Withdrawing gluten‐free food from prescriptions in England: a mixed‐methods study to examine the impact of policy changes on quality of life

Journal of Human Nutrition and Dietetics - Tập 33 Số 4 - Trang 453-464 - 2020
Michele Peters1, Helen Crocker1, Crispin Jenkinson1, Mara Violato1
1Nuffield Department of Population Health, University of Oxford, Oxford, UK

Tóm tắt

AbstractBackgroundSome local areas in England stopped have gluten‐free prescriptions for coeliac disease. An explanatory mixed‐methods study has investigated the impact of these changes.MethodsA cross‐sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on the use of prescriptions and healthcare services, as well as the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis, and the interviews were analysed by thematic analysis. Findings from the interviews guided the survey analysis.ResultsDietary burden was significantly different between prescribing and nonprescribing areas, with little impact on other aspects of quality of life. Survey participants in nonprescribing areas who felt more impacted by the prescription changes reported a lower quality of life. Satisfaction with and use of services was lower in nonprescribing areas. Interviews indicated that, after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten‐free prescriptions to be available, in particular for staple foods.ConclusionsThe main quality of life impact was on Dietary burden. It is encouraging that most participants in the present study maintained a good quality of life. However, issues of worse experiences of care, lower follow‐up opportunities and inequity arose, and these should be taken into consideration in decisions on gluten‐free food prescriptions. The new guidelines for the National Health Service in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in the present study.

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Tài liệu tham khảo

10.1177/2050640614559263

10.1186/1472-6963-10-105

10.1111/j.1365-277X.2005.00591.x

10.1111/j.1365-277X.2011.01160.x

10.1111/j.1365-277X.2012.01288.x

10.1136/flgastro-2018-101088

10.1111/j.1365-2036.2009.03983.x

10.3399/bjgp18X698045

Coeliac UK in collaboration with The British Dietetic Association and the Primary Care Society for Gastroenterology(2011).Gluten‐free foods: A Revised Prescribing Guide 2011.High Wycombe UK:Coeliac UK.

10.1136/bmj.i6810

10.1093/bmb/ldv031

10.3390/nu9070705

Department of Health and Social Care(2018)Consultation of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) (Amendment) Regulations 2018 ‐ Gluten Free Food on NHS Prescription in England.London:Department of Health and Social Care.

10.1161/CIRCOUTCOMES.112.967885

10.1371/journal.pone.0041308

Crocker H, 2017, Diagnosis and Management of Coeliac Disease: Quality of Life and Patient's Experiences of Healthcare Services

10.1007/s11136-012-0322-4

10.1111/apt.14942

10.1016/j.cgh.2008.12.032

10.2147/PROM.S149238

10.1136/postgradmedj-2015-133395

10.1016/j.ehb.2018.06.001

10.1136/gutjnl-2016-312388.303

Department of Health, 2016, NHS Outcomes Framework: At‐a‐Glance

10.1186/s12916-018-1106-7

10.1155/2015/508156

10.1186/s12876-019-0980-6

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Thông tin xuất bản

Journal of Human Nutrition and Dietetics

Tập 33 Số 4

453-464

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