PTH-59 A patient centred pathway to support self management for patients with non-alcoholic fatty liver disease

IntroductionThe aim of this project was to implement the new pathway ‘Transforming the care of patients with non-alcoholic fatty liver disease’ in the secondary care Gastroenterology Clinic with a view to reducing the number of patients requiring medical review, meet waiting time targets and promote supported self-managementNon-alcoholic fatty liver disease (NAFLD) is a spectrum of liver pathology, strongly associated with obesity and diabetes. Lifestyle change aimed at weight loss through diet and physical activity is the mainstay of clinical management guidelines for NAFLD (NICE 2016). Only 34% of people link being overweight to liver disease (versus over 80% understanding the link between ex cess weight and heart disease, high blood pressure and diabetes).Evidence highlights just providing NAFLD patients with information and advice to change behaviour is an insufficient intervention. Readiness to change weight-related behaviours (both physical activity and eating habits) is often low and not associated with severity of liver disease. Being diagnosed with NAFLD is insufficient to propel people into the ‘preparation/action’ stage of change. This is not surprising given that NAFLD is often asymptomatic. Patients do not ‘see’ their condition. (Stewart et al 2014).A multi-disciplinary approach promoting supported self-management is recommended. A review by Taylor et al (2014) stated that all healthcare organisations should be providing self-management as an integral component of care.MethodsLocal health intelligence data was reviewed to justify rationale for establishing a new pathway for patients with NAFLD. According to health intelligence figures, 862 patients were admitted to hospital with NAFLD and NASH as either their main reason for admission or a secondary reason during a 12 month period (1st October 2018 - 30 September 2019).Prior to the new pathway the majority of patients with abnormal Liver Function Test (LFT) were referred to hospital and saw medical staff at their first appointment. Due to the volume of patients this led to a long waiting list to be seen. GPs were unsure when to refer patients and which bloods/investigations should be performed beforehand. There was no dedicated input from Health Psychology or Diabetes Specialists.The Lead Clinician and Lead Hepatology Nurse Specialist led on development of a new pathway. They agreed input and way forward for a multidisciplinary approach with General Practitioners, dietetic and psychology depar