GP EATING DISORDER TREATMENT PLAN (Anorexia)

PATIENT DETAILS:	GP DETAILS:	
[Patient Demographics:Full Details]	[Doctor:Full Details]	
DATE CARE PLAN PREPARED: [Miscellaneous:Date]
PROBLEM LIST:
[Clinical Details:History List (Summary)]
ALLERGIES:
[Clinical Details:Smoking]
[Clinical Details:Allergies]
CURRENT MEDICATIONS:
[Clinical Details:Medication List]

[Clinical Details:Measurement BP]

[Clinical Details:Measurements]
CARE PLAN TEAM MEMBERS:
NAME	TYPE OF CARE	if developing a TCA CONTACTED/ COPY SENT	if developing TCA AGREED?	
[Doctor:Name]	GP (details above)	yes	yes	
[Addressee:Full Details]	Dietitian	yes	yes	
	Psychologist	yes	yes	

PROBLEMS/ NEEDS, GOALS AND PLANNED ACTIONS
Current Health Needs/ Problems	Goal	Planned Actions/ Tasks	Service Provider Responsible	
Eating disorder	Restore Safety
	•	Medical monitoring
•	Develop Crisis plan (medical & psychiatric) & service pathway
•	Psycho-education
	GP, Psychologist	
Eating disorder	Restore Identity & Body Acceptance
	•	Explore the meaning & function of the ED
•	Explore & validate the person’s concerns & worries about weight & shape
•	Help the person see themselves as separate from the ED
•	Encourage body acceptance & strengthen other domains of the ‘self’
•	Provide emotional regulation & expression skills
•	Address any other traumas or interpersonal issues that help maintain the eating disorder
	GP, Dietitian, Psychologist	
Eating disorder – patient’s environment	Restore Family Functioning & Relationships
	•	Explore impact of the ED on Family members
•	Explore family and friends capacity as a resource for treatment
•	In adolescents - empower the parent’s to re-feed their child as per the FBT approach
•	Strengthen family relationships
•	Psycho-education
	GP, Dietitian, Psychologist	
Eating disorder	Restore Education & Work Path
	•	Work with school / workplace
	GP, Dietitian, Psychologist	
Eating disorder	Social connections	•	Create & foster a social network to support the person during recovery
•	Support long term social connection
•	Strengthen existing or create new recreational interests	GP, Dietitian, Psychologist	
Eating pattern	Restore Health & Normal Eating
	Obtain weight history, including initial motivation for weight loss or food restrictions
Openly discuss and have an 
understanding of the complex food and weight-related behaviours of the 
patient so that appropriate supports can be integrated into the treatment 
plan.	GP, Dietitian, Psychologist	
Eating pattern	Restore Health & Normal Eating
	 Conduct a nutritional assessment: 
 It is critical that the health care provider openly discuss and have an 
understanding of the complex food and weight-related behaviours of the 
patient so that appropriate supports can be integrated into the treatment 
plan.
 ·     Assess the patient’s beliefs and fears about food and weight gain
 Excessive focus on food and weight can be a maladaptive method of coping 
with stress.
 ·     Knowledge about nutrition and sources of information
 This information provides the basis for an individualized teaching plan 
about maintaining adequate nutritional intake.
 ·     Behaviours used to reduce calorie intake (dieting), to increase energy 
output (exercising), and generally to lose weight (vomiting, purging, and 
laxative abuse)	GP, Dietitian, Psychologist	
General health monitoring.	Monitoring of general health	Review patient's status.
•	Measure weight, height, BMI, blood pressure.
•	Test total cholesterol profile.
•	 As per Red Book	GP
How often?
once every 12 months.	
Complications.	Prevent	Assess cardiovascular, metabolic, renal, gastric, haematological, and 
endocrine system functioning.	GP	
Smoking	complete cessation	support, educate, counsel	GP	
Need for healthy diet.	To maintain a healthy weight & healthy diet.	Increase understanding of healthy eating. Review diet.	Dietitian & GP	
Physical activity	establish and maintain healthy level of activity	Discuss what is healthy level of physical activity- realistic approach	GP	
Psychological aspects  of eating disorder	manage	assessment and counselling 	GP, psychologist	

Admission and emergency planning.
Clinical indicators for inpatient medical treatment: Adult
Clinical parameter	Medical admission indicated	
Systolic BP	<80 mmHg	
Postural BP	>20 mmHg drop with standing	

Heart rate	
Š40 bpm or > 120 bpm or postural tachycardia > 20/min	
Temp	<350C or cold/blue extremities	

Weight	BMI <13
or ongoing weight loss > 1kg / wk for several weeks	

12-lead ECG	Any arrhythmia, including QTc prolongation, non-specific ST or T- wave changes including inversion or biphasic waves	
Blood sugar	< 2.5 mmol/L	
Sodium	<125 mmol/L	
Potassium	<3.0 mmol/L	
Magnesium	Below normal range	
Phosphate	Below normal range	
eGFR	<60ml/min/1.73m2 or rapidly dropping (25% drop within a week)	
Albumin	<30 g/L	
Liver enzymes	Markedly elevated (AST or ALD >500)*	
Neutrophils	<1.0 x 109/L	

Clinical indicators for inpatient medical treatment: Child/Youth
Clinical parameter	Medical Admission Indicated	

Heart rate	< 50bpm
Postural changes > 30 bpm	

Postural BP changes	Orthostatic change in systolic pressure > 20mmHg between lying & standing	
Core body temperature	< 35.50C	
ECG	QT changes arrhythmias	
biochemistry	K+ < 3.0mmol/l	
Hydration, perfusion	Dehydration
Poor peripheral perfusion	

Weight & BMI	prior weight loss + ongoing weight loss > 0.5kg for Š 2 weeks
% median BMI (mBMI) <70%; >15% loss of body weight Ongoing weight loss & < 3rd percentile BMI	

PATIENT AGREEMENT TO THE GOALS OF THE CARE PLAN: AGREED
I understand the above Care Plan recommendations and agree to the outlined goals.
Copy of Care Plan given to patient __y___  SUGGESTED REVIEW DATE: ............................
Copy of Care Plan sent to other team members___y__ (usually 6 months after starting Care Plan)