Chronic Liver Disease Management Among Primary Care Providers

BackgroundLiver disease is an increasing cause of premature mortality in the UK. Its management in primary care is not well understood. It is unclear what role commissioning bodies are playing in liver disease in the UK.AimThe aim of this study was to assess the level of engagement with community chronic liver disease management amongst CCGs and health authorities across the UK.Design & settingA cross-sectional survey to all UK CCGs and health authorities.MethodSurvey questions were developed by the British Liver Trust, in collaboration with topic experts, and evaluated structures in place relating to liver disease management at commissioning/health board level.ResultsThere were 159 responses representing 99% UK coverage of CCGs/health boards. 20% reported an individual responsible for liver disease within their organisation with 40% and 29% reporting having pathways in place to respond to abnormal liver blood tests and liver disease more generally respectively. All those reporting use of pathways reported using national guidelines to guide content. 25% made use of transient elastography (Fibroscan) and 16% of direct serum fibrosis markers (eg, ELF score) which are both part of current NICE guidelines. There was marked regional variation in all areas of engagement surveyed, with Wales having exceptionally high levels of engagement in all areas in contrast to the other nations.ConclusionThe results of this survey should be used as a catalyst to highlight necessary regional improvements to the primary care management of chronic liver disease across the UK.

Download Full-text

Immunization Needs of Chronic Liver Disease Patients Seen in Primary Care Versus Specialist Settings

Digestive Diseases and Sciences ◽

10.1007/s10620-005-2873-5 ◽

2005 ◽

Vol 50 (8) ◽

pp. 1525-1531 ◽

Cited By ~ 18

Author(s):

R. Jake Jacobs ◽

Allen S Meyerhoff ◽

Sammy Saab

Keyword(s):

Primary Care ◽

Liver Disease ◽

Chronic Liver Disease ◽

Chronic Liver

Download Full-text

Chronic liver disease in New Haven County: Primary care provider referral patterns

Gastroenterology ◽

10.1016/s0016-5085(00)81792-8 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1472-A1473

Author(s):

Victor J. Navarro ◽

Laura Grosso ◽

Erik Hett ◽

Kirsten Ivie ◽

Beth Bell

Keyword(s):

Primary Care ◽

Liver Disease ◽

Chronic Liver Disease ◽

Care Provider ◽

Primary Care Provider ◽

Chronic Liver ◽

New Haven ◽

Referral Patterns

Download Full-text

Nonalcoholic Fatty Liver Disease (NAFLD) for Primary Care Providers: Beyond the Liver

Current Hypertension Reviews ◽

10.2174/1573402116999201209203534 ◽

2020 ◽

Vol 16 ◽

Author(s):

Eddison Godinez-Leiva ◽

Fernando Bril

Keyword(s):

Primary Care ◽

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Systemic Disease ◽

Primary Care Providers ◽

Major Public Health Problem ◽

Care Providers ◽

Nonalcoholic Fatty Liver

Abstract:: Nonalcoholic fatty liver disease (NAFLD) has consolidated as a major public health problem, affecting ~25% of the global population. This percentage is significantly higher in the setting of obesity and/or type 2 diabetes. Presence of NAFLD is associated with severe liver complications, such as nonalcoholic steatohepatitis (NASH; i.e., presence of inflammation and necrosis), cirrhosis and hepatocellular carcinoma. However, the majority of these patients die of cardiovascular disease. For this reason, management of this condition requires a multidisciplinary team, where primary care providers are at center stage. However, important misconceptions remain among primary care providers, preventing them from appropriately approach these patients. Nonalcoholic fatty liver disease should be understood as part of a systemic disease, characterized for abnormal accumulation of fat in tissues other than the adipose tissue. This, in turn, produces dysfunction of those organs or tissues (process sometimes referred to as lipotoxicity). Therefore, due to the systemic nature of this condition, it should not surprise that NAFLD is closely related to other metabolic conditions. In this review, we will focus on the extrahepatic manifestations of NAFLD and its metabolic and cardiovascular implications. We believe these are the most important issues primary care providers should understand, in order to effectively manage these complicated patients. In addition, we have provided a simple and straightforward approach to the diagnosis and treatment of patients with NAFLD and/or NASH. We hope this review will serve as a guide for primary care providers to approach their patients with NAFLD.

Download Full-text

Preventive Care of Liver Disease by Primary Care Providers

The American Journal of Gastroenterology ◽

10.14309/00000434-200910003-00412 ◽

2009 ◽

Vol 104 ◽

pp. S153-S154

Author(s):

Freddy Caldera ◽

Maria Melguiz-Castro ◽

Jeffrey Gilbert ◽

Lisbeth Selby

Keyword(s):

Primary Care ◽

Liver Disease ◽

Preventive Care ◽

Primary Care Providers ◽

Care Providers

Download Full-text

Population health challenges in primary care: What are the unfinished tasks and who should do them?

SAGE Open Medicine ◽

10.1177/2050312118800209 ◽

2018 ◽

Vol 6 ◽

pp. 205031211880020 ◽

Cited By ~ 1

Author(s):

Frederick North ◽

Sidna M Tulledge-Scheitel ◽

John C Matulis ◽

Jennifer L Pecina ◽

Andrew M Franqueira ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Population Health ◽

Chronic Disease Management ◽

Age Groups ◽

Software Tool ◽

Primary Care Providers ◽

Age Group ◽

Care Providers

Background: There are numerous recommendations from expert sources that help guide primary care providers in cancer screening, infectious disease screening, metabolic screening, monitoring of drug levels, and chronic disease management. Little is known about the potential effort needed for a healthcare system to address these recommendations, or the patient effort needed to complete the recommendations. Methods: For 73 recommended population healthcare items, we examined each of 28,742 patients in a primary care internal medicine practice to determine whether they were up-to-date on recommended screening, immunizations, counseling, and chronic disease management goals. We used a rule-based software tool that queries the medical record for diagnoses, dates, laboratory values, pathology reports, and other information used in creating the individualized recommendations. We counted the number of uncompleted recommendations by age groups and examined the healthcare staff needed to address the recommendations and the potential patient effort needed to complete the recommendations. Results: For the 28,742 patients, there were 127,273 uncompleted recommendations identified for population health management (mean recommendations per patient 4.36, standard deviation of 2.65, range of 0–17 recommendations per patient). The age group with the most incomplete recommendations was age of 50–65 years with 5.5 recommendations per patient. The 18–35 years age group had the fewest incomplete recommendations with 2.6 per patient. Across all age groups, initiation of these recommendations required high-level input (physician, nurse practitioner, or physician’s assistant) in 28%. To completely adhere to recommended services, a 1000-patient cross-section cohort would require a total of 464 procedures and 1956 lab tests. Conclusion: Providers and patients face a daunting number of tasks necessary to meet guideline-generated recommendations. We will need new approaches to address the burgeoning numbers of uncompleted recommendations.

Download Full-text