Characteristics of study subjects:
Two-hundred thirty-eight residency programs were contacted by email to distribute the survey to their EM faculty and networks. Over the four-week period the survey was available, 219 participants started the survey. Six did not meet inclusion criteria and 51 did not complete the survey, leaving 162 (74%) participants in the final sample (Table 1). Of the 162 participants, 150 completed all survey questions.
Of the 162 participants, median age was 31 years (range 25-65 years). The majority were female (n=84; 51.8%), Caucasian (n=118; 72.8%), and had practiced for less than five years in the ED (n=116; 71.6%). In the sample of participants, 23 states were represented. The majority of participants reported practicing primarily in California (n=21), Ohio (n=19), Missouri (n=17), New York (n=15), or Arizona (n=13). Based on Census Bureau defined regions, the majority of participants practiced in the Midwest (n=61; 37.7%).
Table 1. Demographic Characteristics of Participants (n=162)
Characteristic
|
Median (IQR)
|
n
|
%
|
Age (years)
|
31 (29-35)
|
|
|
Gender
|
|
|
|
Male
|
|
78
|
48.2%
|
Female
|
|
84
|
51.8%
|
Race/Ethnicity
|
|
|
|
African American
|
|
4
|
2.5%
|
Asian/Pacific Islander
|
|
20
|
12.3%
|
Caucasian
|
|
118
|
72.8%
|
Hispanic
|
|
6
|
3.7%
|
Native American
|
|
0
|
0%
|
Other
|
|
5
|
3.1%
|
> 1 Race/Ethnicity
|
|
9
|
5.6%
|
Geographic Region of Practice
|
|
|
|
Northeast
|
|
31
|
19.1%
|
Midwest
|
|
61
|
37.7%
|
South
|
|
30
|
18.5%
|
West
|
|
38
|
23.5%
|
Not reported
|
|
2
|
1.2%
|
Full-time practice (years)
|
3 (1-5)
|
|
|
Full-time practice in ED (years)
|
3 (1-5)
|
|
|
Experience in the ED
|
|
|
|
< 5 years
|
|
116
|
71.6%
|
≥ 5 years
|
|
41
|
25.3%
|
Not reported
|
|
5
|
3.1%
|
Abbreviations: IQR = interquartile range; ED = Emergency Department
The majority of participants reported receiving training on eating disorders in medical school (n=138; 85.7%). Of those who did receive training on eating disorders in medical school, 68 (49.3%) reported training was inadequate. Only three participants (1.9%) reported completing a scheduled or elective rotation on eating disorders during residency. The majority (n=152; 93.8%) reported they did not complete a scheduled or elective rotation on eating disorders during residency because it was not offered.
Main results:
Most respondents were not familiar with the American Psychiatric Association’s Practice Guideline for the Treatment of Patients with Eating Disorders (n=151; 93.2%) or the Trent et al. publication, “ED management of patients with eating disorders” (n=154; 95.1%).
The majority of respondents (>50%) were not knowledgeable about seven of the ten resources in their location for patients with suspected or diagnosed eating disorders after an ED visit. In particular, participants did not agree to being knowledgeable about the Alliance for Eating Disorder Awareness (74.2%), community support groups (73.2%), or online support groups (72%). (Table 2). Most respondents (79%) agreed to being knowledgeable about following up with an appropriate primary care physician after a patient with a suspected or diagnosed eating disorder leaves the ED.
Table 2. Physicians’ agreement to knowledge of resources for patients with eating disorders after their ED visit.
Resources
|
Disagree
|
Neutral
|
Agree
|
|
|
n
|
%
|
n
|
%
|
n
|
%
|
Total
|
Alliance for Eating Disorder Awareness
|
115
|
74.2
|
23
|
14.8
|
17
|
11.0
|
155
|
Community support groups
|
115
|
73.2
|
21
|
13.4
|
21
|
13.6
|
157
|
Online support groups
|
113
|
72.0
|
26
|
16.6
|
18
|
11.5
|
157
|
The National Eating Disorders Association
|
111
|
70.7
|
27
|
17.2
|
19
|
12.1
|
157
|
Outpatient treatment programs (partial hospitalization program, intensive outpatient program)
|
107
|
68.2
|
28
|
17.8
|
22
|
14.0
|
157
|
Residential treatment programs
|
101
|
64.3
|
30
|
19.1
|
26
|
16.6
|
157
|
Self-help materials
|
96
|
61.1
|
40
|
25.5
|
21
|
13.4
|
157
|
Patient education materials/discharge instructions
|
41
|
26.1
|
37
|
23.6
|
79
|
50.3
|
157
|
Outpatient follow up (psychiatrist, psychologist, licensed therapist, dietitian, other)
|
37
|
23.6
|
27
|
17.2
|
93
|
59.2
|
157
|
Follow up with primary care physician
|
12
|
7.6
|
21
|
13.4
|
124
|
79.0
|
157
|
Abbreviation: ED = Emergency Department
The majority of respondents (>50%) agreed additional education on 15 of the 19 topics included would be useful. The top three educational needs were: assessment of patients with eating disorders in the ED (85% agreement), medical complications (83.7% agreement), and suggested criteria for hospital admission (82.8% agreement). The fewest agreed additional education on food addiction (43.2% agreement) would be useful (Table 3).
Table 3. Physicians’ agreement to usefulness of additional education and training on eating disorder-related topics.
Topics
|
Disagree
|
Neutral
|
Agree
|
|
|
n
|
%
|
n
|
%
|
n
|
%
|
Total
|
Assessment of Patients with Eating Disorders in the ED
|
3
|
2.0
|
19
|
12.9
|
125
|
85.0
|
147
|
Medical Complications
|
3
|
2.0
|
21
|
14.3
|
123
|
83.7
|
147
|
Suggested Criteria for Hospital Admission
|
3
|
2.1
|
22
|
15.2
|
120
|
82.8
|
145
|
Resources for Patients with Eating Disorders
|
4
|
2.7
|
29
|
19.6
|
115
|
77.7
|
148
|
Treatment Options After ED Discharge
|
5
|
3.4
|
30
|
20.3
|
113
|
76.4
|
148
|
Adult eating disorders
|
4
|
2.7
|
33
|
22.3
|
111
|
75.0
|
148
|
Pediatric eating disorders
|
7
|
4.7
|
31
|
20.9
|
110
|
74.3
|
148
|
Diagnosis of Eating Disorders
|
7
|
4.8
|
31
|
21.1
|
109
|
74.1
|
147
|
Diabulimia
|
9
|
6.1
|
50
|
34.0
|
88
|
59.9
|
147
|
SCOFF Questionnaire for Screening
|
18
|
12.3
|
43
|
29.5
|
85
|
58.2
|
146
|
Bulimia Nervosa
|
12
|
8.2
|
52
|
35.4
|
83
|
56.5
|
147
|
Severe and Enduring Anorexia Nervosa
|
18
|
12.4
|
47
|
32.4
|
80
|
55.2
|
145
|
Anorexia Nervosa Restrictive Type
|
18
|
12.2
|
50
|
33.8
|
80
|
54.1
|
148
|
Anorexia Nervosa Binge-Purge Subtype
|
18
|
12.3
|
50
|
34.2
|
78
|
53.4
|
146
|
Binge Eating Disorder
|
18
|
12.3
|
52
|
35.6
|
76
|
52.1
|
146
|
Orthorexia
|
17
|
11.6
|
61
|
41.5
|
69
|
46.9
|
147
|
Avoidant/ Restrictive Food Intake Disorder
|
16
|
10.9
|
63
|
42.9
|
68
|
46.3
|
147
|
Other Specified Feeding or Eating Disorder
|
19
|
13.0
|
61
|
41.8
|
66
|
45.2
|
146
|
Food Addiction
|
24
|
16.2
|
60
|
40.5
|
64
|
43.2
|
148
|
Abbreviations: ED = Emergency Department; SCOFF Questionnaire = Sick, Control, One, Fat, Food