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GPs ‘under-prescribing gluten-free foods’ for coeliac disease

GPs under prescribe gluten-free (GF) foods for patients with coeliac disease and do not follow national prescribing guidelines, according to a Scottish study.

The study

The study is the first to look at the quantities of GF food prescribed by GPs and compare them with the monthly allowance recommended in prescribing guidelines by Coeliac UK Primary Care Society for Gastroenterology and the British Dietetic Association. From April 2010 to March 2011, researchers evaluated retrospectively the GP electronic medical records of patients registered at 16 GP practices in the west of Scotland.

The findings

Of the total number of patients registered (85,667), 175 were prescribed GF foods and/or had a diagnosis of coeliac disease or dermatitis herpetiformis (DH). Some 102 patients (61%) of the patients with a recorded diagnosis of gluten-sensitive enteropathy received GF foods on prescription while 64 (37%) did not receive any GF foods on prescription.

There was variation in the number of GF food products received on prescription; the mean number was two while some individuals (34%) were prescribed one to five products per year and others (20%) more than five. According to Coeliac UK guidelines, the lowest recommended unit allowance for any adult is 156 units for women >75 years. In this study, most individuals (82%) received between 0.75 to 155 units of GF foods on prescription over one year.

What does this study mean for GPs?

The author comment: ‘The present study has provided a unique evaluation of the prescribing of GF foods within one health authority in the UK, highlighting the need to ensure that all individuals receiving GF foods on prescription have a confirmed diagnosis of a gluten-sensitive enteropathy’.

J Hum Nutr Diet 2013, online 2 May


Readers' comments (13)

  • Given that times have changed, and now GF foods are available in every supermarket at a comparable cost to their gluten-containing equivalents, why do we continue to prescribe food for patients who would otherwise have to have purchased it anyway?

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  • I wouldn't call on average at least twice the cost comparable!!

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  • The prices of gluten-free foods are hardly comparable to gluten-containing foods.

    A quick perusal at Tesco online shop shows:

    Genius (gluten-free bread) 535g - £3.00

    Hovis Loaf (gluten-containing bread) 800g - £1.35

    Coeliacs pay more than double the price for a smaller size loaf.

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  • It is difficult to decide where this starts and ends.

    Do we prescribe low sugar food to all diabetics? They are more expensive than your average food and will undoubtedly help.
    Do we prescribe low fat food to all over weight?
    Do we prescribe money to those in poverty? There are strong links with poverty and poor health.

    Personally, clearer cut is to stop prescribing things on NHS for things that can be obtained OTC. The country is struggling to meet the health demands, there needs to be a way of controlling the spenditure or the whole system will fail.

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  • RE: Anonymous | 20 May 2013 12:55pm

    The above ^^ is a poor analogy.

    There are lots of food options out there for people with diabetes that do not bear an increased financial outlay.

    Diabetics are specifically advised to avoid special "diabetic foods" and to just include a variety of healthy foods in their diet instead. The BDA's recommendations have been around since 1992.

    Similarly, there is no major price difference between low-fat spreads, milks etc and full fat milks, spreads etc. so your analogy breaks down here too.

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  • Yes, I know all that. It's a poor writing on my behalf but "healthy" food with less carb/fat generaly cost more - just compare the content & cost of value ready made meal at your local supermarket against buying the ingredients and making the food yourself with less carbs/fats from scratch.

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  • I feel all food should be bought by the patients not to be prescribed on NHS prescriptions including any formula milk.

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  • The comments conflate two issues, firstly what is appropriate nutritional products for the state to provide?and secondly in the light of this study and the pressures on GP , is a prescription an adequate let alone the best way of meeting the delivery?
    I do not actually hold a view on the first , but I am utterly convinced a voucher system for pharmacy uptake issued by state registered dietician is the only sensible way to issue an appropriate diet for those nutritional products the state has adjudicated are "therapeutic"

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  • I agree that a means tested voucher system for those on low income to help in the purchase of basic gluten free foods from supermarkets is needed.
    meat and veg do not contain gluten and there are lots of ways of eating healthy nutritious natural foods that are cheap and appropriate.
    Since when did any patient, ever medically require chocolate chip cookies/pizza/cake....gluten free or not...
    Currently, the NHS not only foots the bill for unnecessary OTC 'medicines' [ including gluten free foods, shampoo, sun tan and moisturising lotions, nit treatment...often requested without due medical need.] but also the enormous costs of transporting and delivery.

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  • The cost of gluten free products are certainly not comparable to normal foods. They are extremely expensive and much of the foods available are not available on prescription anyway.
    I think basic foods, flour mixes, bread and pasta should be available on prescription as it is a medical condition which needs treating. If prescriptions for these foods were stopped many families would struggle to afford appropriate foods and probably end up straying from the sort more readily.

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