Review shows success of eating disorder MBS items

Eating disorder MBS items will remain in place, after a new review found patients and healthcare professionals have reported a ‘substantial improvement’ since their introduction.
 
But the RACGP has been left with reservations, following the launch of the Evaluation of eating disorders MBS items final report this week.
 
A suite of eating disorder-specific MBS item numbers were introduced in 2019 as the Eating Disorder Plan, following recommendations from the Eating Disorders Working Group of the MBS Review Taskforce.
 
The evaluation was designed to assess whether eating disorder MBS items are meeting the needs of people experiencing an eating disorder, their carers, and health professionals providing services under the items.
 
Its recommendations include increased access to bulk billing, higher rebates for those who are credentialed eating disorder clinicians and amending eligibility criteria by removing ‘clinically underweight’ criterion.

While MBS items for eating disorders do not fully align with the RACGP’s position on disease-specific MBS items, any model of care to support GPs managing chronic conditions, to upskill in providing care, and that can lead to best possible patient outcomes, are backed by the college.
 
‘The evaluation is welcome as it reinforces the need to review programs and new MBS initiatives,’ Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine and college representative on the National Eating Disorders Collaboration Working Group, told newsGP.
 
‘While the RACGP clearly supports generalist and holistic healthcare accessible to all patients regardless of diagnosis, it is still useful to observe the effects of reforms and dig deeper into understanding specific conditions regarding what is effective and why.’
 
According to Dr Andronis, the standout finding from the review is the recognition that well-trained practitioners using evidence-based practices result in better outcomes for patients.
 
The review reinforces the importance of quality education and continued professional development in specific disorders, the need for multidisciplinary team care, and the importance of access to dietitians with mental health training. 
 
‘When holistic GPs take the time to assess and manage patients with eating disorders in expert team-care arrangements with allied health professionals who are highly skilled in eating disorders, patients benefit,’ Dr Andronis said.  
 
Approximately one in five people with an eating disorder use the suite of MBS items, and the average number of mental health services used under the initiative was higher than the maximum number previously available through MBS under the Better Access Mental Health Treatment Plan initiative.
 
‘Having a higher number of treatment sessions was associated with significantly greater eating disorder symptom improvement, satisfaction with treatment, and perceived helpfulness of treatment for recovery,’ the report states.
 
Additionally, 93% of people who had received treatment for an eating disorder reported the Eating Disorder Plan to be better than a Mental Health Treatment Plan for providing personalised and comprehensive sessions within a multidisciplinary care model comprising medical, psychological, and dietetic providers.
 
The report notes these results suggest the initiative ‘fulfilled its goal of enhancing potential for receipt of coordinated care’.
 
Dr Andronis says overall, the MBS items support GPs to improve their skills in supporting patients with eating disorders.

‘The encouraging findings showing improvements for eating disorders patients is useful in guiding GPs to seek expert practitioners to refer to for specific conditions,’ she said.
 
‘Just as we refer to medical specialists judiciously, GPs and their patients benefit from team care with specialist allied health providers. We need to understand the way that our non-medical healthcare workers operate and to advocate for higher standards and expertise supported by evidence of best practice.
 
‘Collaboration benefits us as well as the patient; good communication and shared knowledge enlightens all of us. When GPs see good outcomes in their patients, they stay hopeful, engaged and motivated to improve their skills and knowledge.’ 
 
The review comes as rates of eating disorders in Australia are skyrocketing, particularly among young people – with 27% of those with an eating disorder aged under 19 years, a jump from 15% in 2012.
 
An estimated 1.1 million Australians are currently living with an eating disorder, an 10.5% will experience an eating disorder at some point in their lifetime. 
 
With these statistics, coupled with GPs reporting they need more support and training to manage  complex eating disorders, resources are growing to support GPs and other healthcare professionals to better identify and provide evidence-based care.
 
The final evaluation report found being a credentialed clinician leads to ‘significantly higher’ confidence, knowledge and skill in providing eating disorder treatment than non-credentialed health professionals.
 
Findings will also be used to develop recommendations to inform the ongoing performance of the eating disorders MBS items, including retention of the maximum of 40 psychological treatment and 20 dietetic health sessions available within a 12-month period through the initiative.
 
But there are some challenges that come with the MBS initiative relating to equitable access to care, according to Dr Andronis, who says GPs have a big role in advocating for improvement.
 
‘It is clear the most advantaged and assertive patients receive the best care most often – they can afford the costs and are better connected and educated in accessing services,’ she said.
 
‘The eating disorders sector is one of the most active in advocacy and this has proved effective. It is paramount that GPs continue to advocate for greater equity and access to high-quality services for the most disadvantaged communities who are least able to do so without support.  
 
‘Support and quality care take time, and our MBS needs to reflect this. We cannot expect best evidence-based practice if we don’t appreciate the efforts of professionals who provide quality care.
 
‘Quality time is rarely rushed.’  
 
The RACGP-endorsed GP Hub and Practice Management Toolkit launched this month, with Dr Andronis sitting on its Advisory Committee. GPs also recently joined dietitians and mental health professionals as credentialed eating disorder clinicians.
 
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