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. 2021 Oct 26;5(5):BJGPO.2021.0085.
doi: 10.3399/BJGPO.2021.0085. Print 2021 Oct.

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

Helen Jarvis  1 , Jonathan Worsfold  2 , Vanessa Hebditch  2 , Stephen Ryder  3
Affiliations

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

Helen Jarvis et al. BJGP Open. .

Abstract

Background: Liver 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.

Aim: To assess the level of engagement with community chronic liver disease management among clinical commissioning groups (CCGs) and health authorities across the UK.

Design & setting: A cross-sectional survey to all UK CCGs and health authorities.

Method: Survey 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 and health board level.

Results: There were 159 responses representing 99% UK coverage of CCGs and health boards. Twenty per cent 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. Twenty-five per cent made use of transient elastography (FibroScan) and 16% of direct serum fibrosis markers (for example, enhanced liver fibrosis [ELF] score), which are both part of current National Institute for Health and Care Excellence (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.

Conclusion: The 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.

Keywords: access and evaluation; liver diseases; primary health care; quality of health care; surveys and questionnaires.

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Figures

Figure 1.
Figure 1.. The availability of clinical commissioning group or health board-endorsed community liver pathways in the UK.
Key: red = no pathway for either the interpretation of liver blood tests or liver disease more generally; yellow = pathway for the interpretation of liver blood tests only or pathways in development; blue = pathways for both; black = no response to survey.
Figure 2.
Figure 2.. Percentage of clinical commissioning group or health authorities using proactive methods to identify liver disease by risk factor
Figure 3.
Figure 3.. Percentage of clinical commissioning groups and health authorities using proactive methods to identify liver disease by assessment method
See this image and copyright information in PMC

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