Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics
Primary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a maj...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2020-04-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1486 |
| _version_ | 1797936441770115072 |
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| author | Harendran Elangovan Sashen Rajagopaul Suzanne M. Williams Benjamin McKillen Laurence Britton Steven M. McPhail Leigh U. Horsfall Patricia C. Valery Kelly L. Hayward Elizabeth E. Powell |
| author_facet | Harendran Elangovan Sashen Rajagopaul Suzanne M. Williams Benjamin McKillen Laurence Britton Steven M. McPhail Leigh U. Horsfall Patricia C. Valery Kelly L. Hayward Elizabeth E. Powell |
| author_sort | Harendran Elangovan |
| collection | DOAJ |
| description | Primary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a major referral hospital, and to determine the severity of liver disease and patient pathway following evaluation in secondary care. New patients seen in the hepatology outpatient clinic (HOC) with a secondary care diagnosis of NAFLD were identified from the HOC scheduling database. PCP referrals for these patients were retrieved from the electronic medical records and reviewed by study clinicians, along with the hepatologists’ clinic notes and letters. Over a 14‐month period, 234 new PCP referrals received a diagnosis of NAFLD, accounting for 20.4% of the total number of new cases (n = 1,147) seen in the HOC. The 234 referrals were received from 170 individual PCPs at 135 practices. Most patients with NAFLD (88.5%) were referred for investigation of abnormal liver enzymes or other clinical concerns, including abnormal iron studies, hepatomegaly, and abdominal pain. Only 27 (11.5%) referrals included an assessment of liver disease severity. Following evaluation in the liver clinic, 175 patients (74.8%) were found to have a low risk of advanced fibrosis, and most (n = 159; 90.9%) were discharged back to their PCP for ongoing follow‐up in primary care. Conclusion: In addition to better access to noninvasive fibrosis tests, educational strategies to enhance awareness and recognition of NAFLD as a cause for many of the initial concerns prompting patient referral might improve risk stratification and increase the appropriateness of PCP referrals. |
| first_indexed | 2024-04-10T18:30:49Z |
| format | Article |
| id | doaj.art-40dde59b71fb4540b4e86db82d41b2ba |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T18:30:49Z |
| publishDate | 2020-04-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-40dde59b71fb4540b4e86db82d41b2ba2023-02-02T04:27:15ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2020-04-014451852610.1002/hep4.1486Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology ClinicsHarendran Elangovan0Sashen Rajagopaul1Suzanne M. Williams2Benjamin McKillen3Laurence Britton4Steven M. McPhail5Leigh U. Horsfall6Patricia C. Valery7Kelly L. Hayward8Elizabeth E. Powell9Center for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaInala Primary Care Inala AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaAustralian Center for Health Services Innovation Queensland University of Technology Brisbane AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaCenter for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba AustraliaPrimary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a major referral hospital, and to determine the severity of liver disease and patient pathway following evaluation in secondary care. New patients seen in the hepatology outpatient clinic (HOC) with a secondary care diagnosis of NAFLD were identified from the HOC scheduling database. PCP referrals for these patients were retrieved from the electronic medical records and reviewed by study clinicians, along with the hepatologists’ clinic notes and letters. Over a 14‐month period, 234 new PCP referrals received a diagnosis of NAFLD, accounting for 20.4% of the total number of new cases (n = 1,147) seen in the HOC. The 234 referrals were received from 170 individual PCPs at 135 practices. Most patients with NAFLD (88.5%) were referred for investigation of abnormal liver enzymes or other clinical concerns, including abnormal iron studies, hepatomegaly, and abdominal pain. Only 27 (11.5%) referrals included an assessment of liver disease severity. Following evaluation in the liver clinic, 175 patients (74.8%) were found to have a low risk of advanced fibrosis, and most (n = 159; 90.9%) were discharged back to their PCP for ongoing follow‐up in primary care. Conclusion: In addition to better access to noninvasive fibrosis tests, educational strategies to enhance awareness and recognition of NAFLD as a cause for many of the initial concerns prompting patient referral might improve risk stratification and increase the appropriateness of PCP referrals.https://doi.org/10.1002/hep4.1486 |
| spellingShingle | Harendran Elangovan Sashen Rajagopaul Suzanne M. Williams Benjamin McKillen Laurence Britton Steven M. McPhail Leigh U. Horsfall Patricia C. Valery Kelly L. Hayward Elizabeth E. Powell Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics Hepatology Communications |
| title | Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics |
| title_full | Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics |
| title_fullStr | Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics |
| title_full_unstemmed | Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics |
| title_short | Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics |
| title_sort | nonalcoholic fatty liver disease interface between primary care and hepatology clinics |
| url | https://doi.org/10.1002/hep4.1486 |
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