Is Peer Support in Group Clinics as Effective as Traditional Individual Appointments? The First Study in Patients With Celiac Disease

Abstract

INTRODUCTION: Celiac disease (CD) is common, affecting approximately 1% of the population. The cornerstone of management is a gluten-free diet, with dietetic advice being the key to aiding implementation. The aim of the study was to assess group clinics in comparison with traditional individual appointments. METHODS: Patients with a new diagnosis of CD, confirmed histologically, were prospectively recruited over 18 months in Sheffield, United Kingdom. Patients received either a group clinic or traditional one-to-one appointment, led by a dietitian. Quality-of-life questionnaires were completed at baseline, as well as biochemical parameters being recorded. Patients were followed up at 3 months, where adherence scores were assessed as well as biochemical parameters and quality of life questionnaires being completed. RESULTS: Sixty patients with CD were prospectively recruited and received either an individual (n = 30) or group clinic (n = 30). A statistically significant reduction in tissue transglutaminase was noted following group clinics (mean 58.5, SD 43.4 U/mL vs mean 13.2, SD 5.7 U/mL, P < 0.01). No significant differences in baseline and follow-up biochemical parameters between one-to-one and group clinics were noted. At follow-up, there was no statistically significant difference between mean gluten-free diet adherence scores (mean 3.1, SD 0.4 vs mean 3.1, SD 0.7, P = 0.66) between one-to-one and group clinics. DISCUSSION: This first study assessing group clinics in CD demonstrates they are as effective as traditional one-to-one clinics, with the added benefits of peer support and greater efficiency, with an estimated 54% reduction of dietetic resources.

The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

“…Moreover, in the group-based education, the patients find more other patients with similar concerns, and their anxiety level about the disease was decreased and they become more motivated to increase their adherence to GFD, and consequently their quality of life improve [ 29 , 35 , 36 ]. However, Rej et al, showed that group-based education of newly diagnosed patients with CD has no significant effect on QOL [ 25 ]. The discrepancy between the results of the present study and Rej et al study partly can be attributed to the characteristics of included participants since they included the newly diagnosed patients.…”

“…Jacobbson et al reported that celiac school improves psychological health and gastrointestinal (GI) symptoms in patients with CD [ 24 ]. Rej et al also reported that in patients with newly diagnosed CD, group clinics had a positive effect on patients' QOL [ 25 ].…”

Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study

“…Dietetic services in the UK have been demonstrated to be inadequately resourced, with the majority of trusts not providing specialist clinics, 37 and thus innovative methods for providing dietetic services are required such as group clinics, 38 telephone clinics or digital apps. If a pathway could be created that is achievable and economical for the whole of the UK then this system could be mandated by the Coeliac National Charity perhaps under the auspices of a patient charter.…”

Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease

“…Recently, several studies have investigated the association between CeD and the social domain of QOL [13][14][15][16]. A study investigating the efficacy of one-on-one counseling versus group counseling sessions found higher anxiety scores in the group-counseled participants compared to the one-on-one category.…”