Comparing dietetic interventions to support newly diagnosed patients

Project Title: A study to compare group versus individual dietetic intervention in patients with newly diagnosed coeliac disease

Nick Trott is a Gastroenterology Dietitian at the Royal Hallamshire Hospital, Sheffield covering the coeliac clinic. His clinical interests include coeliac disease, gluten ataxia, non coeliac wheat sensitivity, and the low FODMAP approach for disorders of the gut brain interaction. Nick was awarded the ‘Coeliac Professional of the Year’ by Complete Nutrition in 2017. Nick was a key member of this research project’s team, alongside Professor David Sanders, comparing individual vs group dietetic appointments. Nick has presented on this topic at Coeliac UK’s Research Conference.

National guidelines recommend that patients newly diagnosed with coeliac disease should receive information and support on the gluten free diet from a healthcare professional with specialist knowledge of coeliac disease. A dietitian with expertise in coeliac disease is best placed to provide this support, but we know that people can face long waiting times for their first appointment with a dietitian.

Why did we fund this research?

The use of group clinics in coeliac disease has the potential to improve access to dietetic services and reduce waiting times – it is a model that is already working in other health conditions. Group clinics for coeliac disease are already running in some parts of the UK but there has been limited published data to compare outcomes from group clinics with individual appointments.To fill the gap in the evidence, Coeliac UK funded researchers at the Royal Hallamshire Hospital, Sheffield to explore if group clinics are as effective as traditional individual appointments. The research has now been published in Clinical and Translation Gastroenterology.

How was the research conducted?

People newly diagnosed with coeliac disease were allocated to either a group clinic or an individual appointment. Some people needed a one-to-one appointment to receive more tailored advice, such as those with multiple conditions (e.g.having both diabetes and coeliac disease) and people with communication barriers. These individuals were excluded from the analysis.

Several outcomes were compared between the two groups. The researchers looked at nutritional status, antibody levels in blood and also asked participants to complete validated questionnaires to assess adherence to the gluten free diet, quality of life and anxiety and depression. These measures were taken before the first dietetic session and at follow up three months after the first appointment.

What did the researchers find?

The researchers found no significant differences between the groups for nutritional status, adherence to the gluten free diet or antibody levels in blood. On average, those attending the individual appointments had lower scores for anxiety than those in the group sessions, however both groups had scores below the threshold for probable anxiety or depression.

There are two other potential benefits of group clinics. Firstly, they allow people newly diagnosed with coeliac disease to meet other people who are in the same position providing another support network. Secondly, the research also found that group clinics were also associated with cost savings, achieving a 54% reduction in dietetic resources when compared with one-to-one appointments.

What are the next steps?

To share this research among dietitians and as a model of good practice that may be considered by other dietetic departments who are providing services to people with coeliac disease.