Mounting evidences suggest an increasing trend in the incidence of liver disease in developed countries. Primary care is a vital setting which requires improvement in the detection and management of liver disease. The lacunae lies in the understanding and confidence of general practitioners (GPs’) in detecting liver disease.

The current study evaluated GPs’ experiences of liver disease highlighting prompt detection and interpretation of liver function tests (LFTs). This qualitative study included semi-structured interviews of a purposive sample of GPs from five primary care study sites. The authors undertook telephone and face-to-face interviews of GPs for obtaining data, which were evaluated thematically with the help of a constant comparative approach.

The results showed that among the 25 GP interviews, four themes were recognized from the data: test-requesting behaviour, confidence and challenges in diagnosing disease, access to specialist tests, and guidance and education. However, explanations of how the recruited patient’s request and interpret LFTs were widely diverse. The major reason found among patients requesting blood tests was the concern over missing diagnoses; patients with mildly abnormal LFTs and those at risk of non-alcoholic fatty liver disease (NAFLD) were specifically the cause of concern. Moreover, GPs perceived themselves as generalists, with unwillingness to take on specialist investigations. Although recommendations improved confidence for some clinicians, others reported that liver disease was too complex to be compliant to simple instructions. Maximum number of GPs felt that relevant, focused education on liver disease were inaccessible to them.

Based on the outcome of the study, it can be summarized that the liver disease is usually not prioritized in primary care. Therefore, GPs should be encouraged to take an active part in identification and management of liver disease. Promotion of awareness, knowledge, and confidence in GPs is warranted to reduce the health burden of liver disease.

Source: Standing HC, Jarvis H, Orr J. GPs’ experiences and perceptions of early detection of liver disease: a qualitative study in primary care. British Journal of General Practice 2018; 68 (676): e743-e749.Available at: https://bjgp.org/content/68/676/e743