BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

A SERVICE EVALUATION OF A DIETETIC-LED CLINIC FOR THE MANAGEMENT OF PAEDIATRIC PATIENTS WITH COELIAC DISEASE

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Anna Pigott
Anna Pigott
3 months ago

It would be nice to see the data from the traditional clinic. I would also be interested to know what blood monitoring is done, and who requests and reviews any bloods? Do you have a meeting with the consultant? Do parent reports correlate with TTGs? What are your red flags?
I’m sure dietitian led clinics are better than traditional ones, we run one in Stoke and it has been a success, we have a consultant available in the clinic to address any issues the dietitians can’t eg skin rashes, other medical problems that parents think couls be related to coeliac disease.

Isobel Connolly
Isobel Connolly
3 months ago
Reply to  Anna Pigott

Thank you for your interest, yes data from the previous clinic in terms of compliance etc. would have been helpful to assess prior to moving to the DLC clinic. The blood requests and reviews is done by the two gastro dietitians, and we meet weekly with the gastroenterologists at the MDT meeting where blood test results can be discussed if required. I have not found on the whole, in my practice that patient reports correlate with TTGs. The red flags that we use are:
• Complex, unstable or untreated coeliac disease
• Unintentional and/or unexplained weight loss (weight centile decrease by two centiles)
• Abnormal blood results (that cannot be managed by the GP)
• Abnormal bowel symptoms e.g. loose stools or abdominal pain with normal coeliac screen
• Complex dietary needs e.g. restrictive diet or suspicion of disordered eating
• Family screening
• Any other medical problems identified during consultation. We also do run our clinics at the same time as Dr Onyeador, Paediatric Gastroenterologist runs a clinic so that if there is anything urgent that arises from clinic review, this can be discussed with her.

sue protheroe
sue protheroe
3 months ago

Hi Isobel. Great findings and poster.
How often are patients seen please?
Have you offered group sessions for families ( in Non covid times) ?
We found that these were highly rated and offered extra opportunities for peer support.

Isobel Connolly
Isobel Connolly
3 months ago
Reply to  sue protheroe

Thanks for your interest in the poster, patients are seen at least annually, newly diagnosed patients are seen twice in the first year post diagnosis and younger patients <5 or patients where there are growth concerns are seen six monthly. We actually asked patients prior to establishing the DLC clinic if they would be interested in group meetings, anticipating that there would be however the results were split 50/50 and therefore we focused our energy in establishing the DLC but potentially in the future we would ask about interest again and look to establish group sessions in tandem with DLC.

Siba Paul
Siba Paul
3 months ago

Excellent study and well presented poster Isobel

Great to see that the new model of AHP led coeliac services is working so well

I’m aware that similar service models exist in Scotland and Bristol, presume in some other places as well

It would be good to join forces and publish a position statement paper on how to establish and run similar clinics and the training required for AHP colleagues – this will be particularly useful for colleagues in the DGHs – I’m sure BSPGHAN Coeliac working group will be able to facilitate this

Thanks

Isobel Connolly
Isobel Connolly
3 months ago
Reply to  Siba Paul

Thank you, yes we are happy that the DLC is working well. Yes absolutely there are many similar service models, I sent a survey through BSPGHAN in 2017 prior to establishing the DLC in George’s and there were nine centres at that time following a similar model, I would anticipate that there are even more now. Yes I agree a position statement would be beneficial as we understand that current guidelines from BSPGHAN are that paediatric patients require medical and dietetic follow-up, I am glad to hear that this would be of interest to colleagues in DGHs. I am interested in the Coeliac UK presentation about co-production of guidelines and what families need and want and following on from this I will look to link in with the BSPGAHN Coeliac working group.

Suchandra Pande
Suchandra Pande
3 months ago

Hi Isobel, excellent poster. We have Dietician led Coeliac clinic at Leicester. As Anna Pigott mentioned, we have a consultant available in clinic to see patients if any concern raised by dietician. Dieticians have regular post clinic meeting with lead consultant to discuss blood results etc.
I noted response rate to your questionnaire was 40%, did you post the questionnaire or gave to patients as they attended clinic?

Isobel Connolly
Isobel Connolly
3 months ago

Hi Suchandra, thank you for your comment. We sent the questionnaires via email, I phoned parents of patients to see if they consented to partaking in the service evaluation and to get their email address, we then used a web based questionnaire platform and sent the link to the parents of patients to ensure confidentiality of responses.