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Comparing alternative follow-up strategies for patients with stable coeliac disease
  1. Lucy Pritchard1,
  2. Carolyn Waters2,
  3. Iain Alexander Murray2,
  4. James Bebb2,
  5. Stephen Lewis3
  1. 1 Dietetics, Derriford Hospital, Plymouth, UK
  2. 2 Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
  3. 3 Gastroenterology, Derriford Hospital, Plymouth, UK
  1. Correspondence to Dr Stephen Lewis, Gastroenterology, Musgrove Park Hospital, Plymouth, Devon TA1 5DA, UK; sjl{at}doctors.org.uk

Abstract

Background Once clinically stable, patients with coeliac disease should have annual follow-up. Lack of capacity in gastroenterology outpatient clinics mean alternatives are required.

Objectives We studied the effectiveness of follow-up deferred to general practitioners (GP-FU) and compared this with a neighbouring Trust where follow-up was through a dedicated nurse-led telephone clinic (T-FU).

Design All patients with coeliac disease were posted a questionnaire examining patient satisfaction, adherence with gluten-free diet and calcium intake.

Results 517 of 825 patients (62.7%) completed a postal questionnaire (median age 61, 72% female). 28% of GP-FU and 84% of T-FU patients received an annual review. Of those seen, 33% (GP-FU) and 53% (T-FU) were weighed (χ2 65.8, p<0.001), 44% and 63% had symptom review (χ2 81.1, p<0.001) and 33% and 51% had dietary adherence checked (χ2 60.6, p<0.001). Almost all patients considered their adherence with gluten-free diet (GFD) good or excellent, although the majority of patients failed to achieve the recommended daily intake of calcium. GP-FU patients were more likely to receive calcium±vitamin D supplements (77% vs 42%, χ2 88.2, p<0.001) and they were also more likely to receive appropriate vaccinations (67% vs 38%, χ2 17.6, p<0.001).

Conclusions Discharge of patients with coeliac disease to primary-care in many cases results in their complete loss to follow-up. When patients were reviewed, either by GP-FU and T-FU, many aspects of their care are not addressed. Whether this will result in late complications remains to be seen.

  • coeliac disease
  • follow up clinics
  • gluten free
  • standard of care
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Footnotes

  • Contributors The study was designed by IAM, JB, LP and SL; the data collection and tabulation by CW and LP; analysis by LP and SL; writing up by CW, IAM, JB, LP and SL. SL submitted the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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