Peer-reviewed article
Adolescent anorexia nervosa treated in primary care with a family-based method - long-term outcomes.
Jaana Ronkainen, Erika Jääskeläinen, Päivi Tossavainen, Tanja Nordström, Jukka Ronkainen ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed adolescents with anorexia nervosa for an average of 6.6 years to compare long-term outcomes of two treatment approaches. Patients treated in primary care using a family-based coaching method (where parents took responsibility for nutrition) had similar or better outcomes than those treated in traditional tertiary care. At follow-up, 77% of the primary care group needed no further medical appointments compared to 54% of the tertiary care group, and 87% of the primary care group received only outpatient treatment.
Key points
- 77% of adolescents treated in primary care with family-based coaching did not need medical appointments at follow-up, compared to 54% in traditional tertiary care
- 87% of the primary care group received outpatient-only treatment versus 9% of the traditional treatment group
- No significant differences between groups in self-reported depression, anxiety, or health outcomes
- 40% of both groups still reported concerns about weight and shape at follow-up
- Study suggests primary care treatment with family-based coaching methods can be as effective as tertiary care for adolescent anorexia nervosa
Limitations
The response rate was only 43% (73 of 168 patients), which may introduce bias if responders differ systematically from non-responders. The study relied on self-reported health outcomes rather than clinical assessments, and the difference in need for medical appointments approached but did not reach statistical significance (p = 0.052).
Abstract
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.