Understanding the implementation of a liver disease stratification pathway in primary care: a qualitative study.

Abstract

Introduction: Liver disease is a major cause of morbidity and mortality in the UK, with general practitioners (GPs) playing a critical role in early detection and management. Despite the existence of non-invasive markers for liver fibrosis, such as transient elastography and blood marker panels, referral rates to liver disease pathways vary across practices.

Methods: This study aimed to identify barriers and facilitators for implementing a liver disease identification and referral pathway in primary care, using the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with 11 practitioners, including GPs and a specialist nurse, in Nottinghamshire, UK. The interviews were analyzed across 14 TDF domains to understand factors affecting professional behavior change.

Results: Nine key TDF domains were identified as influencing pathway implementation, with knowledge being the most significant. Practitioners demonstrated varying levels of understanding regarding liver disease and the referral criteria. Other factors included environmental and organizational barriers, such as resource constraints and unclear professional roles, which hindered screening and referral practices. Practitioners also raised concerns about the efficiency of the pathway, long waiting times, and the limited success of lifestyle interventions.

Conclusion: To improve pathway adoption, the study recommends enhanced training, streamlined referral processes, and addressing systemic challenges. Continuous evaluation and engagement with stakeholders are essential for successful integration into primary care.

Spanish abstract: http://links.lww.com/IJEBH/A641.