[Evaluation of abnormal liver chemistries in primary care - A survey on the prerequisites, procedure and challenges faced by general practitioners]

Abstract

Introduction: In primary care, abnormal liver chemistries are often being diagnosed unintentionally. In addition to paying attention to symptoms, it is crucial for an effective clarification which liver values are taken into account as indicators and when patients are referred for further diagnostics. It is also important to have a functioning collaboration between GPs and specialists. To date, there are hardly any current findings about the procedure and the challenges experienced by GPs in German-speaking countries when it comes to clarifying increased liver values.

Methods: In the course of a survey based on several preliminary studies, a total of 2,701 GPs in Hesse and Baden-Württemberg were interviewed between October 2019 and March 2020. The focus was on behavior and strategies with regard to the clarification of elevated liver values. In addition to the descriptive analysis, a factor analysis was performed.

Results: The results show various challenges and problems that primary care is confronted with in everyday practice. There are very different clusters with regard to paying attention to warning signs as well as liver values that are being analyzed in the course of a liver function test. In the case of increased liver values, 59 % of the physicians surveyed generally prefer a controlled waiting. Nevertheless, many GPs refer patients with elevated liver values directly to gastroenterological specialists (66 %). The doctors surveyed experience various interface problems in working with gastroenterological specialists.

Discussion: It seems sensible to take measures that contribute to greater professionalization and standardization of primary care diagnostics and to a more structured cooperation with gastroenterological specialists. These include, for example, a broader range of training and further education formats, the development of a validated diagnostic pathway for classifying and evaluating elevated liver enzymes (especially early detection of patients at increased risk for liver fibrosis or liver cirrhosis) or the establishment of a liver function screening as part of the general medical check-up. The development of a GP-based guideline for dealing with increased liver values should be followed up.