{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:53:20Z","timestamp":1790034800306,"version":"4.0.1"},"reference-count":19,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100013374","name":"NIHR School of Primary Care Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100013373","name":"NIHR Biomedical Research Centre, Oxford","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"crossref"}]},{"name":"The Health Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,2,16]]},"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>There is substantial disagreement about whether gluten-free foods should be prescribed on the National Health Service. We aim to describe time trends, variation and factors associated with prescribing gluten-free foods in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>English primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>English general practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We described long-term national trends in gluten-free prescribing, and practice and Clinical Commissioning Group (CCG) level monthly variation in the rate of gluten-free prescribing (per 1000 patients) over time. We used a mixed-effect Poisson regression model to determine factors associated with gluten-free prescribing rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 1.3 million gluten-free prescriptions between July 2016 and June 2017, down from 1.8 million in 2012\/2013, with a corresponding cost reduction from \u00a325.4 million to \u00a318.7 million. There was substantial variation in prescribing rates among practices (range 0 to 148 prescriptions per 1000 patients, IQR 7.3\u201331.8), driven in part by substantial variation at the CCG level, likely due to differences in prescribing policy. Practices in the most deprived quintile of deprivation score had a lower prescribing rate than those in the highest quintile (incidence rate ratio 0.89, 95% CI 0.87 to 0.91). This is potentially a reflection of the lower rate of diagnosed coeliac disease in more deprived populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gluten-free prescribing is in a state of flux, with substantial clinically unwarranted variation between practices and CCGs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-021312","type":"journal-article","created":{"date-parts":[[2018,4,16]],"date-time":"2018-04-16T19:00:15Z","timestamp":1523905215000},"page":"e021312","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-6135","authenticated-orcid":false,"given":"Alex J","family":"Walker","sequence":"first","affiliation":[{"name":"EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen J","family":"Curtis","sequence":"additional","affiliation":[{"name":"EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seb","family":"Bacon","sequence":"additional","affiliation":[{"name":"EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8114-9186","authenticated-orcid":false,"given":"Richard","family":"Croker","sequence":"additional","affiliation":[{"name":"EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Goldacre","sequence":"additional","affiliation":[{"name":"EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,4,16]]},"reference":[{"key":"2025121605111168000_8.3.e021312.1","doi-asserted-by":"crossref","first-page":"705","DOI":"10.3390\/nu9070705","article-title":"Adherence to a gluten free diet is associated with receiving gluten free foods on prescription and understanding food labelling","volume":"9","author":"Muhammad","year":"2017","journal-title":"Nutrients"},{"key":"2025121605111168000_8.3.e021312.2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2017-313369"},{"key":"2025121605111168000_8.3.e021312.3","unstructured":"Governance of UK. Availability of gluten-free foods on NHS prescription\u2014GOV.UK. 2017. https:\/\/www.gov.uk\/government\/consultations\/availability-of-gluten-free-foods-on-nhs-prescription (accessed 20 Dec 2017)."},{"key":"2025121605111168000_8.3.e021312.4","unstructured":"NICE CKS. Coeliac disease: recognition, assessment and management. 2015. https:\/\/cks.nice.org.uk\/coeliac-disease (accessed 18 Sep 2017)."},{"key":"2025121605111168000_8.3.e021312.5","unstructured":"Coeliac UK. Document: Gluten-free foods: a revised prescribing guide. 2013. https:\/\/www.coeliac.org.uk\/document-library\/378-gluten-free-foods-a-revised-prescribing-guide\/?return=\/gluten-free-diet-and-lifestyle\/prescriptions\/national-prescribing-guidelines\/ (accessed 18 Sep 2017)."},{"key":"2025121605111168000_8.3.e021312.6","unstructured":"Coeliac UK. Prescription policies. 2017. https:\/\/www.coeliac.org.uk\/gluten-free-diet-and-lifestyle\/prescriptions\/prescription-policies\/ (accessed 18 Sep 2017)."},{"key":"2025121605111168000_8.3.e021312.7","unstructured":"NICE. Coeliac disease. UK: NICE, 2016. https:\/\/www.nice.org.uk\/guidance\/qs134\/resources\/coeliac-disease-pdf-75545419042501."},{"key":"2025121605111168000_8.3.e021312.8","unstructured":"NHS Digital. Practice level prescribing in England: a summary. 2017. http:\/\/content.digital.nhs.uk\/gpprescribingdata (accessed 14 Mar 2017)."},{"key":"2025121605111168000_8.3.e021312.9","unstructured":"Public Health England. National general practice profiles. 2017. https:\/\/fingertips.phe.org.uk\/profile\/general-practice\/data (accessed 31 Jul 2017)."},{"key":"2025121605111168000_8.3.e021312.10","unstructured":"Office for National Statistics. Statistical bulletin: population estimates for UK, England and Wales, Scotland and Northern Ireland: mid-2016. 2016. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2016 (accessed 11 Sep 2017)."},{"key":"2025121605111168000_8.3.e021312.11","unstructured":"EBM DataLab. Open prescribing. 2017.https:\/\/openprescribing.net\/measures (accessed 31 Jul 2017)."},{"key":"2025121605111168000_8.3.e021312.12","unstructured":"Open Prescribing. Direct oral anticoagulants (DOACs) by all CCGs. 2017. https:\/\/openprescribing.net\/measure\/doacs\/ (accessed 13 Mar 2017)."},{"key":"2025121605111168000_8.3.e021312.13","unstructured":"Open Prescribing. Prescribing of pregabalin by all CCGs. 2017. https:\/\/openprescribing.net\/measure\/pregabalin\/ (accessed 13 Mar 2017)."},{"key":"2025121605111168000_8.3.e021312.14","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.55"},{"key":"2025121605111168000_8.3.e021312.15","doi-asserted-by":"publisher","DOI":"10.1177\/1756283X16637532"},{"key":"2025121605111168000_8.3.e021312.16","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-307105"},{"key":"2025121605111168000_8.3.e021312.17","unstructured":"NHS England. NHS England launches action plan to drive out wasteful and ineffective drug prescriptions, saving NHS over \u00a3190 million a year. 2017. https:\/\/www.england.nhs.uk\/2017\/07\/medicine-consultation\/ (accessed 31 Jul 2017)."},{"key":"2025121605111168000_8.3.e021312.18","unstructured":"Coeliac UK. Prescriptions. 2017. https:\/\/www.coeliac.org.uk\/gluten-free-diet-and-lifestyle\/prescriptions\/ (accessed 19 Sep 2017)."},{"key":"2025121605111168000_8.3.e021312.19","unstructured":"Coeliac UK. What is the truth about cost? 2017. https:\/\/www.coeliac.org.uk\/campaigns-and-research\/campaigning-on-health\/campaign-to-protect-prescription-services-in-england\/what-is-the-truth-about-cost\/ (accessed 19 Dec 2017)."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-021312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T13:11:25Z","timestamp":1765890685000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-021312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,4,16]]},"published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1136\/bmjopen-2017-021312"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-021312","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}