Center for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
BMC Prim Care. 2022 May 3;23(1):104. doi: 10.1186/s12875-022-01714-x.
In primary care, elevated liver values often appear as incidental findings. As well considering the presenting symptoms, key factors in effective diagnosis are which liver values to include as indicators and when to refer patients for further diagnostics. It is also important that there is coordinated collaboration between GPs and specialists. There has hitherto been a lack of reliable findings on the status quo regarding the evaluation of (abnormally) elevated liver values in primary care.
Between 2017 and 2021, four written explorative surveys of GPs and gastroenterological specialists were conducted in various German states, aimed at taking stock of the current status of GP-based diagnostics of (abnormally) elevated liver values. In addition, interviews were conducted with 14 GPs and gastroenterological specialists. This review article discusses the overall findings of the series of studies in a condensed manner at a higher level. The article aims to derive starting points for optimising the diagnosis of liver cirrhosis in primary care.
There are various challenges and problems associated with the evaluation of elevated liver values. For example, GPs draw on very different laboratory parameters, which are combined in different clusters. When elevated liver values are found, a majority of GPs prefer a controlled wait-and-see period, but often make use of direct referrals to specialists due to diagnostic uncertainties. GPs report interface problems with gastroenterological specialists, which are associated, among other things, with the preliminary evaluation that has been made and the timing of referral. Both GPs and specialists consider the introduction of an evidence-based diagnostic algorithm to be an important starting point for improving early detection and better coordination between healthcare levels.
Efforts should be made to contribute to greater professionalisation and standardisation of primary care diagnostics and to better structure the interaction with gastroenterological specialists. These include a wider range of training formats, the development of a validated diagnostic pathway and the mandating of a liver function test as part of the check-up. The development of a GP-based guideline for managing elevated liver values also seems advisable.
在基层医疗中，升高的肝酶值通常作为偶然发现。除了考虑到症状外，有效诊断的关键因素还包括将哪些肝酶值作为指标纳入考量以及何时将患者转介进行进一步诊断。协调全科医生和专家之间的合作也很重要。迄今为止，关于基层医疗中评估（异常）升高的肝酶值的现状，还缺乏可靠的研究结果。
2017 年至 2021 年，在德国多个州对全科医生和胃肠病学专家进行了四次书面探索性调查，旨在了解基于全科医生的（异常）升高的肝酶值诊断的现状。此外，还对 14 名全科医生和胃肠病学专家进行了访谈。本文以综述的形式，在更高的层面上简要讨论了这一系列研究的总体发现。本文旨在为优化基层医疗中肝硬化的诊断提供起点。
评估肝酶升高值存在各种挑战和问题。例如，全科医生使用的实验室参数差异很大，这些参数被组合成不同的簇。当发现肝酶升高时，大多数全科医生倾向于进行有控制的观望，但由于诊断不确定性，他们经常直接转介给专家。全科医生报告与胃肠病学专家之间存在接口问题，这些问题与初步评估、转诊时机等有关。全科医生和专家都认为引入基于证据的诊断算法是提高早期发现和改善医疗保健水平之间协调的重要起点。
应努力促进基层医疗诊断的专业化和标准化，并更好地组织与胃肠病学专家的互动。这些努力包括提供更广泛的培训形式、开发经过验证的诊断途径以及将肝功能检查作为常规体检的一部分，并制定基于全科医生的管理升高的肝酶值的指南。
