Pritchard Lucy, Waters Carolyn, Murray Iain Alexander, Bebb James, Lewis Stephen
Dietetics, Derriford Hospital, Plymouth, UK.
Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK.
Frontline Gastroenterol. 2019 Apr 29;11(2):93-97. doi: 10.1136/flgastro-2018-101156. eCollection 2020 Mar.
Once clinically stable, patients with coeliac disease should have annual follow-up. Lack of capacity in gastroenterology outpatient clinics mean alternatives are required.
We studied the effectiveness of follow-up deferred to general practitioners (GP-FU) and compared this with a neighbouring Trust where follow-up was through a dedicated nurse-led telephone clinic (T-FU).
All patients with coeliac disease were posted a questionnaire examining patient satisfaction, adherence with gluten-free diet and calcium intake.
517 of 825 patients (62.7%) completed a postal questionnaire (median age 61, 72% female). 28% of GP-FU and 84% of T-FU patients received an annual review. Of those seen, 33% (GP-FU) and 53% (T-FU) were weighed (χ 65.8, p<0.001), 44% and 63% had symptom review (χ 81.1, p<0.001) and 33% and 51% had dietary adherence checked (χ 60.6, p<0.001). Almost all patients considered their adherence with gluten-free diet (GFD) good or excellent, although the majority of patients failed to achieve the recommended daily intake of calcium. GP-FU patients were more likely to receive calcium±vitamin D supplements (77% vs 42%, χ 88.2, p<0.001) and they were also more likely to receive appropriate vaccinations (67% vs 38%, χ 17.6, p<0.001).
Discharge of patients with coeliac disease to primary-care in many cases results in their complete loss to follow-up. When patients were reviewed, either by GP-FU and T-FU, many aspects of their care are not addressed. Whether this will result in late complications remains to be seen.
乳糜泻患者临床症状一旦稳定，应每年进行随访。胃肠病门诊缺乏相应能力，这意味着需要其他替代方式。
我们研究了转由全科医生进行随访（全科医生随访）的效果，并将其与邻近信托机构通过专门的护士主导电话诊所进行随访（电话诊所随访）的情况进行比较。
向所有乳糜泻患者邮寄了一份问卷，调查患者满意度、无麸质饮食依从性和钙摄入量。
825名患者中有517名（62.7%）完成了邮寄问卷（中位年龄61岁，72%为女性）。28%的全科医生随访患者和84%的电话诊所随访患者接受了年度复查。在接受复查的患者中，33%（全科医生随访）和53%（电话诊所随访）进行了体重测量（χ² = 65.8，p<0.001），44%和63%进行了症状复查（χ² = 81.1，p<0.001），33%和51%检查了饮食依从性（χ² = 60.6，p<0.001）。几乎所有患者都认为自己的无麸质饮食依从性良好或优秀，尽管大多数患者未达到推荐的每日钙摄入量。全科医生随访的患者更有可能接受钙±维生素D补充剂（77%对42%，χ² = 88.2，p<0.001），他们也更有可能接受适当的疫苗接种（67%对38%，χ² = 17.6，p<0.001）。
在许多情况下，将乳糜泻患者转至初级保健机构会导致他们完全失去随访。当通过全科医生随访或电话诊所随访对患者进行复查时，他们护理的许多方面并未得到关注。这是否会导致晚期并发症还有待观察。
