Engagement with community liver disease management across the UK: a cross-sectional survey

Abstract

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.

Exploring changing attitudes to non-invasive liver fibrosis tests in secondary care pathways: comparison of two national surveys

“…Attempts to rectify these inequalities in access has been facilitated through the National Pathology Exchange hosted by the NHS, allowing any lab across the UK to request and access an ELF test 32. Similar accessibility issues were found with TE, with only 19% of CCGs in England having access compared with all health boards in Wales (100%) 26. NICE is set to publish guidance supporting the use of TE in the primary and community care setting in 2023 which should also begin to ameliorate issues around accessibility 33.…”

“…When examining pathways in primary or secondary care that use NITs of liver fibrosis to guide management of patients with, or at risk of liver disease, we found 65.2% of respondents, representing 40.1% of acute hospital trusts, stating they did have a pathway in place in 2021. This contradicts a recent comprehensive cross-sectional study by Jarvis et al of 99% CCGs and health boards in the UK in 2020 26. The authors found 40% had a primary care pathway to evaluate abnormal liver blood tests and 29% had a pathway to manage common liver diseases 26.…”

“…This is corroborated by Jarvis et al in their survey of CCGs and health boards in the UK, with substantial regional variation. For example, direct serum fibrosis markers such as ELF test, were utilised by 13% of CCGs in England vs 50% of Scottish health boards 26. This is despite ELF test being recommended by the National Institute for Health and Care Excellence (NICE) guidelines for risk stratification in patients with NAFLD 31.…”

Community pathways for the early detection and risk stratification of chronic liver disease: a narrative systematic review

“…A national survey by Jarvis et al of clinical commissioning groups across the UK, with 99% of groups responding, found only 29% and 40% of regions had some pathway in place to manage liver disease or abnormal LFTs respectively in the primary care setting (41). This is despite all the pathways presented in this review having demonstrated superiority over "standard of care" in detection of liver disease, with robust cost benefit being illustrated in modelling from iLFTs and Scarred Liver Project.…”

Liver disease management as routine work in primary care: a qualitative interview study to guide implementation

“…Several research studies have shown pathways to find chronic liver disease in the community lead to an increase in detection of significant disease 5 , 6 and are cost-effective. 7 Despite this, implementation of these pathways has been slow and partial 8 and there has been little prospective study of how they may fit within routine primary care work.…”