Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna

  • Antonella Piazza
  • Paola Rucci
  • Massimo Clo
  • Dino Gibertoni
  • Lucia Camellini
  • Marinella Di Stani
  • Maria Pia Fantini
  • Mila Ferri
  • Angelo Fioritti
  • The Regional Group on Eating Disorders
Original Article



To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas.


The study cohort consists of patients aged 12–64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases.


The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12–17 years) were 18.6 %, young adults (18–30) 32.7 % and older adults (31–64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found.


Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.


Anorexia nervosa Bulimia nervosa EDNOS Prevalence Care pathway 



The authors thank Drs. Eleonora Verdini and Giuseppina Lanciotti (Information System Unit, Health Care and Social Authority, Emilia-Romagna Region) for providing data and precious advice on regional administrative databases.

The members of Regional Group on Eating Disorders are Giuliano Limonta, Massimo Rossetti (Department of Mental Health and Pathological Addictions, Piacenza Local Health Authority), Anna Maria Gibin (Department of Mental Health and Pathological Addictions, Parma Local Health Authority), Enrica Manicardi (Reggio Emilia Hospital Trust), Claudio Annovi (Department of Mental Health and Pathological Addictions, Modena Local Health Authority), Carlotta Gentili (Department of Mental Health and Pathological Addictions, Bologna Local Health Authority), Emilio Franzoni (Bologna Hospital-University Trust), Carlo Della Gala (Department of Mental Health and Pathological Addictions, Imola Local Health Authority), Stefano Caracciolo (Ferrara Hospital-University Trust), Ester Giaquinto (Department of Primary Care, Romagna Local Health Authority), Daniela Ghigi (Department of Mental Health and Pathological Addictions, Romagna Local Health Authority).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical and informed consent

Regional databases were linked using a unique patient identifier and data were analyzed in anonymous form. Therefore, approval from the Local Ethics Committee and patients’ informed consent was not sought, in line with Italian privacy regulations.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Antonella Piazza
    • 1
  • Paola Rucci
    • 2
  • Massimo Clo
    • 3
  • Dino Gibertoni
    • 2
  • Lucia Camellini
    • 4
  • Marinella Di Stani
    • 5
  • Maria Pia Fantini
    • 2
  • Mila Ferri
    • 6
  • Angelo Fioritti
    • 7
  • The Regional Group on Eating Disorders
    • 8
  1. 1.Department of Mental Health and Pathological AddictionsBologna Local Health AuthorityBolognaItaly
  2. 2.Department of Biomedical and Neuromotor SciencesAlma Mater Studiorum-University of BolognaBolognaItaly
  3. 3.Information System UnitHealth Care and Social AuthorityBolognaItaly
  4. 4.Innovation and Organizational Evaluation ServiceModena Local Health AuthorityModenaItaly
  5. 5.Department of Mental Health and Pathological AddictionsRomagna Local Health AuthorityRavennaItaly
  6. 6.Outpatient Care UnitHealth Care and Social AuthorityBolognaItaly
  7. 7.Bologna Local Health AuthorityBolognaItaly
  8. 8.Health Care and Social AuthorityBolognaItaly

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