Pharmacy de-medicalising of gluten free products through a subsidy card scheme – exploring views on the scheme, including impact on quality of life, perceived economic implications and potential barriers to uptake.

Background and Context

Coeliac disease requires a strict gluten-free diet, to prevent long-term complications. Gluten free foods (GFF) were made available on prescription in the late 1960s to encourage patients to adhere to a GF diet when the availability of such foods in shops was extremely limited. GF foods are now readily available in large supermarkets and patients can obtain these foods without a prescription. The Hywel Dda University Health Board introduced the GFF subsidy card in 2019 as an alternative to providing GFF through prescriptions, which is still the method used by other health boards in Wales.

The current prescription system has limitations, and this research seeks to explore patients’ views of the subsidy card scheme to help people with coeliac disease buy GFF more easily and to explore whether accessing gluten-free foods (GFF) can be difficult, especially in rural areas where availability and affordability may be limited.

Aims

The study aimed to:

• Understand people’s views on the current prescription system
• Understand people’s views on the new subsidy card scheme
• Identify barriers and facilitators to using the card
• Understand what’s most important to people when it comes to accessing gluten-free products
• Understand the reasons why some people chose not to join the pilot program run by the Hywel Dda University Health Board
• Provide suggestions for how future programmes should be designed and rolled out

Strategy/Method

The study used semi-structured interviews to explore participants’ experiences and perspectives.

The researchers conducted interviews with coeliac patients and parents of coeliac children. They used a qualitative approach to gather detailed insights.

The study included people with coeliac disease, including both current users of the subsidy card, those using prescriptions, and those who opted out of the card scheme.

Findings/Outcomes

• Flexibility, Convenience and Financial savings: Users appreciated the card’s flexibility, variety of products, and convenience compared to prescriptions.They mentioned that it helps reduce their financial burden and allows them to feel more included in social activities.
• Challenges: Issues included managing card balances, limited retailer acceptance, and geographical disparities.
• Non-Users’ Concerns: Non-users liked the idea of increased choice but worried about inflation, misuse, and the additional burden on taxpayers. Most people (70%) were interested in switching to the subsidy card, but a smaller group felt unsure or hesitant about it.

Impact – so what?

The research highlights the potential of the subsidy card scheme to improve the quality of life for many people with coeliac disease by making GFF more accessible and convenient.

How will the research be used? The findings will be used to inform the development of the subsidy card scheme as an option for coeliac patients across Wales.

How will it be of benefit in the real world? By implementing the recommendations, the subsidy card scheme can provide a more effective and user-friendly solution for accessing GFF, ultimately supporting better health outcomes and reducing the financial burden on both patients and the healthcare system.

Key Findings

The subsidy card scheme offers significant benefits to patents, such as reduced financial burden, increased choice and convenience, but requires improvements in digital tools for balance management, expanded retailer partnerships, and better communication to address existing challenges and concerns.

Lay Summary written by Anthony Cope, Public Partnership Group Member. 

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