Identification of potential barriers to implementing a community-based liver service to identify progressive liver disease; and the effectiveness of biomarkers and transient elastography to identify early progressive liver disease within the service

Abstract

Liver disease is the UK’s third commonest cause of premature death, and is present, often undiagnosed, in 30% of the UK population. Early identification of liver disease is key to helping manage disease progression. Liver disease can be hard to identify because it progresses without symptoms. In recent years the investigation into the early stages of liver disease has been developed in the sphere of primary care.
My research for this PhD by Publication examined the efficacy of this community based approach to liver disease. My initial aim was a qualitative investigation into how well a community based liver service works from the view of the practice staff, and what changes could be made to improve the service. I then evaluated the liver service, following up on those patients who had visited it, and assessed approaches within liver health care including vibration controlled transient elastography scanning, the use of biomarkers and their threshold values. Finally, I assessed whether it is possible to use commonly collected patient data to identify patients at risk of significant liver disease.
My research showed that the concept of a Community Liver Service has been met with wide approval by those involved with it, confirming that the earlier stages of liver disease can be managed in primary care. My evaluation of the Community Liver Service resulted in my presenting recommendations for revised biomarker thresholds, and allowed me to formulate an algorithm which uses common patient data to identify those at risk of significant liver disease. I conclude by arguing that my service evaluation data supports the case for liver screening as part of routine health care, particularly for high risk patients such as those living with type 2 diabetes.
If we can improve early identification and treatment of the disease within primary care, and increase the efficiency of our early investigations and treatments, we can potentially save lives. This thesis presents the research that shows how such advances are possible.

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ORCID for Katherine Bradbury: orcid.org/0000-0001-5513-7571

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