Impact of community dietetic leadership in paediatric food allergy on the burden of care for both primary care and families: A service evaluation comparison

Abstract

Objectives: Food allergy is common in infants and young children and symptoms overlap with other common gastrointestinal disorders and atopic conditions, all impacting on primary care practitioner (GP) workload. This project aimed to describe the potential benefits of a dietetic-led allergy service to support this. Method: Between October 2019 and July 2020, two dietetic services for children aged 0-11 years referred with food allergy were compared. One is a dietetic-led service where dietitians train community children's nurses (0-19 team) to recognize potential cases of food allergy. The second is a traditional model of dietetic community care, obtaining referrals from GPs and secondary care. Ethical approval was obtained. Results: In the dietetic-led service 86 patients were seen [80% non-IgE cow's milk allergy) CMA)], of which 62% were referred by the 0-19 team. In the community service 96 patients were seen (85% non-IgE CMA), of which 27% were referred by the 0-19 team and 67% from GPs. 78% of children referred to the dietetic-led service were under 6 months of age, compared to 40% in the community service, where 34% were over 1 year. Hypoallergenic formula was first prescribed at a mean age of 9.4 weeks in dietetic-led vs 13.9 weeks in community care. Patient contacts with GPs prior to referral was 3 vs 6 visits (p = 0.001) and input from secondary care was also lower (8 vs 25 patients; p = 0.002) in dietetic-led vs community services respectively. There were similar numbers of patient contacts with the 0-19 team in both services (median 2). A substantial reduction in prescription of medications occurred following diagnosis (Figure 1). Conclusions: Real-world data highlight that a dietetic-led paediatric service can relieve the burden of care of food allergy in primary care, empowering community children's nurses as part of integrated care system working.