Exploring the Community Pharmacist's Knowledge of Celiac Disease

Carmela Avena-Woods, PharmD, BS Pharm; Robert A. Mangione, EdD; Wenchen Kenneth Wu, PhD, MBA


Am J Pharm Educ. 2018;82(2) 

In This Article

Abstract and Introduction


Objective. To evaluate pharmacists' knowledge of celiac disease, and identify potential areas where additional continuing education may be needed.

Methods. A survey was sent to community pharmacists practicing in a national chain pharmacy in one region of New Jersey and New York.

Results. There were 418 pharmacists who responded to the survey with a response rate of 38%. Only 27% of all respondents who reported their understanding of celiac disease to be basic or advanced correctly defined celiac disease as both an autoimmune and a chronic lifelong disease. The majority (60%) of respondents correctly stated there are no federal regulations requiring manufacturers to designate medications as gluten-free. Twenty percent of respondents said they often recommended a change in diet to people suspected to have celiac disease before a confirmed diagnosis.

Conclusion. Community pharmacists possess some knowledge of the disease and would benefit from and desire additional education about this disorder.


Celiac disease is an important chronic autoimmune disease that is estimated to affect 1% of the U.S. population.[1] This disorder is often overlooked or misdiagnosed, potentially leading to decreased quality of life for individuals with the disease and an increase in health care costs. People with celiac disease have a genetic intolerance to gluten and must therefore maintain a strict lifelong gluten-free lifestyle totally avoiding any ingestion of wheat, barley or rye. Although the major site of injury in celiac disease is the small intestine, resulting in various gastrointestinal problems, ingesting gluten by these patients may also result in a wide variety of other clinical manifestations including vitamin and other nutritional deficiencies, systemic inflammatory reactions, other autoimmune diseases, serious types of cancer and other illnesses.[2] Pharmacists can play a key role in assisting patients with celiac disease by helping to identify people who may have the disease, providing information about gluten-free pharmaceutical products and food, and encouraging patients to maintain a gluten-free diet after diagnosis.[3]

Pharmacists have consistently been viewed as one of the most trusted health care professionals. Community pharmacists are also recognized as one of the most accessible health care providers. It is also noteworthy that for several consecutive years pharmacists have been highly ranked as ethical and honest professionals. In 2016, they were the second top ranked profession for honesty and ethics.[4]

Researchers have demonstrated that community pharmacists, working in collaboration with other health care providers, have helped to decrease readmission rates and reduce the number of medication-related problems experienced by patients with various disorders and have a positive impact on improving overall patient outcomes.[5–7] For example, pharmacists with competent knowledge on celiac disease can potentially prevent and help patients and other health care providers identify complications from the disease which may lead to hospitalizations, readmissions and a decreased quality of life for patients.

Knowledgeable pharmacists can help patients to more effectively manage their medical conditions, which may potentially lower risks of disease-related complications and health care costs. Interventions led by community pharmacists have demonstrated to help patients with specific chronic diseases achieve better outcomes.[8–10] While several continuing education programs on celiac disease do exist, the level of pharmacist knowledge regarding this disease specifically was never assessed in previous studies.

The objective of this study is to evaluate the extent of community pharmacists' self-assessed and actual knowledge about celiac disease and to identify areas where additional training may be needed.