GPs’ experiences and perceptions of early detection of liver disease: a qualitative study in primary care

Standing, Holly, Jarvis, Helen, Orr, James, Exley, Catherine, Hudson, Mark, Kaner, Eileen and Hanratty, Barbara (2018) GPs’ experiences and perceptions of early detection of liver disease: a qualitative study in primary care. British Journal of General Practice, 68 (676). e743-e749. ISSN 0960-1643

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Abstract

Background: The incidence of liver disease is increasing in the UK and primary care is a key setting where improvement in the detection and management of liver disease is required. Little is known about general practitioners’ (GPs) understanding and confidence in detecting liver disease.

Aim: To explore GPs’ experiences of liver disease with a focus on early detection and interpretation of liver function tests (LFTs).

Design and setting: Qualitative study employing semi-structured interviews. Purposive sample of 25 GPs from five study sites.

Method: Telephone and face-to-face interviews. Data were analysed thematically, using a constant comparative approach.

Results: Four themes were identified from the data: test requesting behaviour, challenges in diagnosing disease, access to specialist tests, and guidance and education. Participants’ descriptions of how they request and interpret LFTs varied widely. Concern over missing diagnoses was a common reason for requesting blood tests; patients with mildly abnormal LFTs and those at risk of non-alcoholic fatty liver disease (NAFLD) were a particular cause of concern. GPs saw themselves as generalists, with a reluctance to take on specialist investigations. Guidelines promoted confidence for some clinicians, but others felt that liver disease was too complex to be amenable to simple instructions. Most felt that they did not have access to relevant, focused education on liver disease.

Conclusion: Liver disease is not perceived as a priority in primary care. If GPs are to take on a greater role in identification and management of liver disease, support is needed to promote awareness, knowledge and confidence.

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