Abstract
BackgroundLiver 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.AimTo assess the level of engagement with community chronic liver disease management among clinical commissioning groups (CCGs) and health authorities across the UK.Design & settingA cross-sectional survey to all UK CCGs and health authorities.MethodSurvey 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.ResultsThere 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.ConclusionThe 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.
Highlights
Liver disease is a common and increasing cause of morbidity and premature mortality in the UK and globally.[1]
Twenty-five per cent made use of transient elastography (FibroScan) and 16% of direct serum fibrosis markers, 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. 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
Summary
Liver disease is a common and increasing cause of morbidity and premature mortality in the UK and globally.[1] This is in contrast to other common chronic diseases such as heart disease where reduction. Research in morbidity and mortality has been seen over the past 50 years.[2] The main causes of liver disease in the UK are alcohol-related liver disease (ARLD) and non-a lcohol-related fatty liver disease (NAFLD), which is increasing in parallel with the obesity and type two diabetes mellitus (T2DM) epidemics seen in the UK and across the globe.[3] As such, the risk factors for liver disease are in common with those for many other chronic diseases and cancers. 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
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