Abstract
Elevated liver values are often an incidental finding in outpatient care. A solid working relationship between general practitioners and specialists plays as much of a role in effective diagnostics as do selection and examination of liver values and context as indicators for referral towards more in-depth diagnosis. This article focuses on the status quo as well as potential hurdles and challenges in the relationship between general practitioners and specialists with regard to analysing elevated liver values of uncertain origin. A total of 529 physicians in gastroenterological practices in the German states of Baden-Württemberg, Hesse and Thuringia were invited to take part in an online survey in 2020, of which 313 responded. This contribution focuses on those parts of the survey covering the relationship between general practitioners and specialists. According to the results, 72% of the surveyed gastroenterologists saw working relationships between general practitioners and specialists as beneficial and effective. Even so, a variety of challenges and difficulties in everyday care dominate. Specialists especially criticised preliminary analyses performed by general practitioners as well as time of referral. Apart from that, a wide majority (85%) saw a major role in a structured diagnostic algorithm towards improving early detection and coordination between primary and specialist care. The survey revealed problems in the relationship between general practitioners and specialists. Together with targeted training and further training programmes for general practitioners, a validated diagnostic algorithm for classifying and analysing elevated liver values may be a valuable tool for general practitioners to perform diagnostics and improve the structure within which they work with specialists.Supplementary InformationThe online version of this article (10.1007/s10354-021-00855-5) contains supplementary material, which is available to authorized users.
Highlights
Around 21,000 people in Germany die every year as a result of liver disease, chronic or otherwise, with liver cirrhosis as the cause in 80% of such cases [1,2,3,4,5]
Apart from the question as to which values in which reference ranges and contexts should be included as relevant indicators [19, 22, 24], differentiation plays a crucial role for general practitioners dealing with elevated liver values of unknown aetiology, which cases justify a wait-and-see approach and which cases indicate an immediate need for further diagnostics, for example by direct referral to a specialist or to outpatient liver clinic [19, 21, 22]
The present study has addressed internal and gastroenterological specialists in how they see their relationship with general practitioners in diagnosing and treating patients with moderately elevated liver values, where deficits exist, and which measures would be warranted towards improving early identification of liver disease in outpatient settings
Summary
Around 21,000 people in Germany die every year as a result of liver disease, chronic or otherwise, with liver cirrhosis as the cause in 80% of such cases [1,2,3,4,5]. The frequency with which liver values of unknown aetiology are detected as (incidental) findings [17,18,19] and the role that liver-related disease plays in the healthcare system suggest the importance of timely diagnosis and initiation of targeted treatment This requires a functioning and sufficiently effective relationship between outpatient primary and specialist care [20]. General practitioners as providers of primary care are often the first to discover moderate increases in liver values in their patients during routine examination [16,17,18,19, 21] This poses general practitioners with the challenge of providing quality differential diagnostic analysis within the constraints of time and cost, and often with only basic resources available to them [21, 22]. Apart from the question as to which values in which reference ranges and contexts should be included as relevant indicators [19, 22, 24], differentiation plays a crucial role for general practitioners dealing with elevated liver values of unknown aetiology, which cases justify a wait-and-see approach (with repeat laboratory testing) and which cases indicate an immediate need for further diagnostics, for example by direct referral to a specialist or to outpatient liver clinic [19, 21, 22]
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