Cristian Costas

Improving patient care for those with coeliac disease in Bradford.

Dietitian recognition award for improvement in patient care

“Impact of a new secondary care dietetic-led coeliac service in Bradford that has saved NHS money, improved efficiency and improved patient care.”

Before December 2018, coeliac patient care in the Bradford area was inconsistent. There was minimal access to a dietitian and the care could fall under a wide range of people from the GP to a surgeon.

“Funding was secured for my role as a GI dietitian who would focus on coeliac disease which I began in December 2018. From the start, teamwork was crucial and with the support of the gastroenterologists (who are there to discuss, and if necessary, manage any medical problems that arise) I was able to take on the full care of coeliac patients including order bloods and assessing patients for DEXA bone scans. Making the coeliac service dietetic led meant that gastroenterologists could discharge patients to my clinic, where I was able to offer ongoing specialist dietetic support and address many of the barriers patients encounter when trying to follow the gluten free diet.

I introduced a range of patient support including email communication so patients could ask questions in between appointments and brought food labels to clinic to educate patients on how to spot gluten in foods. I restarted the Bradford coeliac support group and created a monthly newsletter. I recorded videos sharing gluten free diet advice on YouTube account and created an Instagram page with advice.”

What was the outcome of this for patients and the NHS?

“As a result of this service, newly diagnosed patients now obtain dietary advice within 1-2 months of referral rather than 3-4 months.  Feedback questionnaires demonstrate that, after a dietitian appointment, confidence in managing a gluten free diet has increased from 6.5/10 to 9/10 and gluten ingestion was reduced for 68% of patients. 66 patients were discharged from the gastroenterology clinic and transferred to the coeliac clinic (freeing up appointments for gastroenterologists). Dietitian led decisions on gluten avoidance adherence meant that patients avoided up to 6 repeat endoscopies and follow-up coeliac antibody blood tests.

The implementation of this dietitian led coeliac service has had a great impact on patient care whilst improving efficiency by better use of gastroenterologists’ and dietitians’ time. The feedback has been extremely positive from patients and gastroenterologists and it has saved significant NHS money. It is a win-win situation.’

“It feels amazing to win this award and get external validation to show that this work is really important. It shows how important it is for us to collect outcomes and show how much we can improve patient care and save NHS money as dietitians. I will be using the money to help fund my masters where I will be using a lot of this data to analyse it in more detail and publish research that can hopefully inform practice nationally and internationally and help secure more funding for dietitians across the board.”

Cristian Costas

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