Liver Fibrosis Monitoring (HP030)

Liver Fibrosis Monitoring (HP030)

Purpose:

This protocol will:
  1. Highlight where patients have chronic liver disease and if they don't have:
    1. A NAFLD/FIB4/ELF score in the last 12 months
    2. A cardiovascular assessment in the last 12 months

What does it actually do?

The protocol helps practices achieve the NICE guidance on management of Non-Alcoholic Fatty Liver disease, which states:

Ensure a person with non-alcoholic fatty liver disease (NAFLD) and a low risk of advanced liver fibrosis is reviewed in primary care annually, depending on clinical judgement.
Examine the person to check:
  1. For signs of advanced liver disease, that may indicate progression of NAFLD.
  2. Blood pressure to assess for hypertension. See the CKS topic on Hypertension for more information.
  3. Weight and body mass index (BMI) — to assess for obesity and the impact of any diet and exercise changes on weight loss. See the CKS topic on Obesity for more information.
 Arrange blood tests
  1. to assess for metabolic risk factors, and manage accordingly.
  2. Renal function tests to assess for chronic kidney disease. See the CKS topic on Chronic kidney disease for more information.
  3. HbA1c to assess for impaired glucose regulation and type 2 diabetes. See the CKS topic on Diabetes - type 2 for more information.
  4. Lipid profile — to assess for hyperlipidaemia. See the CKS topic on Lipid modification - CVD prevention for more information.
Reassess the person's risk of cardiovascular disease annually — see the CKS topic on CVD risk assessment and management for more information.
Reassess the person's risk of advanced liver fibrosis every 3 years — do not use routine liver blood tests.
 
See the section on Assessment for more information.
  1. If the person is at high risk of advanced liver fibrosis, refer the person to a hepatology specialist for further assessment and management.
  2. If the person is at low risk of advanced liver fibrosis, reassess the risk every 3 years, and continue to manage the person in primary care.

What does it look like?




Clicking on the alert will take you to a template with the relevant information:


System Dependencies:

This is dependent on the practice coding NAFLD accurately, but otherwise automatically launches 

System Trigger

Automatic triggers 
System Trigger: Load a patient
Run mode: Always run 
Enable trigger for: All clinical team members

Fitting your practice

Alert your team that if they will see the alert if patients have NAFLD and don't have the requirements of the NICE guidance

How to get it

This protocol is an optional handy protocol.  You can request if via the PCIT hub or submit a ticket to request installation.

Support Information

Development Log

v1.0

Published 17/9/2020
Initial release

v6.4

Published 17/01/2023
More extensive support article to help with implementation

Communications Log (v6.4)

Primary Care IT are pleased to announce the release of our NAFLD alert.  This alert will highlight where patients have NAFLD but don't have the monitoring suggested by NICE.  The alert has recently been updated to include our FIB4 and NAFLD calculators.  We will be rolling this out to all subscribers over the coming weeks.  This is an optional handy protocol which can be requested via the PCIT hub or submit a ticket to request installation. 

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