P88 Management of liver disease in community and primary care – an update on provision of services

• Published in: Gut Vol. 72; no. Suppl 3; p. A71
• Main Authors: Jarvis, Helen, Berry, Charlotte, Worsfold, Jonathan, Hebditch, Vanessa, Ryder, Stephen
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.09.2023
• Subjects: Cirrhosis; Liver diseases; Mortality; Primary care; Quality control; Risk assessment; Surveys; Variation; United Kingdom > UK
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2023-BASL.103

IntroductionThere are significant regional variations in liver disease outcomes across the UK including in rates of hospital admission and liver disease mortality. The impact that variations in primary care for those at risk of liver disease may have on these outcomes is unknown, but to avoid late presentation of decompensated cirrhosis, with its associated high mortality rates, earlier detection is now accepted as vital. In 2020 we carried out a cross-sectional survey of all UK commissioning bodies/health authorities (1) which revealed huge inequalities in primary care provision for people at risk of liver disease, with variable use of pathways for interpreting abnormal liver blood tests and finding those at high risk of disease, with limited use of non-invasive testing (both serum testing and access to transient elastography). In 2020, only 26% of the UK had an effective pathway in place.This new study will map progress.MethodsA repeat cross-sectional survey is currently being carried out across the UK, using the same methods and questions, with the addition of some questioning to reflect the slightly different commissioning structure in England (Integrated Care Boards). The repeat survey was sent as a Freedom of Information request to all English ICB areas and devolved nation equivalent health boards. Using this method instigated a 98% response rate in the previous survey. Survey responses will be collected and analysed using simple quantitative analysis methods, to be able to map commissioner perspective on provision of pathways of care, and access to tests. The data from this repeat survey will be compared to the previous survey.ResultsThe initial results of the second survey and comparisons to the first survey will be available for presentation at September conference. There has been a rapidly growing interest in early detection of liver disease within the UK liver community. It is crucial that specialist providers (making up the majority of conference audience) are aware of any impact that increasing research activity, collaboration and clinical quality improvement activity is having at a wider commissioning level on community services.ConclusionIt is imperative that we remove the ‘postcode lottery’ of primary care management for people at risk of chronic liver disease. This can best be done by supporting and advising those involved in commissioning community services with up-to-date data. We will present progress in this field since 2020, and discuss strategies to use this data going forward to reduce regional variations in care further.