G126(P) Is dietician led community clinic answer to managing cow’s milk protein allergy referals

Abstract

Aims The Dietetics department conducted a Cow’s milk protein allergy (CMPA) project to explore the feasibility for developing a community clinic. Methods Majority of cases of CMPA is non-IgE- mediated. The regional Pan Mersey guidelines suggest management by community dietician in such cases if infants are not failing to thrive. Consultant led Hospital clinics for such cases is not cost effective and may not add any benefits in patient care. A dietician led 3 month pilot between March 2018 and June 2018 was conducted at district General Hospital. The referrals were received from GPs, Hospital Paediatric Consultants and Community Dieticians/Health Visitors Results There were 24 new referrals over a 3 month period. There was one DNA and one cancellation (96% attendance) Out of 22 patients, 8 were from GPs, 13 from Consultant Paediatricians and 1 from community dietitian. 5 did not have milk allergy. Out of 17 with CMPA 5 were Ig-E mediated and 12 (70%) were non IgE –Mediated. Out of 8 GP referrals, 1 did not have CMPA, 2 were IgE and 5 non IgE mediated CMPA. Out of 13 referrals from Paediatricians 3 did not have CMPA, 3 were IgE and 7 were non Ig E mediated CMPA. 4 children had resolved CMPA. Parents were asked to rate their anxiety levels about their child’s milk allergy on a scale of 1–10 at the start of the consultation and at the end of the consultation (1 being lowest level of anxiety and 10 being highest). Average level of anxiety at the start of the consultation was 6/10, which reduced to 2/10. Conclusion A focused milk allergy clinic had a good attendance rate. The majority (70%)of the patients had mild-moderate non-IgE mediated allergies, which could safely and effectively be managed by a community paediatric Dietitian. The parents reported reduced level of anxiety scores at the end of clinic consultation suggesting improved parent satisfaction and experience. The study concludes that community dietetic clinic is feasible which is likely to be cost effective and may move care closer to community.