Base de donn?es sur les mesures de qualit?

Un service permettant le diagnostic et l?initiation du traitement à un stade précoce de la maladie, alors qu?une intervention simple ou minimale peut produire des résultats thérapeutiques (ex.: dans les deux premières années de la maladie)
Autres domain(es) : Accessibilité, Patients souffrant de troubles alimentaires

Early detection and treatment of eating disorders may improve outcomes in eating disorders. General practitioners and other members of the primary care team are in a good position to identify patients with eating problems early. Screening tools may facilitate this process. The most effective screening device probably remains the general practitioner thinking about the possibility of an eating disorder.
It would be impractical for general practitioners to try and screen all their patients for eating disorders, as the prevalence of eating disorders in the general population is low. It might be possible to screen new patients when they register. One or two screening questions could be used to raise the index of suspicion, either verbally during the registration health check or in writing as part of the registration questionnaire.
High-risk groups within the general practice population could be targeted
opportunistically. Such groups include young women, patients with a low or high BMI, adolescents consulting with weight concerns, menstrual disturbances or amenorrhoea, gastrointestinal disorders and psychological problems. A brief screening questionnaire could be used for such high-risk groups.
A number of brief screening methods have been developed that have some utility in detecting eating disorders. The SCOFF has been shown to be capable of determining cases of eating disorders in adult women in primary care. The place of longer questionnaires (e.g. EAT, EDI, BITE, EDE-Q) may be in further assessment, once index of suspicion has been raised. They may also be useful to facilitate decisions regarding referral to secondary care or other specialist services. Certain clinical presentations should also raise the index suspicion, for example, adolescent girls with concerns about weight, and women consulting with menstrual disturbances, gastrointestinal or psychological symptoms.
A range of questionnaires exists of which the Eating Attitudes Test, EAT (Garner & Garfinkel, 1979) is probably the most widely used as a screening tool in epidemiological studies. In addition there are a number of other pencil and paper measures to assess eating disorder psychopathology (e.g. the Eating Disorder Inventory, EDI Garner et al., 1983). However, these take a long time to administer and may need to be interpreted by specialists. Such instruments may be well suited for evaluating treatment progress in patients with eating disorders, but may not perform well in screening for eating disorders in community samples due to symptom denial and low prevalence (Williams et al., 1982; Carter & Moss, 1984).
Questionnaires of this type may have a role for screening in very high-risk groups in special settings, e.g. in ballet schools, fitness and sports facilities. They may have occasional application in general practice, when a patient with a probable eating disorder has already been identified.
Several brief screening questionnaires, more suitable for use in community samples, have been developed and evaluated. These include the SCOFF (Morgan et al., 1999), Anstine and Grinenko (2000), the BITE and the BES (Ricca et al., 2000), the EDS-5 (Rosenvinge, 2001), Freund et al. (1993), the ESP (Cotton et al., 2003), Ri-BED-8 (Waaddegaard et al.,1999), the EDDS (Stice et al., 2000), the EAT-12 and the EDE-S/Q (Beglin & Fairburn,1992, 1994). The most promising to date is the SCOFF.
The SCOFF questionnaire (Morgan et al., 1999; Luck et al., 2002; Perry et al., 2002) consists of five questions designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form and there is one study validating the use of the SCOFF in adult women in a general practice population (Luck, 2002). Further research is needed to evaluate the SCOFF questions in general practice populations before they can be recommended for use in primary care.

NICE Eating Disorders. Core interventions in the treatment and management of the anorexia nervosa, bulimia nervosa and related eating disorders. Clinical Guideline 9. January 2004. Section 4.3.1.2, pp: 63; Section 5.2.5.4, pp: 79  Retrieved on August 3, 2006 from:http://www.nice.org.uk/page.aspx?o=cg009niceguidance

IV: Données reposant uniquement sur l?avis d?un expert.

• *Ce genre d?investigation pourrait ne pas être efficace puisque la plupart des personnes aux prises avec ce genre de désordres ne sont pas conscientes qu?elles ont un problème. La participation de la famille est indispensable.
• L'obésité et l'anorexie représentent des risques de santé de première importance.
• Je crois qu'il serait plus neutre de demander au patient à l'intérieur d'un bilan de santé physique quel est selon lui son poids idéal. Il existe de nombreux désordres alimentaires cachés, et cette façon de s'informer stigmatise moins que de demander : « Vous inquiétez-vous de façon excessive? »

Rang selon les cotes Pertinence 94 Applicabilité 22 Importance générale 101		Rang selon les groupes d'acteurs Universitaires/chercheurs 68 Cliniciens 65 Usagers 87 Décideurs 76 ?		Rang selon les groupes particuliers Premières Nations 83 Régions rurales 108 Acteurs fédéraux 77
Rang selon les provinces et territoires CB AB SK MA ON QC NB NÉ IPE TN YU TNO NU 94 75 54 67 74 95 108 56 38 17 58 73 37				Rang global        74