Care Pathways Overview. Improving Transitions from Inpatient Care: Collaborative Digital Solutions - W092
Background. Inpatient care for anorexia nervosa is used for patients at high medical and psychiatric risk and who cannot be safely managed as outpatients. Approximately a third of patients relapse within the first 6 months. The aim of this programme of work was to examine whether psychoeducational interventions preparing for the transition back to the community codesigned by, and for, carers and patients to carers are of benefit.
Study 1 (CASIS). Patients (n=178) admitted to inpatient units across the UK entered a randomised trial in which carers received treatment as usual, with, or without augmentation with carers self-management materials. Outcomes were followed over two years (Hibbs et al 2016, Magill et al 2017).
Study 2 (TRIANGLE pilot) Patient (n=31) and carers (n=21) admitted to inpatient care were given the ECHOMANTRA intervention (with separate subsections for each) and were followed for 3 months after discharge (Adamson et al 2019).
In CASIS, carer burden was reduced (Effect size 0.5) as was carer emotional behaviour (Effect size 0.5). The length of admission was shortened (148 vs 168 days) and re-admission rates were reduced (27% vs 32%; p=0.04). In the TRIANGLE pilot there were positive comments about the collaborative work from both parties. The length of admission was reduced by 4.5 weeks and weight gain was increased by 0.11 kg/week in the group given the ECHOMANTRA intervention in comparison to outcomes from audit data.
Augmenting treatment to help patients and carers to prepare for discharge can consolidate changes from inpatient care.