tailieunhanh - Handbook of Eating Disorders - part 8

Điều này chỉ ra rằng các thiết lập điều trị tốt nhất cho bệnh nhân là cung cấp điều trị đầy đủ và có hiệu quả nhưng không phải là không cần thiết hạn chế, phức tạp hoặc tốn kém. Một bệnh nhân được cho là đã đạt được lợi ích tối đa 'ở một mức độ chăm sóc | 330 LORNA RICHARDS can be generalised to publicly funded health systems is an aim for care that is medically necessary provided in an appropriate manner and at the least restrictive level. This indicates that the best treatment setting for a patient is that which provides adequate and effective treatment but is not unnecessarily restrictive complex or expensive. A patient is thought to have achieved maximal benefit at a certain level of care if improvement has plateaued and the patient can continue to make progress at a lower level of care Walter et al. 1996 . This method of service delivery acknowledges the need for correspondence between problem severity and the intensity of the intervention offered. Matching patient need to the appropriate level of treatment however demands a clear understanding of the individual s characteristics as well as a sound evidence base for treatments available. Accurate determination of both factors may present problems particularly in the absence of clear prognostic indicators for different forms of treatments when applied to an individual patient. Stepped care is a model in keeping with managed care where treatment is arranged in a series of steps of graded intensity. Those who respond to a minimal intervention are then filtered out which has advantageous economic implications. Low-intensity models of care are more developed in bulimia nervosa compared to anorexia nervosa. Psycho-education selfhelp manuals incorporating education cognitive-behavioural and motivational elements and group attendance are examples of such. Thornicroft and Tansella 1999 describe nine leading principles that affect mental health services organisation. In addition to the above requirements of acceptability accessibility and equity and cost-effectiveness they suggest that autonomy continuity coordination comprehensiveness and accountability of services demand consideration. These factors will all influence the capability of a service to meet the needs of a