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Dietitian visits were a safe and cost‐effective form of follow‐up care for children with celiac disease
Author(s) -
Johansson Karolina,
Malmberg Hård af Segerstad Elin,
Mårtensson Helena,
Agardh Daniel
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14411
Subject(s) - medicine , pediatrics
Aim This study compared follow‐up protocols for paediatric celiac disease (CD) led by either paediatricians or dietitians at Swedish university hospitals. Methods We followed 363 CD patients under 18 years at the university hospitals in Malmö (n = 140) and Lund (n = 79) between 2011 and 2013 and after they merged to become Skåne (n = 144) between 2014 and 2016. Both Lund and Malmö provided regular paediatrician follow‐up visits, whereas Skåne provided mainly dietitian‐led visits. Results Children at Lund were followed for a mean of 1.0 ± 0.5 visits per year, compared to 0.7 ± 0.6 at Malmö (p < 0.0001) and 0.9 ± 0.6 at Skåne (p = 0.11). The ratio of annual paediatrician to dietitian annual visits was 1.4:1.0 at Lund, which was higher than Malmö (0.9:1.0; p = 0.0017) and Skåne (0.6:1.0; p < 0.0001). There was no difference in the prevalence of non‐compliant patients between the clinics (p = 0.26, Malmö 13.6%, Lund 10.1%, Skåne 7.6%). Tissue transglutaminase autoantibody levels reversed equally over time at all three clinics after the subjects started a gluten‐free diet (r = −0.55, p < 0.0001). The total mean annual cost per patient was lowest at Malmö and highest at Lund (p < 0.0001). Conclusion Dietary compliance was similar regardless of whether care was provided by a dietitian or paediatrician. Dietitian‐led follow‐up visits may provide lower long‐term costs.