DIETITIANS could provide outpatient medical gastroenterology clinics for patients with irritable bowel syndrome (IBS). Evidence for this was presented on 3rd October 2021 at the virtual UEG Week by Christian Shaw, Sheffield Teaching Hospital NHS Foundation Trust, UK.
Currently, there is an unmet need for gastroenterologists in the UK, with 43% of new consultant appointments vacant. An ageing population with more complex needs leaves some patients waiting for long periods to see a clinician for the management of their symptoms. Private contractors are being used to meet the demand for gastrointestinal services, which has grown exponentially over the last 10 years.
After training two Band 6 dietitians to undertake outpatient gastroenterology clinics, patients with symptoms compatible with IBS were assessed by a physician (62%) and dietitian (38%). Patients were then asked how satisfied they were on a scale of 0–10. Their clinical notes were reviewed to assess the diagnostic outcome.
Of the 91 patients reviewed, the majority were diagnosed with IBS (73%), followed by bile acid diarrhoea (12%), functional diarrhoea (4%), and microscopic colitis (2%). The remaining 9% had different diagnoses. However, there was no significant difference in clinical satisfaction between physician- and dietitian-led clinics (mean: 9.2±1.5 versus 9.4±1.1, respectively; p=0.5).
Training dieticians to become advanced clinical practitioners is expensive, costing 40,500 GBP/year/dietitian. They must also enrol in an MSc in advanced clinical practice. However, a payment by results model suggests that the total income generated would be 68,200 GBP, on the basis that each dietitian will have 84 clinics, with three new patients and seven follow-ups. Subtracting the cost employ a Band 7 dietitian would lead to a 14,700 GBP surplus.
As there was no difference in clinical satisfaction between physician- and dietitian-led clinics, there is the potential for patients with IBS to attend the latter. This would lead to 14,700 GBP surplus and reduce the number of patients seeing premium-rated consultants.
