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Abstract Details
Towards collaborative management of nonalcoholic fatty liver disease (TCM-NAFLD): a 'real-world' pathway for fibrosis risk assessment in primary care
Intern Med J. 2021 Jun 17. doi: 10.1111/imj.15422. Online ahead of print.
Kelly L Hayward12, Benjamin J McKillen12, Leigh U Horsfall12, Carolyn McIvor3, Katerina Liew3, Jo Sexton3, Amy L Johnson12, Katharine M Irvine14, Patricia C Valery15, Steven M McPhail67, Laurence J Britton28, William Rosenberg910, Ingrid Weate11, Sue Williams12, Elizabeth E Powell12
Author information
1Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.
2Department of Gastroenterology and Hepatology, Princess Alexandra Hospital; Woolloongabba QLD, Australia.
3Department of Gastroenterology, Logan Hospital; Logan City QLD, Australia.
4Mater Research, The University of Queensland, Translational Research Institute; Woolloongabba QLD, Australia.
5QIMR Berghofer Medical Research Institute; Herston QLD, Australia.
6Clinical Informatics Directorate, Metro South Health; Woolloongabba QLD, Australia.
7Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology; Kelvin Grove QLD, Australia.
8Greenslopes Clinical School, Faculty of Medicine, The University of Queensland, Greenslopes QLD, Australia.
9Institute for Liver and Digestive Health, Division of Medicine, University College London; London, UK.
10The Royal Free London, NHS Foundation Trust; London, UK.
11Jimboomba Medical Centre; Jimboomba QLD, Australia.
12Inala Primary Care; Inala QLD, Australia.
Abstract
Background: The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear.
Aims: We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 Index) with transient elastography (FibroScan®) to streamline NAFLD referrals from a 'routine' primary care population to specialist hepatology management clinics (HMC).
Methods: The 2-step "Towards Collaborative Management of NAFLD" (TCM-NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged ≥18 years with a new or established PCP-diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at "high risk" of clinically significant fibrosis to HMC for specialist review, and "low risk" patients to receive ongoing management and longitudinal follow-up in primary care.
Results: A total of 162 patient assessments between Jun-2019 and Dec-2020 were included. Mean age was 58.7 ± 11.7 years, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ± 6.9 kg/m2 . 122 patients were considered "low risk" for clinically significant fibrosis, two patients had incomplete assessments, and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments.
Conclusion: Implementation of the 2-step TCM-NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost-effective and targeted use of specialist hepatology resources.