Geographical Factors Associated With Prescribing Of Gluten-Free Foods In England


Researcher aims to describe time trends, variation, and factors associated with prescribing gluten-free foods in England. Prescribing practice for gluten-free foods in England varies hugely and does not seem to be driven by obvious medical factors. And those living in the most deprived areas of the country are the least likely to be prescribed these products, which may be due to a lower rate of diagnosis of coeliac disease in disadvantaged groups. The study was published in the online journal BMJ Open.

A gluten-free diet is the only effective treatment for the lifelong autoimmune condition, coeliac disease. But the cost to the NHS of prescribing these foodstuffs and their ready availability in supermarkets has prompted calls for them to be removed from the list of prescription items to divert much-needed cash elsewhere in the NHS.

But following a public consultation, the government decided earlier this year to allow a restricted range of gluten-free products to be retained rather than impose an outright ban. To explore the factors associated with the prescribing of gluten-free foods and how this might have changed over time in England, the researchers mined prescribing and treatment cost data for the period 1998-2017 for 7627 general practices with a list size more than 1000 patients.

Their data analysis revealed that after a steady increase in prescriptions between 1998 and 2010, the prescription rate for gluten-free foods has fallen in recent years. Between July 2016 and June 2017, family doctors prescribed 1.3 million gluten-free products, at a total cost of £18.7 million to the NHS-roughly around £14.50 per item. In 2012-13, the equivalent figures were 1.8 million prescribed items at an overall cost of £24.4 million to the NHS.

The Author concludes that further restrict the availability of prescription would, therefore, be controversial. However, it is clear that the level of variation in gluten-free prescribing is very high, and that this variation appears to exist largely without good reason, being determined to a large extent by factors such as CCG.

Prescribing patterns varied widely among clinical commissioning groups (CCGs) in 2016-17, ranging from 0.1 to 55.5 items per 1000 patients. But most of this variation seemed to be driven by differences in prescribing policy among CCGs, a pattern that has changed little over time, the analysis shows. Differences in prescribing patterns according to the level of deprivation and performance were also evident. Practices in areas of the greatest deprivation had to prescribe rates that were 11 percent lower than those in the least deprived areas.