Trends and variation in gluten-free food prescribing
Many people I’ve spoken to aren’t aware that gluten-free foods can be prescribed, but it happens quite extensively in an effort to help patients with coeliac disease adhere to a gluten-free diet.
Below is a chart showing the rate of gluten-free product prescribing since 1998, where there is a gradual increase until 2011, when guidance changed to recommend only prescribing of staple foods such as bread and flour. Recently there has been a sharper decline.
There was recently a Department of Health consultation examining whether their availability on prescription should be restricted, with the rationale that they are “readily available in supermarkets and other food outlets”.
Patient groups such as Coeliac UK have advocated against these changes and highlight the variation in prescribing policies between different CCGs, ranging from “following national guidelines” to “partial or complete withdrawal of prescriptions”.
Our analysis and the OpenPrescribing site show that areas where gluten free prescribing is restricted do have much lower rates of gluten-free prescribing, if you look at the map below in comparison with the prescribing policy map.
We’ve also determined that there is a lot of variation amongst practices, with some practices prescribing none at all. What is clear is that there is a recent trend over the last two years towards a drop in overall prescribing.
There are potential clinical benefits to doctors being able to prescribe gluten-free foods, and there are potential cost saving advantages to restricting their prescribing. However the current situation is a strange and rapidly changing middle ground, where availability is different according to where you live.
Our preprint paper (EDIT: now published in BMJ Open as of April 16, 2018) explores this issue further, including investigating some of the factors associated with volume of gluten-free prescribing, such as practice list size or deprivation score. You can also explore the volume of gluten-free prescribing at any CCG or practice on OpenPrescribing.net.