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Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study

OBJECTIVES: There is substantial disagreement about whether gluten-free foods should be prescribed on the National Health Service. We aim to describe time trends, variation and factors associated with prescribing gluten-free foods in England. SETTING: English primary care. PARTICIPANTS: English gene...

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Autores principales: Walker, Alex J, Curtis, Helen J, Bacon, Seb, Croker, Richard, Goldacre, Ben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905743/
https://www.ncbi.nlm.nih.gov/pubmed/29661914
http://dx.doi.org/10.1136/bmjopen-2017-021312
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author Walker, Alex J
Curtis, Helen J
Bacon, Seb
Croker, Richard
Goldacre, Ben
author_facet Walker, Alex J
Curtis, Helen J
Bacon, Seb
Croker, Richard
Goldacre, Ben
author_sort Walker, Alex J
collection PubMed
description OBJECTIVES: There is substantial disagreement about whether gluten-free foods should be prescribed on the National Health Service. We aim to describe time trends, variation and factors associated with prescribing gluten-free foods in England. SETTING: English primary care. PARTICIPANTS: English general practices. PRIMARY AND SECONDARY OUTCOME MEASURES: We described long-term national trends in gluten-free prescribing, and practice and Clinical Commissioning Group (CCG) level monthly variation in the rate of gluten-free prescribing (per 1000 patients) over time. We used a mixed-effect Poisson regression model to determine factors associated with gluten-free prescribing rate. RESULTS: There were 1.3 million gluten-free prescriptions between July 2016 and June 2017, down from 1.8 million in 2012/2013, with a corresponding cost reduction from £25.4 million to £18.7 million. There was substantial variation in prescribing rates among practices (range 0 to 148 prescriptions per 1000 patients, IQR 7.3–31.8), driven in part by substantial variation at the CCG level, likely due to differences in prescribing policy. Practices in the most deprived quintile of deprivation score had a lower prescribing rate than those in the highest quintile (incidence rate ratio 0.89, 95% CI 0.87 to 0.91). This is potentially a reflection of the lower rate of diagnosed coeliac disease in more deprived populations. CONCLUSION: Gluten-free prescribing is in a state of flux, with substantial clinically unwarranted variation between practices and CCGs.
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spelling pubmed-59057432018-04-20 Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study Walker, Alex J Curtis, Helen J Bacon, Seb Croker, Richard Goldacre, Ben BMJ Open Gastroenterology and Hepatology OBJECTIVES: There is substantial disagreement about whether gluten-free foods should be prescribed on the National Health Service. We aim to describe time trends, variation and factors associated with prescribing gluten-free foods in England. SETTING: English primary care. PARTICIPANTS: English general practices. PRIMARY AND SECONDARY OUTCOME MEASURES: We described long-term national trends in gluten-free prescribing, and practice and Clinical Commissioning Group (CCG) level monthly variation in the rate of gluten-free prescribing (per 1000 patients) over time. We used a mixed-effect Poisson regression model to determine factors associated with gluten-free prescribing rate. RESULTS: There were 1.3 million gluten-free prescriptions between July 2016 and June 2017, down from 1.8 million in 2012/2013, with a corresponding cost reduction from £25.4 million to £18.7 million. There was substantial variation in prescribing rates among practices (range 0 to 148 prescriptions per 1000 patients, IQR 7.3–31.8), driven in part by substantial variation at the CCG level, likely due to differences in prescribing policy. Practices in the most deprived quintile of deprivation score had a lower prescribing rate than those in the highest quintile (incidence rate ratio 0.89, 95% CI 0.87 to 0.91). This is potentially a reflection of the lower rate of diagnosed coeliac disease in more deprived populations. CONCLUSION: Gluten-free prescribing is in a state of flux, with substantial clinically unwarranted variation between practices and CCGs. BMJ Publishing Group 2018-04-16 /pmc/articles/PMC5905743/ /pubmed/29661914 http://dx.doi.org/10.1136/bmjopen-2017-021312 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Gastroenterology and Hepatology
Walker, Alex J
Curtis, Helen J
Bacon, Seb
Croker, Richard
Goldacre, Ben
Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title_full Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title_fullStr Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title_full_unstemmed Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title_short Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study
title_sort trends, geographical variation and factors associated with prescribing of gluten-free foods in english primary care: a cross-sectional study
topic Gastroenterology and Hepatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905743/
https://www.ncbi.nlm.nih.gov/pubmed/29661914
http://dx.doi.org/10.1136/bmjopen-2017-021312
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