Evaluation of Abnormal Liver Chemistries in General Practitioner Care - The Reality of Primary Care in Germany

Abstract

In general practitioner care, abnormal liver chemistries are often being diagnosed unintentionally. So far, there is no evidence-based, structured diagnostic pathway for classifying and evaluating elevated liver enzymes, especially with regard to the early detection of patients at increased risk for liver fibrosis or liver cirrhosis. Accordingly, dealing with elevated liver values which are noticed in the course of a general blood examination is a diagnostic challenge that strongly depends on the doctor's approach. In the course of a survey, 391 general practitioners in Rhineland-Palatinate and Saarland were interviewed between March and June 2017. The focus was on behavior and strategies with regard to the clarification of elevated liver values as well as the identification of challenges and training interests. In addition to the descriptive analysis, a factor analysis was performed. The determination of liver values such as γ-GT, AST and ALT is frequently performed in general practitioner care without the existence of any particular cause. There are strongly different clusters of liver values that are being analyzed in the course of a liver function test. In the case of increased liver values, a majority of the physicians surveyed generally prefer a controlled waiting (58 %). Due to the absence of an established diagnosis and treatment pathway, challenges arise in everyday practice which relate to controlled waiting, cooperation with gastroenterological specialists, as well as orientation to predefined laboratory value portfolios. In addition to the introduction of an evidence-based diagnosis and treatment pathway, it should be considered to optimize the flow of information between general practitioners and gastroenterological specialists. Last but not least, it would be desirable if more training courses for general practitioners could be offered in this subject area.