Impact of Morbidity in Populations of North London Clinical Commissioning Groups on Patient Admission Rates and Gp Referrals

Abstract

Objectives: To examine follow-up of autoantibody testing and health care utilization among patients with (sustained) celiac disease. MethOds: From the PHARMO Database Network, patients with a positive autoantibody test for deamidated gliadin peptide (anti-DGP), endomysial (EMA) or tissue transglutaminase (anti-tTG) (period 1998-2011) were classified as celiac disease patients. The first positive test served as index date. For patients with ≥ 12 months follow-up, autoantibody tests in the year after index date were assessed. Patients with a second positive test, using the same cut-off, between 6-12 months after index date were classified as 'sustained celiac disease' patients and matched 1:1 on gender, birth year and year of index date to celiac disease patients without a second positive test. For these patients, health care utilization in 2012 was determined. Results: 1,815 patients had at least one positive autoantibody test, of which anti-tTG was most common (86%). 1,724 patients had ≥ 12 months follow-up, of which 75% did not have any type of autoantibody test in the year after index date. 183 patients (11%) were classified as 'sustained celiac disease' patients. Of these, 63 were active in the database in 2012 and could be matched. The proportion of patients with at least one GP visit and/ or hospitalization in 2012 was lower among sustained celiac disease patients: 76% and 14% vs. 83% and 24% for patients without sustained celiac disease. However, the mean (±SD) number of GP visits was higher among sustained celiac disease patients (4.3 ± 7.3 vs. 3.4 ± 3.5) as was the mean (±SD) number of outpatient drug dispensings (21.6 ± 96.3 vs.10.5 ± 17.5). cOnclusiOns: This study shows limited follow-up autoantibody testing among patients with celiac disease and does not suggest higher health care utilization with sustained celiac disease. These findings are consistent with notion of patients managing the disease without engaging the health care system. HS2 tHe imPact oF diFFerent levelS oF clinical PHarmaciSt interventionS on tHe tHeraPeutic Plan and coSt Saving