COMMANDS-02 : An e-consult NAFLD Integrated Care Pathway

• Research type

  Research Study

• Full title

  Implementation of an Innovative e-Consult Integrated Care Pathway to Improve Community-based Management of Non-Alcoholic Fatty Liver Disease in East Yorkshire

• IRAS ID

  197755

• Contact name

  George Farid Abouda

• Contact email

  George.Abouda@hey.nhs.uk

• Sponsor organisation

  Hull and East Yorkshire Hospitals NHS Trust

• Duration of Study in the UK

  5 years, 11 months, 28 days

• Research summary

  NAFLD is the largest contributor to the increasing burden of advanced liver disease, with an estimated 25% adult prevalence in the UK. Few defined management pathways exist and current community-based management is poorly defined.
  Some NAFLD patients progress to cirrhosis of the liver or liver cancer and when to refer patients to liver specialists is a challenge for GPs.This can lead to inappropriate use of secondary care resources and negatively impacts on patient experience.

  The aim of the study is to evaluate patient care in primary care setting using a new e-consult Integrated Care Pathway (NAFLD e-ICP), in order to standardise patient journey, support GP decision making, provide e-consult specialist support and reduce service costs in order to improve patient experience, patient outcomes and GP management of NAFLD. We will achieve this by supporting GPs in 4 specific areas:

  1) Making early and accurate diagnoses of NAFLD
  2) Monitoring patients safely in primary care
  3) Making appropriate and timely specialist referrals
  4) Complex decision-making via e-consult where the need for referral is unclear

  Patients presenting in primary care with abnormal Liver Function Tests (LFTs) will be entered onto either the e-consult ICP or standard pathway. The GP will perform a standard set of liver investigations to exclude other diagnoses and determine the severity of NAFLD disease. Based on these results, GPs may choose a subsequent referral option: stay in primary care, refer to secondary care, or refer to e-consult, depending on whether the patients are on standard or e-ICP pathway. The specialist will review the investigation results, avoiding duplication and saving time and money for clinicians, outpatient services and patients. Specialists will offer GPs follow-up guidance and support. Patients will be recruited from GP practices in Hull and in East Yorkshire with a 5 year 'follow-up' period.

• REC name

  Yorkshire & The Humber - South Yorkshire Research Ethics Committee

• REC reference

  16/YH/0063

• Date of REC Opinion

  30 Mar 2016

• REC opinion

  Further Information Favourable Opinion