Elangovan Harendran, Rajagopaul Sashen, Williams Suzanne M, McKillen Benjamin, Britton Laurence, McPhail Steven M, Horsfall Leigh U, Valery Patricia C, Hayward Kelly L, Powell Elizabeth E
Center for Liver Disease Research Faculty of Medicine The University of Queensland Translational Research Institute Woolloongabba Australia.
Department of Gastroenterology and Hepatology Princess Alexandra Hospital Woolloongabba Australia.
Hepatol Commun. 2020 Feb 20;4(4):518-526. doi: 10.1002/hep4.1486. eCollection 2020 Apr.
Primary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a major referral hospital, and to determine the severity of liver disease and patient pathway following evaluation in secondary care. New patients seen in the hepatology outpatient clinic (HOC) with a secondary care diagnosis of NAFLD were identified from the HOC scheduling database. PCP referrals for these patients were retrieved from the electronic medical records and reviewed by study clinicians, along with the hepatologists' clinic notes and letters. Over a 14-month period, 234 new PCP referrals received a diagnosis of NAFLD, accounting for 20.4% of the total number of new cases (n = 1,147) seen in the HOC. The 234 referrals were received from 170 individual PCPs at 135 practices. Most patients with NAFLD (88.5%) were referred for investigation of abnormal liver enzymes or other clinical concerns, including abnormal iron studies, hepatomegaly, and abdominal pain. Only 27 (11.5%) referrals included an assessment of liver disease severity. Following evaluation in the liver clinic, 175 patients (74.8%) were found to have a low risk of advanced fibrosis, and most (n = 159; 90.9%) were discharged back to their PCP for ongoing follow-up in primary care. In addition to better access to noninvasive fibrosis tests, educational strategies to enhance awareness and recognition of NAFLD as a cause for many of the initial concerns prompting patient referral might improve risk stratification and increase the appropriateness of PCP referrals.
基层医疗医生在非酒精性脂肪性肝病（NAFLD）的诊断和管理中起主要作用，并负责挑选患者转诊至肝病专家处进行进一步评估。本研究旨在描述一家大型转诊医院中被诊断为NAFLD的患者由基层医疗医生转诊的情况，并确定二级医疗评估后的肝病严重程度及患者就医流程。从肝病门诊（HOC）排班数据库中识别出在肝病门诊就诊且二级医疗诊断为NAFLD的新患者。这些患者的基层医疗医生转诊记录从电子病历中获取，并由研究临床医生与肝病专家的门诊记录和信件一同进行审查。在14个月的时间里，234例新的基层医疗医生转诊患者被诊断为NAFLD，占肝病门诊新病例总数（n = 1147）的20.4%。这234例转诊来自135家医疗机构的170名基层医疗医生。大多数NAFLD患者（88.5%）因肝酶异常或其他临床问题（包括铁代谢检查异常、肝肿大和腹痛）被转诊进行检查。只有27例（11.5%）转诊包括对肝病严重程度的评估。在肝病门诊评估后，175例患者（74.8%）被发现进展为肝纤维化的风险较低，且大多数患者（n = 159；90.9%）被转回基层医疗医生处，以便在初级保健中进行持续随访。除了更好地获得非侵入性纤维化检测外，提高对NAFLD作为导致许多促使患者转诊的初始问题原因的认识和识别的教育策略，可能会改善风险分层，并提高基层医疗医生转诊的合理性。
