Early Detection of Coeliac Disease Using Community Pharmacy
The National Association of Primary Care (NAPC) are working with Coeliac UK on a pilot project using the Community Pharmacy setting to active case finding in coeliac disease.
Coeliac disease is an autoimmune condition triggered by intolerance to gluten, the protein found in wheat, barley and rye and is characterised by damage to the lining of the small intestine. From screening studies it is estimated that around 1% of the UK population have coeliac disease, however only 24% of those are diagnosed. This means that approximately 500,000 people in the UK remain undiagnosed.
The reason for under diagnosis in coeliac disease may be due to a range of challenges including lack of awareness of the condition and misdiagnosis, since it is established that one in four people diagnosed with coeliac disease have previously been treated for irritable bowel syndrome (IBS).
The current diagnosis process involves consultation with a GP in primary care to obtain a serological test with referral to secondary care for an endoscopy and biopsy following a positive result. A point of care test (POCT) in the form of a rapid finger prick blood test has the potential to increase recognition of coeliac disease, if used as part of an active case finding approach in community pharmacies. There are currently four POCTs available for detection of coeliac disease, with limited research around their use, however Simtomax® is supported by an emerging evidence base.
The opportunity to provide additional capacity and improved patient experience through utilising community pharmacy is identified in the NHS England report “Community Pharmacy – helping provide better quality and resilient urgent care”.
Community pharmacies have considerable benefits in terms of improving patient access and experience, as illustrated by the following:
- There are over 11,000 community pharmacies in England providing NHS services.
- Community pharmacies are highly accessible, located in the heart of the community where people live, work and shop.
- In the areas of highest deprivation almost 100% of households live within walking or using public transport.
- Adults in England visit a pharmacy on average 16 times a year.
- Many pharmacies are open for extended hours in the evenings and weekends and nearly 900 of them are open for 100 hours a week.
- People may seek advice from the local pharmacist on ‘gut problems’ that they may not go to the GP with.
Pilot Study Hypothesis
The use of community pharmacies for active case finding in coeliac disease, using a simple questionnaire and POCTs will increase recognition of coeliac disease and will act as an adjunct pathway in helping to find the half a million people with undiagnosed coeliac disease. Pharmacies are a good use of NHS resources, providing a cost effective, accessible and acceptable approach to early recognition of coeliac disease.
PIN 3 Project Meetings
15th April 2015 @ NAPC Offices
2nd July 2015 @ NAPC Offices TBC
24th September 2015 @ NAPC Offices TBC
Coeliac UK are working with the NAPC for its 5th Primary Care Innovation Network project.
Coeliac UK are the oldest and largest coeliac disease charity in the world and have been working for people with coeliac disease and dermatitis herpetiformis since 1968. They have over 60,000 members with around 1,200 joining every month. Coeliac UK are not Government funded and rely on its members and the generosity of fundraisers and supporters to continue their work.
Coeliac UK formerly launch their new campaign: Is it coeliac disease? at the start of Awareness Week on the 11th May 2015 - a two year campaign which aims to reach the half a million undiagnosed people and make them aware of coeliac disease and the range of symptoms associated with the condition.
April 2015 to October 2015