P163 Coeliac disease: in person appointments and annual reviews remain important for a subset of patients

Introduction

Innovative service provision has been developed to improve patient experience, quality of care and cost savings in the face of increasing patient numbers. The study aimed to report what service adults with coeliac disease (CD) had experienced and to inform future service provision.

Methods

In 2019, an online questionnaire was completed by 723 adults with CD, to collect data on access to healthcare professionals and preferences for the management of CD and included questionnaires; for gluten free dietary adherence (CDAT), health literacy (HLS-Q12) and knowledge of gluten free foods. In 2021, 351 adults with CD competed an online questionnaire focused on telehealth provision of CD appointments. Adults were recruited via Coeliac UK membership and a GF food manufacturer database for both. Data presented as median with interquartile range.

Results

From the 2019 data, 85% (n=610) considered annual reviews important in their CD care; this subset of patients had significantly lower health literacy (34; 30–37 v’s 35; 32.5–40, p=0.003), poorer GF dietary adherence (13.5; 11–16 v’s 12.5; 10–15, p=0.03) and lower gluten free dietary knowledge scores (4.7; 4–6 v’s 5.0 4–6 p=0.01) compared with those who did not consider annual reviews important. For those who considered annual reviews important, 62% of patients first choice would be to see a dietitian (with 80% of those requesting a specialist dietitian) and 42% a gastroenterologist. The majority of all patients (82%) wanted to be able to request an appointment on an ‘as and when’ needed basis, and 78% preferred to have access to dietetic expertise via email or phone for their queries. From the 2021 data, 71% were very confident in using technology and 82% had experienced a telephone or online appointment for a health condition. Half (51%) reported to prefer an ‘in-person’ appointment, 25% a telephone/online appointment and 24% reported no preference. Patients with a lower household income (56% v’s 42%, p=0.029) or without a degree qualification (59% v’s 48%, p=0.046) were more likely to request an in-person appointment.

Conclusion

The diagnosis and underlying incidence of CD are increasing and despite the ongoing development of novel methods of follow-up, this will impact on current levels of service provision. Therefore, current guidelines for universal annual review are likely to remain unachievable, and for a subset of patients - unnecessary. It is important that we listen to the needs of patients in the development of ‘on demand’ follow-up and ‘remote-monitoring’ to focus resources on those who would most benefit from ongoing support. Identifying those who may benefit from long term reviews, should be further explored.