Does A Dietitian-Led Celiac Disease Clinic (DLCC) Facilitate Timely Diagnosis and Nutrition Care for Patients With Celiac Disease?

Abstract

Background and aim: Given lengthy diagnosis and treatment delays existed for adult outpatients with newly diagnosed celiac disease (CD), a dietitian-led celiac disease clinic (DLCC) was implemented in 2020. Under DLCC, the dietitian removed eligible patients from the gastroenterology waitlist and ordered pathology and endoscopy for CD diagnosis, and those with CD were given timely, regular dietetic education. This pretest/posttest study aimed to compare time to CD diagnosis and treatment, and the proportion of patients were offered gastroenterologist appointments between the previous (pre-DLCC) and the DLCC expanded scope (post-DLCC) clinics.

Methods: Eligible patients were adults, referred to the gastroenterology dietitian between 2018 and 2021, with newly diagnosed CD. Demographic, medical, and appointment data were sourced from medical records. A satisfaction survey was administered to post-DLCC patients. Chi-squared and t-tests were used to compare groups.

Results: Fifty-four patients were eligible (69%F, 43 ± 15 years, 86% had anti-TTG > 20 U/mL, n = 33 post-DLCC). Time from gastroenterologist referral triage to treatment commencement was improved by 404 days from pre- to post-DLCC (p < 0.01) in those whose CD diagnosis was not led by nursing staff, with reductions observed in both time from referral triage to CD diagnosis and CD diagnosis to treatment (p < 0.05). These improvements were conservative given COVID-19 delayed services for most (n = 29/33) post-DLCC patients. Thirty-six percent fewer post-DLCC patients were offered gastroenterologist appointments (p < 0.01). All (100%) post-DLCC respondents reported satisfaction with the clinic.

Conclusion: A DLCC expanded scope clinic may provide more timely diagnosis and treatment access for adult patients with newly diagnosed CD, with fewer requiring gastroenterologist appointments.