Academic journal article Australian Health Review

Identifying Areas of Need Relative to Liver Disease: Geographic Clustering within a Health Service District

Academic journal article Australian Health Review

Identifying Areas of Need Relative to Liver Disease: Geographic Clustering within a Health Service District

Article excerpt

Introduction

The global burden of liver disease is rising, due, in part, to an increasing prevalence of alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), as well as untreated viral hepatitis.1-3 A recent comprehensive review of liver disease in the UK noted an imbalance between service provision and clinical need, and identified that knowledge and awareness of liver disease in primary care was low, with a lack of training in the diagnosis and management of early liver disease.4 It was recognised that many people with cirrhosis were not detected until they presented to hospital with advanced liver disease, when opportunities for intervention are reduced and morbidity is high.4 Similarly, in Australia, management of liver disease presents challenges at many levels, from organisational and geographical impediments to effective management in the primary care setting. One-quarter of new cases seen in specialist hepatology clinics at the Princess Alexandra Hospital, a major tertiary referral centre in Brisbane, Queensland, presented with advanced liver disease5 and more than one-third of referred patients with chronic hepatitis C virus (HCV) infection had comorbidities such as heavy alcohol consumption, obesity and type 2 diabetes, which increase the risk of progressive liver disease and related complications.6 The sparse liver clinics and hepatitis treatment centres in Queensland7 and the recently documented long wait times for out-patient hepatology services6 may be some of the contributing factors to patients presenting with advanced disease.

Although liver disease shares some common lifestyle risk factors, it is not generally considered as one of the chronic lifestyle-related diseases that are managed in primary care, such as cardiovascular disorders, diabetes, chronic lung or renal disease. However, it is clear that increased involvement of primary care clinicians in the detection and management of liver disease is necessary in order to identify people at risk of progressive disease and enable earlier intervention and management of comorbidities. Effective management in the community may be hampered by a lack of experience with liver disease, with low numbers of patients identified by individual general practitioners (GPs).6 With a view to building capacity and liver expertise in the community, it may be logical to focus training or mentoring of GPs in high-prevalence disease areas and specific populations with an identified need.

In order to better understand the geographic areas of need relative to liver disease in the Metro South Hospital and Health Services (HHS) district, we undertook a retrospective audit of people seen in the tertiary referral hepatology clinics over a 3-month period. The main aim of the present study was to describe the geographic location (place of residence) of people seen in the liver clinics. The secondary aim was to examine associations between patient demand for tertiary hepatology services and the ethnic and sociodemographic characteristics of the geographic areas with clustering of people living with chronic liver disease (CLD), as well as the characteristics of the individuals clustered within these areas.

Methods

Patients and clinical data

The study included consecutive patients booked in hepatology out-patient clinics at the Princess Alexandra Hospital (Brisbane, Qld, Australia) over a 3-month period in 2013. This facility has a dedicated gastroenterology and hepatology department and is the primary referral centre for public patients with liver disease within the Metro South HHS district, which spans 3856 km2 and serves an estimated population of 1 million. The study protocol was approved by the Metro South HHS and Queensland University of Technology Human Research Ethics Committees, who granted a waiver of individual consent because the study used routinely collected clinical and hospital booking systems data that were anonymised and involved no risk to patients' rights or welfare. …

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