Lynch Ruairi, Fallowfield Jonathan, Blane David, Swann Rachael, Mills Kirsty, Cordwell Amy, Forrest Ewan
Department of Hepatology, NHS Tayside, Dundee, Scotland, UK.
Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, Scotland, UK.
NIHR Open Res. 2024 Nov 27;4:58. doi: 10.3310/nihropenres.13650.2. eCollection 2024.
Scotland has the highest rate of deaths from chronic liver disease (CLD) in the UK. Socioeconomic and geographic isolation represent significant challenges to delivery of care. The multidisciplinary Scottish Hepatology Access Research Partnership (SHARP) aimed to identify and break down barriers to diagnosing and treating liver disease in Scotland.
SHARP comprised a core Partnership Management Group that developed projects and a Partnership Advisory Group which provided oversight.
SHARP established workstreams to achieve its aims: Understanding current access to liver services To identify barriers to liver patient care in Scotland we audited liver services and surveyed the experience of patients (n=276); primary care physicians (n=199) and Gastroenterologists/Hepatologists (n=99). Technologies to monitor and diagnose CLD Liver disease is diagnosed and monitored using routine blood testing which disadvantages isolated patients. We plan to develop a point of use test to analyse ALT and AST to enable community-based identification and monitoring of liver disease. Identification of patients at risk of liver disease CLD is often diagnosed late. We propose developing an artificial intelligence tool to predict an individual's risk of an emergent admission to hospital due to CLD. This tool will be validated in a Welsh cohort. Barriers to engagement with care for liver disease Hepatology did-not-attend rates are the highest of any specialty. We propose research to co-design a suite of recommendations to improve engagement with care for CLD patients. We aim to achieve this by interviewing practitioners alongside patients who do and don't engage with services.
Through a national survey SHARP has developed an understanding of the issues affecting access to hepatology services in Scotland. SHARP has developed projects that will help address the issues that socioeconomically and geographically isolated patients face when it comes to identifying and treating liver disease.
在英国，苏格兰的慢性肝病（CLD）死亡率最高。社会经济和地理隔离给医疗服务的提供带来了重大挑战。多学科的苏格兰肝病诊疗准入研究合作项目（SHARP）旨在识别并消除苏格兰肝病诊断和治疗过程中的障碍。
SHARP包括一个负责开展项目的核心合作管理小组和一个提供监督的合作咨询小组。
SHARP设立了工作流程以实现其目标：了解当前肝病服务的可及性 为了识别苏格兰肝病患者护理的障碍，我们对肝病服务进行了审计，并调查了患者（n = 276）、初级保健医生（n = 199）以及胃肠病学家/肝病学家（n = 99）的体验。监测和诊断CLD的技术 目前通过常规血液检测来诊断和监测肝病，这对身处偏远地区的患者不利。我们计划开发一种即时检测方法来分析谷丙转氨酶（ALT）和谷草转氨酶（AST），以便在社区层面识别和监测肝病。识别肝病高危患者 CLD往往在晚期才被诊断出来。我们提议开发一种人工智能工具，以预测个体因CLD紧急入院的风险。该工具将在威尔士队列中进行验证。肝病护理参与的障碍 肝病科的未就诊率在所有专科中是最高的。我们提议开展研究，共同设计一套建议，以提高CLD患者对护理的参与度。我们的目标是通过采访参与和未参与服务的患者及从业者来实现这一目标。
通过全国性调查，SHARP已了解到影响苏格兰肝病服务可及性的问题。SHARP已开展了一些项目，将有助于解决社会经济和地理上孤立的患者在肝病识别和治疗方面面临的问题。
