Blood tests in primary care cut unnecessary NAFLD referrals by 80%, finds study.

Blood tests carried out in primary care could cut the number of unnecessary secondary care referrals for NAFLD by almost 80%, a study has found.

Tests carried out by GPs reduced unnecessary NAFLD referrals by detecting cases of clinically significant liver disease earlier.

The study, published in the Journal of Hepatology, was carried out by UK researchers and looked at just over 3000 patients with NAFLD in Camden and Islington CCGs.

Half of the patients received standard care from their GP and half were put on a pathway that involved having a FIB-4 score recorded, which was based on blood tests including platelet count, ALT and AST, to determine their risk of developing fibrosis.

Patients at low risk were managed in primary care, patients at high risk were referred for specialist assessment and those with an indeterminate result were given a further blood test to assess their fibrosis risk. They were then managed in primary care or referred accordingly.

The researchers found that of the patients on the NAFLD pathway who were referred to secondary care, 30% had advanced fibrosis and 15% had cirrhosis, compared with 5% and 4% respectively before the introduction of the pathway.

When compared to standard care referrals from Camden and Islington, the pathway was five times better than standard care at detecting advanced fibrosis and cirrhosis.

The NAFLD pathway also led to an 81% reduction in the number of unnecessary referrals to secondary care when compared to standard primary care management.

The researchers said in the paper: ‘Prior to introduction of the pathway, the vast majority of referrals made to secondary care hepatologists could have been managed in primary care.

‘We believe that this pattern of referral is common for NAFLD. Reducing inappropriate referrals represents an opportunity to reduce unnecessary investigations, inconvenience and even harm for patients, pressure on secondary care services and costs for the healthcare system.

‘The NAFLD pathway is highly generalisable, as GPs will have access to both FIB-4 and ELF tests through most biochemistry laboratories.’