New patient checklist

The following is a checklist of important areas to cover when seeing a patient who is newly diagnosed with coeliac disease. As you will see there are a lot of areas to cover, so it may take more than one appointment to go through all the information:

• Weight, height, BMI
• Symptoms - before and after diagnosis. Some patients may not attribute any health problem specifically to their coeliac disease - you may need to help them retrospectively identify their symptoms
• Assess patient's understanding of coeliac disease - they may have accessed information from a variety of sources before attending the appointment
• Explanation of coeliac disease - what it is and how it affects the body
• Gluten-free diet - explain what gluten is, where you find it and tools available to select safe foods e.g. allergen labelling.
• Highlight which foods are naturally gluten-free e.g. rice, potatoes, plain meat, fish, eggs, cheese, milk, most yoghurts, fruits, vegetables, pulses (peas, beans, lentils).
• Assess the patient's understanding of the gluten-free diet and consider involving other family members in dietary education.
• Cross-contamination with gluten and sensible steps on how to avoid it
• Prescribable products - what's available and how patients can get gluten-free food on prescription. Discuss pre-payment certificates if the patient pays for prescriptions.
• Starter cards - should be given to the patient so they can order samples from a variety of gluten-free manufacturers
• Availability of gluten-free food - discuss ranges available in supermarkets, health food shops, mail order and the internet
• Eating out - discuss with the patient strategies to overcome challenges when eating out e.g.  ring before going to restaurant, let the staff know about the gluten-free diet.
• Give the patient a current Coeliac UK membership form and information on the services the Charity provides.
• Explain how to use the Food and Drink Directory, including the importance of monthly updates
• Calcium intake - it is recommended that adults with coeliac disease aim for 1000mg/day. For post menopausal women and men over the age of 55, the recommended daily intake is 1200mg/day. Assess whether a supplement may be required. For children, there is no recommendation of increased calcium requirements, so a calcium rich diet using Reference Nutrient Intakes (RNI) as a guide is appropriate.
• Consider other lifestyle issues which may impact on bone health e.g. regular weight bearing activity, avoid smoking and alcohol excess. Check if the patient has been referred for a DEXA scan.
• Balanced diet - as well as ensuring the diet is gluten-free it is also important to ensure it is well balanced in line with general healthy eating recommendations.   

• Arrange a follow-up appointment.