INAUGURAL NI AHP CONFERENCE

2013:

Wednesday, 23 October, Lagan Valley Island,

Lisburn

“AHP’s – Transforming Your Care”

Extended Scope Practitioner (ESP) Led

Coeliac ClinicJoy Whelan, Community Dietitian

Anne Gormley, Head of Nutrition and Dietetic Services

William Dickey, Consultant Gastroenterologist

What is coeliac disease? An inherited autoimmune sensitivity to gluten

proteins of wheat, barley and rye

Common (1% of population, many undiagnosed)

Multisystem: most commonly gut symptoms, but any organ system can be affected

Treatment (gluten-free diet) effective but can be very difficult for the patient

Long term condition needing long-term follow-up

The Background Northern Sector: Current number of patients attending the

consultant clinic is approximately 1300

50 new patients, on average, are diagnosed each year

Nearly 400 patients were overdue their consultant review appointment by 12 months plus

Funding from the acute medical waiting list initiative was obtained for one year 

Extended Scope Practitioner (ESP) Led Coeliac Clinic

 

“ESPs are highly qualified expert therapists who work in an extended role and provide a range of interventions which include treatment, education and advice”

A weekly clinic was set up to review all medically stable coeliac patients by a dietitian instead of a consultant gastroenterologist

Extended role training Fulfilled set criteria:

◦ At least 5 years Band 6 experience or equivalent ◦ At least 2 years extensive experience in the dietary

treatment of patients with coeliac disease◦ Beneficial to have completed the referrer’s course for

medical imaging

Shadowed Consultant’s review coeliac clinic

Protocol was jointly designed

Audit of service

Assessment Current symptoms, relevant medical and medications history 

Weight, body mass index (BMI) and gain/loss

Bone scan/pneumococcal vaccination

Current dietary concerns

Coeliac UK membership

Address any other medical issues

Order bloods

Referral for consultant assessment

Concerning symptoms, abnormal results forwarded to consultant by e-mail

Clinical decision made on basis of e-mail alone or review of patient file if appropriate:

-no action-advice to patient or GP -consultant clinic review

Full feed back received

Outcome The initial backlog of 389 patients was eliminated

within the year

Of the 179 patients seen within audit period (24 clinics):

20 (11%) needed consultant review

159 (89%) managed completely by dietitian +/- consultant advice

Every 10 clinics run by dietitian would require 1 clinic run by consultant gastroenterologist

Service improvement

Opportunity for patients to receive dietary advice as required

Prompt consultant review as needed

Significant cost benefits

Favourable service user feedback

Service User Feedback

“As I am aware that I can be referred to the Consultant again if there are any problems I would be very happy to continue to see the dietitian for my review appointment”

Fit for the Future……

Project was first of its kind in Northern Ireland but would be transferable to other Trusts

Having coeliac specialist dietetic posts in each Trust that could review this group of patients

Possibility of moving the service to primary care – thereby “ensuring the provision of a safe, sustainable, resilient and effective service provided in the right place at the right time, by the right people”

Thank you