EAL

MNT: RDN in Medical Team (2015)

Citation:

Mitchell SL, Klein J, Maduramente A. Assessing the impact of an eating disorders treatment team approach with college students. Eat Disord. 2014; 23: 45-59. PubMed ID: 25298146

Study Design:

Retrospective Cohort Study

Class:

B - Click here for explanation of classification scheme.

Quality Rating:

NEUTRAL: See Quality Criteria Checklist below.

Research Purpose:

To compare client characteristics and treatment utilization for college students treated with psychotherapy alone vs. an interdisciplinary treatment team approach.

Inclusion Criteria:

Any student given an eating disorder diagnosis during a two-year academic period (2011 to 2013), using DSM-IV criteria.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Design

Retrospective chart review.

Intervention

Therapy utilization: Eating Disorder Treatment team (EDTT) (i.e., the EDTT group) were compared to students who received psychotherapy only (i.e., the non-EDTT group) across several variables of interest.

Data Collection Summary:

Timing of Measurements

Chart review of student counseling records between 2011 and 2013.

Dependent Variables

Demographic variables of interest included gender, race/ethnicity, academic status (i.e., year in program ranging from undergraduate freshman to graduate student), sexual orientation, age, citizenship status, student-athlete status and previous counseling experience
Clients’ levels of psychological distress on sub-scales of the Counseling Center Assessment of Psychological Symptoms (CCAPS; described in Measures section) were measured at the initial assessment (Center for Collegiate Mental Health, 2012)
Other variables of interest were any co-morbid DSM-IV diagnoses (e.g., depression, anxiety, substance abuse and personality disorders) given by the student’s counselor
The following counselor variables were examined: gender and professional status (senior staff counselor, doctoral level psychology intern, masters’ level trainee).

Independent Variables

The therapy utilization variables were the number of therapy sessions (both group and individual counseling) and premature termination rates (instances where clients initiated an unplanned termination without agreement from the counselor). Lastly, students referred to the EDTT (i.e., the EDTT group) were compared to students who received psychotherapy only (i.e., the non-EDTT group) across several variables of interest.
The client groups were further broken down by levels of care subgroups (i.e., non-EDTT, referred to EDTT but no contact with physician or dietitian, referred to EDTT plus contact with dietitian, referred to EDTT plus contact with physician and referred to EDTT plus contact with dietitian and physician) in order to explore differential treatment utilization across groups.

Control Variables

Data extraction methods.

Description of Actual Data Sample:

Initial N: N=235 participants in this study included undergraduate (N=156, 66%) and graduate students (N=79, 34%) enrolled at a large Eastern university
Attrition (final N): N=210 female (89%) and 25 male (11%)
Age: At 21.6 years with a range from 17 years to 46 years
Ethnicity: The sample was 145 (79%) White; 21 (9%) Asian American/Asian; 13 (6%) African-American/ Black; eight (3%) Hispanic/Latino; five (2%) Multiracial; three (1%) Native American and one (.4%) Other
Location: Buffalo, New York.

Summary of Results:

Key Findings

EDTT clients who received the highest level of care (counseling, medical and nutritional services) attended significantly more individual counseling sessions (M=17.65, SD=12.12) than non-EDTT clients (M=5.66, SD=8.97) and more than EDTT clients who met with a medical provider (M=7.44, SD=6.06)
There were no significant differences in mean number of individual sessions attended between EDTT clients receiving the highest level of care, those who were discussed at the EDTT but did not meet with either a medical provider or dietitian (M=10.28, SD=8.06) and those who met with the dietitian (M=12.93, SD=18.35)
Students receiving the highest level of care attended more group counseling sessions (M=4.18, SD=4.84) than non-EDTT clients (M=1.01, SD=2.99). EDTT clients who were discussed at the EDTT but did not meet with a medical provider or dietician (M=4.06, SD=5.23), those who met only with a medical provider (M=1.06, SD=2.29) and those who met only with a dietitian (M=3.27, SD=6.07) did not differ from each other, the non-EDTT group, or those receiving the highest level of treatment in terms of the number of group counseling sessions attended
With regard to the total number of sessions attended (individual and group), post-hoc analyses indicated that those receiving the highest level of care (counseling, medical, nutrition) tend to stay in therapy longer. They attended 15.67 more total sessions (M=21.85, SD=15.17) than those who were not referred to the team (M=6.18, SD=8.66). Clients receiving the highest level of care attended 13.48 more total sessions than EDTT clients who only met with a medical provider (M=8.38, SD=8.01).

Author Conclusion:

Findings suggest that the team approach is associated with students staying in therapy longer and terminating therapy in a planned fashion.

Funding Source:

Other:

Not Reported.

Reviewer Comments:

Treatment outcomes were not described; only the number of appointments attended were used.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	No
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		???
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	???
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	No
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	No
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	Yes
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	Yes
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	Yes
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	N/A
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	No
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	No
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	No
	10.2.	Was the study free from apparent conflict of interest?	Yes