Liver nurses help spot liver disease in primary care

Last Updated: 2019-01-02

By David Douglas

NEW YORK (Reuters Health) - Incorporating liver nurses into primary-care practice has given an important boost to diagnosis of conditions such as cirrhosis, UK researchers say.

In a paper online December 21 in PLoS One, Dr. Magdy El-Gohary of the University of Southampton and colleagues note that early identification is paramount because liver disease progresses silently, with few if any signs or symptoms.

Alcohol-related liver disease can be a particular problem, they add, but "the increasing prevalence of non-alcohol related fatty liver disease both in the UK and elsewhere is also of concern."

To help improve levels of diagnosis, the team set up nurse-led primary-care-based liver clinics in general practices. Ten practices were randomized to participate in the intervention, which used additional non-invasive testing, or to usual care.

Pre-recruitment audits were carried out in each practice to ascertain the baseline prevalence of liver disease. Participants were then recruited into the intervention practices via GP referral, nurse-led case finding based on risk factors, or from responses to randomly mailed questionnaires.

Between 2014 and 2016 the new approach "yielded a substantially higher total of new diagnoses in the intervention practices compared to the control." This amounted to 544 compared to 221.

Among the cases, 49.5% were due to non-alcohol related fatty liver disease and 39.1% were alcohol-related. Probable cirrhosis was seen in 4.8%.

In total, 910 participants were seen in the nurse-led clinic. Of the 405 cases with a liver-disease diagnosis, 53.8% came from nurse-led case finding, 33.6% were referred by a GP and only 12.6% from the mailed questionnaire.

After adjusting for baseline liver-disease rate, logistic regression analysis yielded a statistically significant odds ratio of 2.4 in favor of the intervention. A further sensitivity analysis including factors such as "just progressive fibrosis or probable cirrhosis" supported the finding.

The researchers note that the study "was also able to demonstrate that the incorporation of liver nurses into the practices was practical, straightforward to implement, and welcomed by the practice staff."

They further observe that a larger trial of the approach "with longer term follow-up including liver outcomes as well as health economic analysis is planned. Alternative strategies to identify and screen harmful drinkers to assess those at higher risk remains a priority."

Dr. El-Gohary told Reuters Health by email, "Our findings hopefully raise the possibility that with improved access to testing for early liver disease in primary care, we can identify and optimise management sooner on in the course of the condition."

This, he concluded, "could for example mean providing better alcohol support services for patients, referring earlier for treatment of viral hepatitis or optimising management of type 2 diabetes, with the aim of reducing liver associated deaths and complications from advanced liver disease."

SOURCE: https://bit.ly/2VoaTO1

PLoS One 2018.