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Evaluation of a primary to secondary care referral pathway and novel nurse-led one-stop clinic for patients with suspected non-alcoholic fatty liver disease. | LitMetric

AI Article Synopsis

  • Non-alcoholic fatty liver disease (NAFLD) affects about 25% of adults, with some at risk for serious conditions like cirrhosis; this study explored a new care pathway involving a nurse-led clinic for NAFLD patients.
  • In a review of 904 patients diagnosed with NAFLD from 2014 to 2017, they found that 70.8% could be safely discharged to primary care after assessments, with lifestyle advice provided.
  • The new pathway improved screening for hepatitis and identified new cases of alpha-1-antitrypsin deficiency, suggesting it helps manage the demand for specialized liver care.

Article Abstract

Objective: Non-alcoholic fatty liver disease (NAFLD) affects approximately one in four adults of the general population, with an important minority of cases at high risk of developing cirrhosis. We evaluated the utility of a primary care NAFLD pathway incorporating a specialist nurse-led NAFLD clinic and a two-step testing approach for advanced liver fibrosis.

Design/method: We performed a retrospective evaluation of prospectively collected demographic and clinical data on all patients diagnosed with NAFLD and intermediate NAFLD fibrosis score seen in our nurse-led NAFLD clinic between 1 May 2014 and 30 April 2017. Patients were assessed using a specific clerking pro forma and transient elastography (TE). Discharge to primary care with lifestyle advice was considered where TE<7.9 kPa.

Results: 904 patients were identified, 114 (12.6%) of whom did not meet NAFLD criteria. Among the NAFLD population (n=790 (87.4%)), TE<7.9 kPa was present in 558 patients (70.6%), 519 of whom were discharged to primary care. Selected patients were followed up in secondary care despite TE<7.9 kPa or discharged with TE≥7.9 kPa. TE was unreliable in 22 patients (2.7%). Overall, 559 (70.8%) of patients with confirmed NAFLD were discharged from the nurse-led clinic. Introduction of the new pathway was associated with increased screening for hepatitis B and C viruses in primary care, and 17 new cases of alpha-1-antitrypsin deficiency were identified.

Conclusion: An integrated primary/secondary care NAFLD pathway, including a specialist nurse-led clinic may be a useful way of managing increasing demand on secondary care hepatology services.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873539PMC
http://dx.doi.org/10.1136/flgastro-2019-101304DOI Listing

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