasa de ganancia ponderal fue superior (p = 0,009) en el grupo "sí-adecuación" a APA (135.5 g/día) versus "no-adecuación" (92,1 g/día). La estancia hospitalaria fue menor (p = 0,025) en "sí-adecuación" al NICE/MSC (39,5 días) versus "no-adecuación" (50,0 días). La adecuación al NICE/MSC fue asociada con menores costes (p = 0,006). Conclusiones: las prescripciones de SN se ajustaron en mayor grado al NICE/MSC que a la APA. La adecuación a APA parece relacionarse con mayor tasa de ganancia ponderal. Los pacientes que se adecuaron al NICE/MSC presentaron menores estancias hospitalarias y costes, probablemente relacionado con su estado nutricional más favorable al ingreso.

Adherence of psychopharmacological prescriptions to clinical practice guidelines in patients with eating behavior disorders.

PURPOSE: The purpose of this study was to analyze the adherence of psychopharmacological prescriptions to clinical practice guidelines (CPGs) for patients with eating behavior disorders (EDs) and to compare the effectiveness, safety, and cost of treatment according to adherence. METHODS: This retrospective observational study included ED patients admitted to the eating disorders unit (EDU) of Ciudad Real Hospital (Spain) between January 2006 and December 2009 and followed until December 2014. Psychopharmaceuticals prescribed during EDU stay(s) were compared with guidelines published by American Psychiatric Association (APA), National Institute for Clinical Excellence (NICE), and Spanish Ministry of Health and Consumption (SMHC). Adherence was considered as the percentage of patients whose prescription followed all recommendations. RESULTS: The study included 113 ED patients. Adherence to APA and NICE/SMHC was 30.1% and 45.1%, respectively. Weekly weight gain during hospital stay was higher (p = 0.037) in the APA "adherence" (807.6 g) versus "non-adherence" (544.4 g) group. An association was found between CPG adherence and higher 5-year full recovery rate (p < 0.040). Adherence to NICE/SMHC was associated with lower incidence (p = 0.001) of adverse effects (33.3% in adherence vs. 66.1% in non-adherence group). CPG adherence was associated with lower medication costs (p < 0.020). The age was higher and there was a greater frequency of self-harm behavior and psychiatric comorbidities in the non-adherence than adherence group (p ≤ 0.040). CONCLUSIONS: CPG adherence was low in EDU-admitted patients. Long-term follow-up showed that clinical outcomes were better and medication costs lower in patients with versus without CPG-adherent prescriptions, likely influenced by the apparently greater severity of illness in those with non-CPG-adherent prescriptions.