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Gold, incentives and meh

Screening patients for liver damage reduces harmful drinking ‘before it is too late’

Screening patients for liver disease in primary care could persuade many people with high-risk drinking behaviour to cut their alcohol intake before they develop irreversible liver damage, researchers have concluded.

The Southampton University team said the approach – which uses a traffic-light colour-coded blood test result to explain to people if they are at high risk of liver fibrosis or cirrhosis – may be more effective than brief advice or interventions to reduce drinking in primary care.

Although cost-effective, brief interventions delivered in general practice only result in around 10% of patients cutting down on drinking, the researchers said, whereas in their study half of patients with evidence of liver damage cut down their drinking significantly.

Having previously shown the traffic-light test is good at predicting the prognosis of liver disease and conducted a pilot screening study, the researchers tested out their approach further in nine general practices in Hampshire. GPs sent out letters to nearly 10,000 25–45-year-old patients, inviting them to complete a World Health Organisation AUDIT questionnaire on their drinking habits.

Of 4,360 responses,1,228 patients were identified as hazardous or harmful drinkers (AUDIT score of 8 or higher) and offered the liver fibrosis check.

Of these, 393 agreed to undergo the test and 202 had a positive (red or amber) test result ‘showing that your liver may be damaged’ and were advised to have further assessments. The other 191 patients with a negative (green) result showing that ‘at the moment, there is no sign of any severe liver fibrosis in the blood test’ were just advised to review their alcohol intake.

Twelve months later, a total of 303 of these patients completed a follow-up audit showing that 128 (42%) had reduced their drinking by at least one audit grade – equivalent to going from harmful/dependent to hazardous drinking, or from hazardous to low-risk.

Of 153 people with a red/amber test result, 76 (50%) had cut down by at least one AUDIT category, compared with ten (35%) of 29 with a green test result.

The authors said the approach could ‘could potentially prevent more people from presenting far too late with the complications of alcohol related cirrhosis’.

They concluded: ‘It has been shown a reasonable proportion of subjects in the community will respond positively to an enquiry about their drinking and the offer of a liver health check, and that the results of this health check are encouraging in that feedback of liver risk appeared to influence their subsequent drinking behaviour, with the biggest reductions in drinking seen in the highest risk groups.’

The team added further evaluation of the approach is now needed in a randomised controlled trial with economic analysis.

Br J Gen Pr 2013; available online 30 September

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