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• W3138464340 abstract "Liver disease, most commonly caused by alcohol or the metabolic syndrome (leading to non-alcohol related fatty liver disease [NAFLD]), is now a leading cause of premature death in the UK.1 Morbidity and mortality due to liver disease have been rising in line with obesity, diabetes, and high levels of hazardous alcohol consumption. Liver disease caused by chronic viral hepatitis is an exception to this trend, with successful vaccination programmes for hepatitis B, along with very effective curative treatments for hepatitis C, leading to a reduction in end-stage liver disease as a result of these aetiologies in the UK.2 Most patients with cirrhosis are diagnosed late, with up to 70% presenting with a complication of cirrhosis, such as variceal haemorrhage or ascites.3 Rising mortality rates due to liver disease are in sharp contrast to most other chronic diseases in the UK, where rates have been steadily falling with improved primary and secondary prevention, and better access to effective interventions.3 This has been partly driven by enhanced risk assessment and early intervention in primary care.4Liver disease should now be considered as a preventable chronic disease. Risk factors are well known and easily identifiable, and access to diagnostic tests and evidence-based interventions has improved. But adoption of a preventive approach in primary care will require a major shift in the framing of liver disease. GPs are more familiar with reacting to abnormal blood results or a late-stage decompensated cirrhotic patient. In contrast with the preventive approach widely adopted for conditions such as heart disease, proactive assessment of the patient with risk factors for liver disease has not yet been widely accepted. There are no Quality and Outcomes Framework (QoF) incentives or widely followed guidelines in UK general practice to prompt change, although evidence is mounting that this …" @default.
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• W3138464340 date "2021-03-26" @default.
• W3138464340 modified "2023-09-26" @default.
• W3138464340 title "The pathway to better primary care for chronic liver disease" @default.
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• W3138464340 doi "https://doi.org/10.3399/bjgp21x715553" @default.
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