Defining comprehensive models of care for NAFLD

Abstract

Nonalcoholic fatty liver disease (NAFLD) is now the leading cause of chronic liver disease globally.Despite the increased demand placed on healthcare systems, little attention has been given to the 2 design and implementation of efficient and effective models of care for patients with NAFLD. In many healthcare settings, no formal pathways exist and where pathways are in place, they are often not standardized according to good practices. We systematically searched the peer-reviewed literature with the aim of identifying published examples of comprehensive models of care that answered four key questions: what services are provided; where are they provided; who is offering them; and how are they coordinated and integrated within healthcare systems. We identified seven models of care and synthesized the findings into eight recommendations nested within the 'what, where, who and how' of care models. These recommendations, aimed at policymakers and practitioners designing and implementing models of care, can help to address the increasing need for the provision of good practice care for patients with NAFLD.

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

“…However, most countries, including Western countries, are not prepared to address NAFLD, lacking adequate policies and civil society awareness and engagement, guidelines, epidemiology, and care management [7]. Structural changes and new models of care are needed in order to improve NAFLD management and public health policies [7,8].…”

Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: a targeted literature review

“…It is also noteworthy that differentiation and integration of care across primary and secondary care, relating to screening and referral, as well as long-term monitoring, is currently lacking in the guidelines reviewed here. This is reflected in clinical practice, where care pathways are often lacking or, where they do exist, are not standardized based on best-practice principles [46]. The paucity of easy-tofollow care pathways developed from evidence-based best practice therefore remains a major hurdle to translating the knowledge base for NAFLD and NASH into improved outcomes for patients.…”

“…For example, applying local processes such as the UK's Camden and Islington NAFLD Pathway can reduce unnecessary referrals to specialist care by 80%, offering both clinical and economic efficiencies [73,74]. However, there are currently widespread deficiencies in the number and standardization of care pathways for NAFLD [46]. Specifically, regarding fibrosis evaluation, the available data indicated that assessment of fibrosis using noninvasive techniques is not consistently conducted according to guidelinedefined recommendations, and many physicians are unsure of the assessments and interpretations required or do not apply them rigorously [65,67,75].…”

Referral care paths for non‐alcoholic fatty liver disease—Gearing up for an ever more prevalent and severe liver disease

“…Despite the rising prevalence and severity of NAFLD, there is still much room for improvement among health care professionals across the lines of care and also on the national guideline level. 21 Lazarus et al 1 conducted a research including 29 European countries for assessment of their NAFLD guidelines and strategies. The United Kingdom scored highest mainly driven by a national guideline that focuses on early detection of NAFLD and associated comorbidities in primary care.…”