New patient appointment checklist

The following is a checklist of important areas to cover when seeing a patient who is newly diagnosed with coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. . As you will see there are a lot of areas to cover, so you may need more than one appointment to go through all the information:

• weight, height, BMI
• symptoms - before and after diagnosis. Some patients may not attribute any health problem specifically to their coeliac disease - you may need to help them retrospectively identify their symptoms
• assess the patient's understanding of coeliac disease - they may have accessed information from a variety of sources before attending the appointment
• explanation of coeliac disease - what it is and how it affects the body
• gluten-freeWhen a food has less than 20 parts per million (ppm) of gluten so it is safe for people with coeliac disease to eat. diet - explain what glutenA protein that is found in the cereals wheat, barley and rye. is, where you find it and tools available to select safe foods e.g. allergenSomething which causes an allergic reaction. labelling
• highlight which foods are naturally gluten-free, for example, rice, potatoes, plain meat, fish, eggs, cheese, milk, most yoghurts, fruits, vegetables, pulses (peas, beans, lentils)
• assess the patient's understanding of the gluten-free diet and consider involving other family members in dietary education
• cross-contamination with gluten and sensible steps on how to avoid it
• prescribable products – what is available and how patients can get gluten-free food on prescription. Discuss pre-payment certificates if the patient pays for prescriptions
• starter cards - should be given to the patient so they can order samples from a variety of gluten-free manufacturers
• availability of gluten-free food - discuss ranges available in supermarkets, health food shops, mail order and the internet
• eating out - discuss with the patient strategies to overcome challenges when eating out, for example, ring before going to a restaurant, inform staff about the gluten-free diet
• explain how to use the Food and Drink DirectoryOur annual Directory of gluten-free food and drink which manufacturers voluntarily submit to. , including the importance of monthly updates
• calcium intake - it is recommended that adults with coeliac disease should have between 1000 milligrams (mg) and 1500mg of calcium each day.  This is based on the British Society of Gastroenterology (BSGBritish Society of Gastroenterology - an organisation focused on the promotion of gastroenterology within the United Kingdom, with a membership drawn from physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in the field. The BSG is a registered charity.), guidelines for osteoporosisA condition where your bones lose bone mass and become brittle. in inflammatory bowel disease and coeliac disease (2007), and the recent review document from the BSG on the management of adults with coeliac disease (2010). Assess whether a supplement may be required. For children with coeliac disease, there is no recommendation for increased calcium requirements, so a calcium rich diet using Reference Nutrient Intakes (RNI) as a guide is appropriate
• consider other lifestyle issues which may impact on bone health, for example, regular weight bearing activity, avoid smoking and excess alcohol. Check if the patient has been referred for a DEXA scan
• as well as ensuring the diet is gluten-free it is also important to ensure the diet is well balanced in line with general healthy eating recommendations
• arrange a follow-up appointment
• give the patient a current Coeliac UK MembershipIf you have been diagnosed with coeliac disease then you can become a Member of Coeliac UK. form and information on the services the Charity provides.