Effectiveness of general practitioner supported self-help for bulimia nervosa
While bulimia nervosa may affect up to five percent of women attending general practice, little attention has been paid to the possibility of treating patients in primary care. Improvements have been reported in patients using cognitive behaviour, self-help manuals. General practitioners may be well placed to support such patients. The study was designed to compare in a pragmatic, randomised controlled trial, the effectiveness of a general practice based self-help approach to the treatment of bulimia nervosa (a self-help manual with general practitioner support) with that of specialist out-patient treatment ascertain, through two postal questionnaires, general practitioners' views about the experience of supporting patients in primary care and explore, using qualitative and quantitative methods, patients' views of the treatment interventions. It was hypothesised that there would be no serious disadvantage in outcome for patients randomised to receive the self-help intervention in general practice compared to those receiving specialist care. Patients recruited from general practitioner referrals to specialist clinics were randomised to receive the general practice based self-help intervention (n=34) or specialist clinic treatment (n=34). The main outcome measure was the Bulimic Investigatory Test Edinburgh score assessed at baseline and at six and nine months. Secondary measures included eating pathology, depression, social adjustment and self-esteem. Seventy-four percent and 80% of patients were followed up at six and nine months respectively. An intention-to-treat analysis revealed that while bulimic symptoms declined in both groups over time, there was no significant difference in outcome between the two groups. The general practitioner surveys and patients' subjective views highlighted advantages and drawbacks to the self-help approach, but suggested that in general neither patients nor general practitioners were averse to using a general practice based intervention. The study findings suggest that general practitioners should consider offering self-help interventions to patients who present with bulimia nervosa.