The multidisciplinary team

Shared care is the preferred model of support for people with viral hepatitis and chronic liver disease. The ability to coordinate support between primary care providers, specialists and specific referral centres will ultimately improve outcomes for people affected and reduce the duplication of services.

The utilisation of a shared care approach can:

  • improve access to care by decentralising care out of the tertiary setting
  • increase numbers of people on treatment
  • enhance access to care in rural and remote settings
  • promote coordination between agencies leading to increased referrals, and
  • identify systemic problems in the delivery of care and seek to solve the issue

Here, we consider the role of various specialities in the management of people living with viral hepatitis, specifically hepatitis C and B virus (HCV and HBV), together with non-alcoholic fatty liver (NAFL) and advanced fibrosis due to non-alcoholic steatohepatitis (NASH).

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Addiction and harm reduction

Injection drug use results in rapid dissemination of HCV,1 as well as some transmission of HBV.2 Therefore, attempts to eliminate HCV and HBV require an existing framework of harm reduction interventions.

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Diabetology

For people with type 2 diabetes, a high index of suspicion for NAFL and advanced fibrosis is warranted. Estimates suggest that around one-third to two-thirds of people with diabetes also have chronic liver disease.3-6

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Endocrinology

Because obesity, dyslipidaemia and metabolic syndrome are highly prevalent in patients with NASH,7 it is important that endocrinologists have the skills to diagnose and manage the condition in clinical practice.

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Hepatology

Hepatologists are at the forefront of healthcare when it comes to prevention and treatment of chronic and progressive liver diseases, including: HCV, HBV, NAFL, advanced fibrosis due to NASH, and hepatocellular carcinoma (HCC).

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Primary care

Given the prevalence of chronic liver disease in the community,8,9 it is essential that primary care providers play an active role in the screening, diagnosis and management of HCV, HBV and advanced fibrosis due to NASH.

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Obesity

This section reviews content relevant to those interested in gaining a better understanding of the relationship between obesity, NAFL, and advanced fibrosis due to NASH.

References

  1. Van Handel MM, et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. J Acquir Immune Defic Syndr. 2016;73:323–31.
  2. Harris AM, et al. Increases in acute hepatitis B virus infections – Kentucky, Tennessee, and West Virginia, 2006–2013. MMWR Morb Mortal Wkly Rep. 2016;65:47–50.
  3. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015;62(1 Suppl):S47-S64.
  4. Leite NC, et al. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int 2009;29:113-119.
  5. Prashanth M, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India 2009;57:205-210.
  6. Fan N, et al. Sex-specific association between serum uric acid and nonalcoholic fatty liver disease in type 2 diabetic patients. J Diabetes Res 2016;3805372.
  7. Younossi ZM, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
  8. World Health Organization (WHO). Global Health Sector Strategy of Viral Hepatitis 2016-2021: Towards ending viral hepatitis. June 2016. Available at: https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (accessed March 2019).
  9. Browning JD, et al. Prevalence of hepatitis steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004;40:1387-1395

Looking for in-depth information on liver diseases?

HCV

Hepatitis C

Background on the global and local burden of HCV; the expanding role of primary care in HCV management; diagnosis and pre-treatment assessment; HCV treatment and ongoing care. The important role of hepatitis nurses in the HCV care pathway is also discussed.

HBV

Hepatitis B

A comprehensive summary of currently available knowledge on HBV is provided here – information that reiterates the key role of primary care clinicians in screening, diagnosis and management of people living with HBV.

N&N

NAFLD & NASH

Despite the increasing prevalence of NAFLD and NASH with progressive fibrosis, there is limited knowledge regarding its natural history, staging, diagnosis, and management. The aim of this section is to summarise the most recent data on the condition and discuss potential therapeutic opportunities.

LID/IHQ/18-12//1048E DATE OF PREPARATION: MARCH 2019