Bulimia Management in a Primary Care Setting

Bulimia nervosa is psychiatric condition characterized by self-induced vomiting, laxative abuse, diuretic use or excessive exercising (Frank et al., 2012). Bulimia can result in various medical complications. Subsequently, patients who suffer from bulimia initially seek care from their primary care provider. Diagnosing patients with bulimia can be challenging as many patients are in denial and also possess secretive behaviors (Brown & Mehler, 2013). Primary care providers inconsistently use clinical tools and recommendations in assessment and treatment of patients with bulimia nervosa. Delayed identification and treatment of bulimia can lead to life threatening medical complications. Research has provided strong evidence supporting improved patient outcomes with the use of clinical tools and recommendations (Wallace & von Ranson, 2011). About 4.2% of women will suffer from bulimia nervosa in their lifetime. In vulnerable populations such as college-aged women the prevalence can be as high as 10-13% (Rushing, Jones, & Carney, 2003). The primary goal of this project was to enhance primary care providers' knowledge and use of an evidence-based algorithm in the assessment and management of bulimia within a primary care setting. Addressing this gap in provider knowledge will improve care and optimize successful recovery among young women with bulimia. A systematic review of literature was utilized to develop a best practice algorithm to guide primary care providers in the assessment and management of bulimia. A list of local community resources was developed for use by health care providers at student wellness clinics to improve the management of care for patients with bulimia. Barriers identified by providers were addressed and recommendations for addressing these barriers were summarized. An educational in-service on the assessment and management of bulimia was developed and presented to health care providers at student wellness centers in the Salt Lake county. Evaluation of learning was determined through pre and post-test scores from the providers at University of Utah Student Health Center and Westminster College Student Health Services. In summary, this project has important clinical implications for the care of young women receiving services through the student wellness centers including University of Utah, Salt Lake Community College, and Westminster College. Results of this project were disseminated to the targeted health care providers and included the developed best practice algorithm, community resources, and an educational in-service. The increase in provider education and awareness of community resources should improve management of care for patients suffering from bulimia.