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


ABSTRACT: 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.

SUBMITTER: Walker AJ 

PROVIDER: S-EPMC5905743 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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

Walker Alex J AJ   Curtis Helen J HJ   Bacon Seb S   Croker Richard R   Goldacre Ben B  

BMJ open 20180416 3


<h4>Objectives</h4>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.<h4>Setting</h4>English primary care.<h4>Participants</h4>English general practices.<h4>Primary and secondary outcome measures</h4>We described long-term national trends in gluten-free prescribing, and practice and Clinical Commissioning Group (CCG) l  ...[more]

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