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P601 Are Inflammatory Bowel Disease patients’ expectations met by dietetic services?

McCarthy, N.(1);Schultz, M.(2);Wall, C.(1);

(1)University of Otago- Christchurch, Department of Medicine, Christchurch, New Zealand;(2)University of Otago, Department of Medicine, Dunedin, New Zealand

Background

Guidelines recommend that Inflammatory Bowel Disease (IBD) patients should have access to specialised dietitian support. Literature suggests that patients are often dissatisfied with their access to reliable nutrition information and dietitian services. Our aim was to assess whether New Zealand (NZ) dietetic services were meeting the expectations of patients.

Methods

In early 2020 an electronic survey to explore experience of dietetic services was disseminated to approximately 2000 patients (and parents) by Crohn’s and Colitis NZ and IBD health professionals. Quantitative responses were analysed via non-parametric methods and qualitative responses were analysed via inductive analysis.

Results

Responses were received from 407 IBD patients. Participants were asked if it ‘is useful for patients diagnosed with IBD to have access to a dietitian for nutrition advice?’ with 86% responding ‘Yes’ and 12% ‘Maybe’. Almost all (95%) patients had nutrition topics that they would like to discuss with a dietitian but only 52% had seen a dietitian and 45% had never been referred. Patients were interested in various nutrition topics (Table 1). Most (65%) would like access to a dietitian whenever a new nutrition issue arises. 

Table 1. Nutrition topics of interest to patients

Diet related topics  
Symptom reduction 75 
Healthy eating 72 
Impact on IBD 71 
To treat IBD 55 
Vitamins/minerals 52 
Weight gain/loss 40 
Fibre 35 
Other 
No/unsure 


The most frequent nutrition advice received was to follow a specific diet, most commonly a low fermentable carbohydrate diet followed by a low residue diet, or general nutrition advice. Two-thirds (66%) of respondents found the dietitian advice at least moderately useful while 18% reported it was not at all useful. Patients who saw a dietitian in a private clinic were more likely to find the advice useful (p=0.0001), as were those who had received written advice (p<0.0001).

Common themes in response to open-ended questions included: frustration at difficulty accessing dietetic services; desire for routine dietitian referral at diagnosis and ongoing access; the need for dietitians to have specialist knowledge of IBD; a perception that some medical staff believe nutrition is not relevant in IBD management.

Conclusion

Many patients have never been referred to a dietitian and a proportion of patients did not find dietitian advice useful. Dietitian advice appears to be on the topics most commonly of interest to patients. Access to dietetic services needs to improve and exploration is needed to elucidate why some aspects of services are not meeting patient expectations.

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