Cardiff and Vale University Health Board (CVUHB) were accepted as an adoption site of the ABMU Bevan exemplar to start in April 2020.
The exemplar project provided a dietetic service for staff with IBS. Due to the global pandemic we were unable to set up and recruit to a staff service. Relocation of community dietetic staff lead to a number of patients with IBS waiting for dietary advice so these patients were transferred to the Bevan project.
The service was delivered by a Registered Dietitian trained specifically in the assessment and delivery of IBS dietary information to include the low FODMAP diet.
Clinics were delivered virtually via telephone and Attend Anywhere. A pathway to enable patients to receive and return a food and symptom diary via email which complied with GDPR was set up. This also enabled us to send patients dietary information and to respond to non-urgent queries for patients.
Observations and lessons learned
55% of patients had tried to follow the low FODMAP diet and failed. Research demonstrates the success of the low FODMAP diet, however, this is with the support of a registered dietitian. Patients need support to understand who the low FODMAP diet is suitable for, the process of elimination and most importantly reintroduction and how to make the necessary dietary changes. Many patients try the low FODMAP diet before trying the simpler first line advice. Often the medical profession overestimates health literacy; patients believe they are following healthy eating guidelines and underestimate the impact of healthy eating on IBS symptoms.
Patients report the value of the individualised approach offered by a registered dietitian who can also explain how the diagnosis of IBS has been made.
Whilst the pandemic led to many challenges, being at home meant many patients reported less stress and anxiety regarding their bowel symptoms.
Patients are reluctant to stop medications, even when they admit they are not particularly effective “just in case”. Our longer term objective is for patients with IBS symptoms, but without red flags to be referred for dietetic advice earlier reducing the need for unnecessary investigations and medication.
Patients were more likely to forget a virtual appointment; we are hoping to set up a text reminder service in the future.