Post by kickingfrog on May 3, 2011 12:50:15 GMT
Guidelines re CD/DH patients & GF scrips
Posted by Lily Paddweller on 2/5/2011
GF board
Guidelines re CD/DH patients & their GF requirements on scrip vary according to area.
Some seem reasonable & accept GFD as a medical treatment and refer to clinical guidelines from NICE, CUK etc re prescriptions for coeliacs.
NHS Chesterfield in June 2010 just seem to say coeliacs /DHers should have GF scrips if they have been correctly diagnosed.
NHS Kirklees state the same and say 'luxury' items are not allowed but agree with CUK guidelines.
NHS Wandsworth agree with Kirklees and also say ...'Dietitians are best placed to assess individual requirements'...
When it comes to Bolton, however, you would think all coeliacs are very greedy pigs who gobble up scrip GF luxuries and share them with non-coeliacs all the time!
Why is there not a national policy of NHS guidelines re GF scrip items?
****************
NHS Chesterfield, NE Derbyshire and High Peak & Dales Medicines Management Team
June 2010
...
Gluten free products should only be supplied on NHS prescription if the
patient meets the ACBS criteria i.e. people with gluten sensitive
enteropathies, including steatorrhea due to
gluten sensitivity, coeliac disease, and dermatitis
herpetiformis....
www.derbyshiremedicinesmanagement.nhs.uk/
images/content/files/newsletters/chesterfield/
meds%20man%20newsletter%20-%20June%2010.pdf
*************
NHS Kirklees Prescribing Guidance – January 2011
....
In the financial year 2009-10 the total cost of prescribed Gluten Free products across NHS Kirklees was in the order of £250,000. 3
Who should they be prescribed for?
Gluten free products should only be prescribed for individuals with a confirmed diagnosis (serological testing for IgA tissue transglutaminase (tTGA)) and a positive result obtained, followed by referral to a gastrointestinal specialist for intestinal biopsy to confirm coeliac disease.1
...
For dermatitis herpetiformis, diagnosis must be confirmed by a dermatologist.
Which products should be prescribed?
The ACBS indications for gluten free foods are gluten-sensitive enteropathies including steatorrhoea due to gluten sensitivity, coeliac disease, and dermatitis herpetiformis.4
...
Guidance for prescribing of gluten-free foods has been based on gluten-free prescribable foods providing 15% of total energy requirements.2
Only staple foods should be prescribed. Luxury items such as chocolate biscuits should not be prescribed, and must not be requested on prescription. Luxury items are readily available to buy from supermarkets or health food stores.
Summary
Key points to remember when prescribing gluten free food:2
Does the person with coeliac disease understand their condition and the importance of dietary compliance?
What is the age of the patient? e.g. an elderly patient may require smaller quantities of foods than an adolescent of 13-15 years?
What is the daily calorific requirement? e.g. a young child is different to a 40 year old office worker or manual worker. Is the patient very active?
Where excess use / ordering of gluten free products is suspected, discuss this with the patient – remind them that the prescribed foods are for the diagnosed patient only and not for other family members.
What are the cultural differences? e.g. be aware of products containing animal fats, gelatine (beef or pork origin)
What was the patient’s consumption of gluten-containing foods e.g. bread, flour, pasta, pizza, cakes and pastries prior to experiencing symptoms?
Has the patient tasted any samples of gluten free foods?
Large quantities of foods may be difficult to store and the shelf life of foods vary, therefore ensure appropriate quantities are prescribed (The very short shelf life of fresh bread should be noted and patients should avoid wastage by collecting any dispensed prescriptions promptly and by freezing any loaves that are not for immediate use)
What else is the patient eating to ensure a balanced diet?
Has the patient joined Coeliac UK for information and support?
References
1. NICE clinical guideline 86 May 2009. Coeliac disease
2. Gluten-free foods: a prescribing guide February 2004 – accessed from www.coeliac.org.uk
3. ePACT October 2010
4. BNF Edition 58 September 2009
www.kirklees.nhs.uk/fileadmin/documents/
New/Public_Information/med_mgt/Formularies_and_
Guidance/Coeliac_Disease___Gluten_Free_Products_
Guide_Final.pdf
********************
NHS Wandsworth Prescribing Guidelines on Gluten-Free products
Information for GPs
This guideline should be used in conjunction with NICE clinical guideline 86
Coeliac disease: recognition and assessment of coeliac disease. May 2009.
Date Prepared: February 2011
Approved by: NHS Wandsworth Clinical Effectiveness and Medicines Management Group
Date Approved: March 2011
Date for review: March 2013
...
General Prescribing Considerations
▪ A gluten-free diet may be low in fibre and may cause or worsen constipation. Appropriate dietetic advice should be given.
▪ Some people with coeliac disease may also need wheat-free or lactose-free products. Some products may be oat, rye and barley free also.
▪ It is important to advise the patient that naturally occurring gluten-free carbohydrates e.g. rice, potatoes are essential.
▪ An extensive range of gluten free foods (including those that are not prescribable) are available from supermarkets and retail outlets.
▪ Gluten-free foods vary from brand to brand. Foods that may be suitable for one patient will not necessarily suit another.
▪ Some foods do not keep for long periods of time, therefore prescribing smaller quantities is advised.
ACBS Approved Gluten-free Foods
Foods available on prescription
Gluten-free foods currently available on prescription are to help replace staple foods in order to achieve a healthy balanced diet.
This covers essential basic items that would form part of a staple diet and include:
Bread
Rolls/baguettes
Plain biscuits (savoury)
Crackers / crispbreads
Flour/flour-type mixes e.g. bread mix, flour mix, pastry mix
Pasta
Pizza bases
Note: “Luxury” items e.g. double choc-chip cookies should not be available on prescription and can be bought from a supermarket or retail outlet.
Cake mix and sweet biscuits:
Prescribing of gluten-free cake mix and sweet biscuits should not be available on prescription as these products are not deemed essential to the diet and do not conform to healthy eating. They are widely available in shops to purchase.
These should only be considered in exceptional circumstances on clinical advice. ....
Quantity Guidance
National guidance was produced for healthcare professionals in 2004, in a collaboration between Coeliac UK, the Primary Care Society for Gastroenterology and the British Dietetic Association. The national guidelines set out recommended amounts of
gluten-free food per individual per month as units based on nutritional recommendations3.
These guidelines are based on:
national nutritional recommendations and make assumptions that in addition to gluten-free food on prescription individuals eat naturally gluten-free carbohydrate food such as rice and potatoes
consumption data from the National Diet and Nutrition Surveys (2) and from individual records of NHS patients with coeliac disease
the eat well plate where carbohydrates should provide 50% of total energy.
The number of gluten-free products people receive on prescription varies from patient to patient. The unit recommendations from 2004 guidance are based on national nutritional recommendations and the amount of products prescribed should follow this guidance.
The number of units available should only be exceeded in exceptional circumstances on the advice of the healthcare team.
Clinician‟s discretion should always be applied, especially in cases where nutritional intake is at risk e.g. there may be cases where crackers are recommended instead of bread for older patients with dental problems or biscuits are recommended for individuals who are underweight or additional units are recommended in patients with additional calorie requirements.
Dietitians are best placed to assess individual requirements. ....
www.wandsworth.nhs.uk/About/CEG/resources/
NHSW%20Gluten%20Free%20Prescribing%20Guidelines%
20FINAL%20MAR%202011.pdf
****************************
NHS Bolton
Commissioning Policy
Number 13.
January 2011
Gluten-Free Foods available on NHS Prescriptions
...
Action required by practices
Patients with cakes / cake mixes or sweet biscuits on their repeats should have these
removed in line with healthy eating advice....
NHS Bolton has recommended that:
Practices do not:
Prescribe gluten-free foods to patients that do not have a clinical diagnosis of
sensitive enteropathies, including steatorrhoea due to gluten sensitivity, coeliac
disease, and dermatitis herpetiformis and
Prescribe more than the quantities ......
....based on Coeliac UK guidelines....
...Action required by practices
Patients who appear to be requesting significantly more than these amounts on a
regular basis should be contacted and informed that the number of units prescribed
may be adjusted to those that are appropriate for a healthy diet.
Patients should be reminded that the prescribed foods are for their own use only, and
are not to be shared with members of the family / household or friends.....
www.bolton.nhs.uk/Library/your_career/
Service_Specifications/110107%20Prescribing%
20Commissioning%20Policy%20No%2013%20-%20Gluten%
20Free%20v1.0.pdf
*************************
Posted by Lily Paddweller on 2/5/2011
GF board
Guidelines re CD/DH patients & their GF requirements on scrip vary according to area.
Some seem reasonable & accept GFD as a medical treatment and refer to clinical guidelines from NICE, CUK etc re prescriptions for coeliacs.
NHS Chesterfield in June 2010 just seem to say coeliacs /DHers should have GF scrips if they have been correctly diagnosed.
NHS Kirklees state the same and say 'luxury' items are not allowed but agree with CUK guidelines.
NHS Wandsworth agree with Kirklees and also say ...'Dietitians are best placed to assess individual requirements'...
When it comes to Bolton, however, you would think all coeliacs are very greedy pigs who gobble up scrip GF luxuries and share them with non-coeliacs all the time!
Why is there not a national policy of NHS guidelines re GF scrip items?
****************
NHS Chesterfield, NE Derbyshire and High Peak & Dales Medicines Management Team
June 2010
...
Gluten free products should only be supplied on NHS prescription if the
patient meets the ACBS criteria i.e. people with gluten sensitive
enteropathies, including steatorrhea due to
gluten sensitivity, coeliac disease, and dermatitis
herpetiformis....
www.derbyshiremedicinesmanagement.nhs.uk/
images/content/files/newsletters/chesterfield/
meds%20man%20newsletter%20-%20June%2010.pdf
*************
NHS Kirklees Prescribing Guidance – January 2011
....
In the financial year 2009-10 the total cost of prescribed Gluten Free products across NHS Kirklees was in the order of £250,000. 3
Who should they be prescribed for?
Gluten free products should only be prescribed for individuals with a confirmed diagnosis (serological testing for IgA tissue transglutaminase (tTGA)) and a positive result obtained, followed by referral to a gastrointestinal specialist for intestinal biopsy to confirm coeliac disease.1
...
For dermatitis herpetiformis, diagnosis must be confirmed by a dermatologist.
Which products should be prescribed?
The ACBS indications for gluten free foods are gluten-sensitive enteropathies including steatorrhoea due to gluten sensitivity, coeliac disease, and dermatitis herpetiformis.4
...
Guidance for prescribing of gluten-free foods has been based on gluten-free prescribable foods providing 15% of total energy requirements.2
Only staple foods should be prescribed. Luxury items such as chocolate biscuits should not be prescribed, and must not be requested on prescription. Luxury items are readily available to buy from supermarkets or health food stores.
Summary
Key points to remember when prescribing gluten free food:2
Does the person with coeliac disease understand their condition and the importance of dietary compliance?
What is the age of the patient? e.g. an elderly patient may require smaller quantities of foods than an adolescent of 13-15 years?
What is the daily calorific requirement? e.g. a young child is different to a 40 year old office worker or manual worker. Is the patient very active?
Where excess use / ordering of gluten free products is suspected, discuss this with the patient – remind them that the prescribed foods are for the diagnosed patient only and not for other family members.
What are the cultural differences? e.g. be aware of products containing animal fats, gelatine (beef or pork origin)
What was the patient’s consumption of gluten-containing foods e.g. bread, flour, pasta, pizza, cakes and pastries prior to experiencing symptoms?
Has the patient tasted any samples of gluten free foods?
Large quantities of foods may be difficult to store and the shelf life of foods vary, therefore ensure appropriate quantities are prescribed (The very short shelf life of fresh bread should be noted and patients should avoid wastage by collecting any dispensed prescriptions promptly and by freezing any loaves that are not for immediate use)
What else is the patient eating to ensure a balanced diet?
Has the patient joined Coeliac UK for information and support?
References
1. NICE clinical guideline 86 May 2009. Coeliac disease
2. Gluten-free foods: a prescribing guide February 2004 – accessed from www.coeliac.org.uk
3. ePACT October 2010
4. BNF Edition 58 September 2009
www.kirklees.nhs.uk/fileadmin/documents/
New/Public_Information/med_mgt/Formularies_and_
Guidance/Coeliac_Disease___Gluten_Free_Products_
Guide_Final.pdf
********************
NHS Wandsworth Prescribing Guidelines on Gluten-Free products
Information for GPs
This guideline should be used in conjunction with NICE clinical guideline 86
Coeliac disease: recognition and assessment of coeliac disease. May 2009.
Date Prepared: February 2011
Approved by: NHS Wandsworth Clinical Effectiveness and Medicines Management Group
Date Approved: March 2011
Date for review: March 2013
...
General Prescribing Considerations
▪ A gluten-free diet may be low in fibre and may cause or worsen constipation. Appropriate dietetic advice should be given.
▪ Some people with coeliac disease may also need wheat-free or lactose-free products. Some products may be oat, rye and barley free also.
▪ It is important to advise the patient that naturally occurring gluten-free carbohydrates e.g. rice, potatoes are essential.
▪ An extensive range of gluten free foods (including those that are not prescribable) are available from supermarkets and retail outlets.
▪ Gluten-free foods vary from brand to brand. Foods that may be suitable for one patient will not necessarily suit another.
▪ Some foods do not keep for long periods of time, therefore prescribing smaller quantities is advised.
ACBS Approved Gluten-free Foods
Foods available on prescription
Gluten-free foods currently available on prescription are to help replace staple foods in order to achieve a healthy balanced diet.
This covers essential basic items that would form part of a staple diet and include:
Bread
Rolls/baguettes
Plain biscuits (savoury)
Crackers / crispbreads
Flour/flour-type mixes e.g. bread mix, flour mix, pastry mix
Pasta
Pizza bases
Note: “Luxury” items e.g. double choc-chip cookies should not be available on prescription and can be bought from a supermarket or retail outlet.
Cake mix and sweet biscuits:
Prescribing of gluten-free cake mix and sweet biscuits should not be available on prescription as these products are not deemed essential to the diet and do not conform to healthy eating. They are widely available in shops to purchase.
These should only be considered in exceptional circumstances on clinical advice. ....
Quantity Guidance
National guidance was produced for healthcare professionals in 2004, in a collaboration between Coeliac UK, the Primary Care Society for Gastroenterology and the British Dietetic Association. The national guidelines set out recommended amounts of
gluten-free food per individual per month as units based on nutritional recommendations3.
These guidelines are based on:
national nutritional recommendations and make assumptions that in addition to gluten-free food on prescription individuals eat naturally gluten-free carbohydrate food such as rice and potatoes
consumption data from the National Diet and Nutrition Surveys (2) and from individual records of NHS patients with coeliac disease
the eat well plate where carbohydrates should provide 50% of total energy.
The number of gluten-free products people receive on prescription varies from patient to patient. The unit recommendations from 2004 guidance are based on national nutritional recommendations and the amount of products prescribed should follow this guidance.
The number of units available should only be exceeded in exceptional circumstances on the advice of the healthcare team.
Clinician‟s discretion should always be applied, especially in cases where nutritional intake is at risk e.g. there may be cases where crackers are recommended instead of bread for older patients with dental problems or biscuits are recommended for individuals who are underweight or additional units are recommended in patients with additional calorie requirements.
Dietitians are best placed to assess individual requirements. ....
www.wandsworth.nhs.uk/About/CEG/resources/
NHSW%20Gluten%20Free%20Prescribing%20Guidelines%
20FINAL%20MAR%202011.pdf
****************************
NHS Bolton
Commissioning Policy
Number 13.
January 2011
Gluten-Free Foods available on NHS Prescriptions
...
Action required by practices
Patients with cakes / cake mixes or sweet biscuits on their repeats should have these
removed in line with healthy eating advice....
NHS Bolton has recommended that:
Practices do not:
Prescribe gluten-free foods to patients that do not have a clinical diagnosis of
sensitive enteropathies, including steatorrhoea due to gluten sensitivity, coeliac
disease, and dermatitis herpetiformis and
Prescribe more than the quantities ......
....based on Coeliac UK guidelines....
...Action required by practices
Patients who appear to be requesting significantly more than these amounts on a
regular basis should be contacted and informed that the number of units prescribed
may be adjusted to those that are appropriate for a healthy diet.
Patients should be reminded that the prescribed foods are for their own use only, and
are not to be shared with members of the family / household or friends.....
www.bolton.nhs.uk/Library/your_career/
Service_Specifications/110107%20Prescribing%
20Commissioning%20Policy%20No%2013%20-%20Gluten%
20Free%20v1.0.pdf
*************************