Stuart Mcpherson
Due to the rising prevalence of its common lifestyle-related metabolic risk factors-obesity, inactivity, smoking, and alcohol consumption-addressing primary care's low confidence in detecting and managing chronic liver disease (CLD) is becoming increasingly important. Although liver blood tests are frequently used to manage long-term conditions, their interpretation rarely focuses on specific risk factors for liver disease. Primary care education should emphasize that isolated minor LFT abnormalities are unreliable in estimating risk of fibrosis progression, emphasize the use of pragmatic algorithms like FIB-4 to differentiate between patients who require referral for further fibrosis risk assessment and those who can be managed in the community, and outline how liver fibrosis is the flag of pathological concern. Utilizing existing frameworks for long-term condition care, measures to increase primary care's interest and engagement should incorporate liver disease consideration alongside other metabolic disorders, type 2 diabetes, cardiovascular disease, chronic kidney disease, and so on. Reduced reflex repeat testing of minor abnormalities, improved secondary care referrals, and improvements in the patient's journey through long-term multimorbidity care are selling points when considering the necessary investment in developing local fibrosis assessment pathways. When pathways are aligned with community lifestyle support services, it is likely that focusing on improving CLD will have a wide range of benefits for metabolic disorders that coexist. The most important message for primary care is to increase the value of the monitoring that is already in place rather than creating more work.
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