Post by kickingfrog on Jul 21, 2017 8:05:04 GMT
British Society of Gastroenterology statement on the proposed removal of prescriptions for GFD
Friday, 23 September 2016 09:36
The proposed removal by CCGs of prescriptions for Gluten Free Diets (GFD) is an important issue for the British Society of Gastroenterology (BSG) as it poses a direct impact on the care of patients with coeliac disease, as well as wider cost implications for the health economy.
The BSG's membership includes most of the consultants and specialists in gastroenterology in the UK that treat patients with coeliac disease and we would like to put on record our support for Coeliac UK on this issue.
Adherence to the gluten-free diet remains the complete medical treatment and having coeliac disease therefore requires significant dietary modification.
The use of gluten-free substitute staple foods facilitates the necessary dietary adaptation. Rates for adherence to the gluten-free diet can vary between 42-91% [1] and gluten-free staples on prescription have been related to adherence [2].
Non adherence to the gluten-free diet is associated with an increased risk of long term complications, including osteoporosis, vitamin D deficiency and iron deficiency [3].
These long-term complications will impact upon quality of life for the patient and treating these complications are likely to result in financial implications for the NHS through other treatment costs or bed days.
In addition to facilitating dietary adaption, gluten-free staple foods contribute important nutrients to the diet. In the UK bread is an important source of energy, dietary fibre, vitamins and minerals.
It provides more than 10% of our intake of protein, B vitamins and iron, and one fifth of our dietary fibre and calcium. Removing important staples from the diet may therefore have a significant effect on the nutrient content of the diet [4].
The National Institute of Health and Care Excellence (NICE) quality standard on coeliac disease is currently under development and highlights that access to gluten-free food may be more difficult for people on low incomes and that these people may need more support.
As part of your review the BSG would urge that due regard is paid to the impact of any withdrawal of GFD prescriptions on patients and wider healthcare costs.
Certainly the published evidence is that high street purchase of GFD products are three to four times the cost of equivalent gluten containing food [5,6]. Furthermore access to GFD remains in large supermarkets and not corner shops which will clearly make purchase difficult for the old and infirm. [5,6].
We are concerned that the consultation document lacks direct reference to coeliac disease but instead states that gluten-free foods are prescribed for people with 'particular dietary requirements'.
We do not feel that this provides enough detail for people completing the survey who do not have coeliac disease themselves.
Gluten-free foods on prescription are only approved by the Advisory Committee on Borderline Substances (ACBS) for patients with a medical diagnosis of coeliac disease.
This misperception of the GFD is leading to an inequity in health care for patients with coeliac disease. Unlike other autoimmune diseases (such as Type 1 Diabetes or Autoimmune Thyroid Disease) where prescriptions are free, the selection of GFD prescriptions as an option for budgetary savings will have a significant impact on patients health and this in turn will generate long-term costs to the NHS which will be greater than the short term savings.
We would urge CCGs to consider these facts in their decision making process and we would recommend a formal consultation process which will allow necessary access to GFD products for patients that require them and examine alternative potentially cost-effective models such as pharmacy led services to be considered.
[1] Hall, N.J. Rubin, G. & Charnock, A. (2009). Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30, 315-330.
[2] Hall, N. et al. (2013). Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey. Appetite 68 56-62
[3] National Institute for Health and Clinical Excellence (2015) Coeliac disease: recognition, assessment and management 2015
[4] O'Connor A (2012) An overview of the role of bread in the UK diet. British Nutrition Foundation. Vol. 37, Issue 3, 193-212, Article first published online: 8 Sep, 2012
[5] Singh, J. & Whelan, K. (2011). Limited availability and higher cost of gluten-free foods. Journal of Human Nutrition and Dietetics, 24, 479-486.
[6] Burden, M., et al., Cost and availability of gluten-free food in the UK: in store and online. Postgraduate Medical Journal, 2015:91;622-6.
www.bsg.org.uk/clinical/news/british-society-of-gastroenterology-statement-on-the-proposed-removal-of-prescriptions-for-gfd.html
Friday, 23 September 2016 09:36
The proposed removal by CCGs of prescriptions for Gluten Free Diets (GFD) is an important issue for the British Society of Gastroenterology (BSG) as it poses a direct impact on the care of patients with coeliac disease, as well as wider cost implications for the health economy.
The BSG's membership includes most of the consultants and specialists in gastroenterology in the UK that treat patients with coeliac disease and we would like to put on record our support for Coeliac UK on this issue.
Adherence to the gluten-free diet remains the complete medical treatment and having coeliac disease therefore requires significant dietary modification.
The use of gluten-free substitute staple foods facilitates the necessary dietary adaptation. Rates for adherence to the gluten-free diet can vary between 42-91% [1] and gluten-free staples on prescription have been related to adherence [2].
Non adherence to the gluten-free diet is associated with an increased risk of long term complications, including osteoporosis, vitamin D deficiency and iron deficiency [3].
These long-term complications will impact upon quality of life for the patient and treating these complications are likely to result in financial implications for the NHS through other treatment costs or bed days.
In addition to facilitating dietary adaption, gluten-free staple foods contribute important nutrients to the diet. In the UK bread is an important source of energy, dietary fibre, vitamins and minerals.
It provides more than 10% of our intake of protein, B vitamins and iron, and one fifth of our dietary fibre and calcium. Removing important staples from the diet may therefore have a significant effect on the nutrient content of the diet [4].
The National Institute of Health and Care Excellence (NICE) quality standard on coeliac disease is currently under development and highlights that access to gluten-free food may be more difficult for people on low incomes and that these people may need more support.
As part of your review the BSG would urge that due regard is paid to the impact of any withdrawal of GFD prescriptions on patients and wider healthcare costs.
Certainly the published evidence is that high street purchase of GFD products are three to four times the cost of equivalent gluten containing food [5,6]. Furthermore access to GFD remains in large supermarkets and not corner shops which will clearly make purchase difficult for the old and infirm. [5,6].
We are concerned that the consultation document lacks direct reference to coeliac disease but instead states that gluten-free foods are prescribed for people with 'particular dietary requirements'.
We do not feel that this provides enough detail for people completing the survey who do not have coeliac disease themselves.
Gluten-free foods on prescription are only approved by the Advisory Committee on Borderline Substances (ACBS) for patients with a medical diagnosis of coeliac disease.
This misperception of the GFD is leading to an inequity in health care for patients with coeliac disease. Unlike other autoimmune diseases (such as Type 1 Diabetes or Autoimmune Thyroid Disease) where prescriptions are free, the selection of GFD prescriptions as an option for budgetary savings will have a significant impact on patients health and this in turn will generate long-term costs to the NHS which will be greater than the short term savings.
We would urge CCGs to consider these facts in their decision making process and we would recommend a formal consultation process which will allow necessary access to GFD products for patients that require them and examine alternative potentially cost-effective models such as pharmacy led services to be considered.
[1] Hall, N.J. Rubin, G. & Charnock, A. (2009). Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30, 315-330.
[2] Hall, N. et al. (2013). Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey. Appetite 68 56-62
[3] National Institute for Health and Clinical Excellence (2015) Coeliac disease: recognition, assessment and management 2015
[4] O'Connor A (2012) An overview of the role of bread in the UK diet. British Nutrition Foundation. Vol. 37, Issue 3, 193-212, Article first published online: 8 Sep, 2012
[5] Singh, J. & Whelan, K. (2011). Limited availability and higher cost of gluten-free foods. Journal of Human Nutrition and Dietetics, 24, 479-486.
[6] Burden, M., et al., Cost and availability of gluten-free food in the UK: in store and online. Postgraduate Medical Journal, 2015:91;622-6.
www.bsg.org.uk/clinical/news/british-society-of-gastroenterology-statement-on-the-proposed-removal-of-prescriptions-for-gfd.html