Nurse-Led Program in Primary Care Can Up Detection of Liver Dz

A nurse-led primary care intervention can increase the number of new diagnoses of liver disease, according to a study published online Dec. 21 in PLOS ONE.

Magdy El-Gohary, B.Sc., B.M., from the University of Southampton in the United Kingdom, and colleagues randomly assigned 10 general practitioner (GP) practices to an intervention, with nurse-led primary care-based liver clinics using additional noninvasive testing, or care as usual. To ascertain baseline prevalence of liver disease, pre-recruitment audits were carried out in each practice. Participants were then recruited via GP referral, nurse-led case findings based on risk factors, or random AUDIT questionnaire mail-outs.

A total of 910 participants were seen in the nurse-led clinic: 4.8 percent with probable cirrhosis, 15.5 percent with progressive fibrosis, 24.2 percent with liver warning, and 55.5 percent with no evidence of liver fibrosis. The researchers found that 49.5 and 39.1 percent of cases were due to nonalcoholic fatty liver disease and alcohol, respectively. For the 405 patients with a liver disease diagnosis, 33.6, 53.8, and 12.6 percent were referred by GP, nurse-led case finding, and the AUDIT mail-out, respectively. A total of 544 incident cases were identified in the intervention arm compared with 221 in the control arm (adjusted odds ratio, 2.4).

"Incorporating a liver nurse within primary care was simple to arrange and yielded a much higher number of new diagnoses of liver disease compared to usual care," El-Gohary said in a statement.

One author disclosed financial ties to the pharmaceutical industry.

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