Reducing inequalities in care for people with non-alcoholic fatty liver disease Implementation of an innovative community-based and specialist supported integrated care pathway in East Yorkshire (Hull and East Yorkshire Hospitals NHS Trust)

Liver disease is the only major cause of mortality that is increasing in prevalence in the UK. Non-alcoholic fatty liver disease (NAFLD) is the most common type, affecting 25% of adults, 70% of people with diabetes and 90% of those who are morbidly obese.

Despite its prevalence, there are few defined management pathways for NAFLD patients. Most patients are diagnosed in primary care, but current community-based management is poorly defined with significant gaps in expertise.

While many patients have ‘simple’ NAFLD, some patients progress to more severe forms, including cirrhosis or liver cancer. Deciding when to refer patients to a liver specialist is a challenge for GPs.

This innovative project from Hull and East Yorkshire Hospitals NHS Trust brings together GPs and liver specialists through an e-consult clinic, as part of an IT-based integrated care pathway for NAFLD.

The e-consult pathway will standardise and improve care by detailing necessary investigations to determine the cause and severity of liver disease, and will promote early and accurate diagnosis.

Patients presenting in primary care with abnormal liver function tests will be entered onto the e-consult pathway. GPs will make a referral decision: to manage them in primary care or refer them to a specialist. In complex cases, GPs will also have the option of referring the patient virtually for an e-consultation with a specialist. The specialist will review the patient data and provide appropriate management and follow-up advice.

Patients will benefit from reduced clinic appointments and duplicated investigations, earlier diagnosis and more appropriate referrals.

Contact

For further information about the project, please email Bronwen Williams, Hepatology Research Nurse, Hull Royal Infirmary.