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9. Towards collaborative management of non‐alcoholic fatty liver disease: a ‘real‐world’ pathway for fibrosis risk assessment in primary care

Author

Hayward, Kelly L., primary, McKillen, Benjamin J., additional, Horsfall, Leigh U., additional, McIvor, Carolyn, additional, Liew, Katerina, additional, Sexton, Jo, additional, Johnson, Amy L., additional, Irvine, Katharine M., additional, Valery, Patricia C., additional, McPhail, Steven M., additional, Britton, Laurence J., additional, Rosenberg, William, additional, Weate, Ingrid, additional, Williams, Sue, additional, and Powell, Elizabeth E., additional

Published
2022
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10. Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC)

Author

Valery, Patricia C, Bernardes, Christina M, Stuart, Katherine A, Hartel, Gunter F, McPhail, Steven M, Skoien, Richard, Rahman, Tony, Clark, Paul J, Horsfall, Leigh U, Hayward, Kelly L, Gupta, Rohit, and Powell, Elizabeth E

Subjects
perceived needs, Patient Preference and Adherence, chronic liver disease, psychometric properties, Original Research, instrument validation
Abstract

Patricia C Valery,1,2 Christina M Bernardes,1 Katherine A Stuart,3 Gunter F Hartel,1 Steven M McPhail,4 Richard Skoien,5 Tony Rahman,6 Paul J Clark,7 Leigh U Horsfall,2,3 Kelly L Hayward,2 Rohit Gupta,8 Elizabeth E Powell2,3 1QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; 2Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 3Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; 4Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; 5Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; 6Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia; 7Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia; 8Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, AustraliaCorrespondence: Patricia C ValeryQIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, AustraliaTel +61 7 33620376Email Patricia.Valery@qimrberghofer.edu.auBackground: We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC).Methods: The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools.Results: Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: “Psychosocial issues”, “Practical and physical needs”, “Information needs”, and “Lifestyle changes”. Cronbach’s alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho − 0.68; p< 0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p< 0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from − 0.48 to − 0.57; p< 0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p< 0.001), and hospital admission status (admitted vs not; p< 0.001).Conclusion: These data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.Keywords: chronic liver disease, perceived needs, instrument validation, psychometric properties

Published
2020

12. Additional file 1 of Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study

Author

Valery, Patricia C., Bernardes, Christina M., Hayward, Kelly L., Hartel, Gunter, Haynes, Katelin, Gordon, Louisa G., Stuart, Katherine A., Wright, Penny L., Johnson, Amy, and Powell, Elizabeth E.

Abstract

Additional file 1. Table S1. Proportion of correct responses to the knowledge survey questions. Table S2. Sociodemographic and clinical characteristics of respondents (n=123) and non-respondents (n=169) of the ‘knowledge survey’. Table S3. Sociodemographic and clinical characteristics of Indigenous Australians according to recruitment method: ‘second opportunity’ pathway (n=6) versus mainstream recruitment (all patients n=117 and Indigenous patients n=6). Table S4. Mean SF-36 scores according to patient knowledge. Table S5. Adjusted incidence rate ratios and cost ratios according to knowledge score: sensitivity analyses carried using a cut-off of 57.1% on the 8-item score; and using a cut-off of ≥60.0% on the 11-item survey among 121 patients ‡.

Published
2022
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15. Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety

Author

Hayward, Kelly L., primary, Valery, Patricia C., additional, Patel, Preya J., additional, Li, Catherine, additional, Horsfall, Leigh U., additional, Wright, Penny L., additional, Tallis, Caroline J., additional, Stuart, Katherine A., additional, David, Michael, additional, Irvine, Katharine M., additional, Cottrell, Neil, additional, Martin, Jennifer H., additional, and Powell, Elizabeth E., additional

Published
2021
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16. Predicting Liver‐Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests

Author

Johnson, Amy L., primary, Hayward, Kelly L., additional, Patel, Preya, additional, Horsfall, Leigh U., additional, Cheah, Alvin Ee Zhiun, additional, Irvine, Katharine M., additional, Russell, Anthony W., additional, Stuart, Katherine A., additional, Williams, Sue, additional, Hartel, Gunter, additional, Valery, Patricia C., additional, and Powell, Elizabeth E., additional

Published
2021
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21. Effectiveness of patient‐oriented education and medication management intervention in people with decompensated cirrhosis

Author

Hayward, Kelly L., primary, Valery, Patricia C., additional, Patel, Preya J., additional, Horsfall, Leigh U., additional, Wright, Penny L., additional, Tallis, Caroline J., additional, Stuart, Katherine A., additional, David, Michael, additional, Irvine, Katharine M., additional, Cottrell, W. Neil, additional, Martin, Jennifer H., additional, and Powell, Elizabeth E., additional

Published
2020
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23. Predicting Liver‐Related Outcomes in People With Nonalcoholic Fatty Liver Disease: The Prognostic Value of Noninvasive Fibrosis Tests.

Author

Johnson, Amy L., Hayward, Kelly L., Patel, Preya, Horsfall, Leigh U., Cheah, Alvin Ee Zhiun, Irvine, Katharine M., Russell, Anthony W., Stuart, Katherine A., Williams, Sue, Hartel, Gunter, Valery, Patricia C., and Powell, Elizabeth E.

Subjects
NON-alcoholic fatty liver disease, PROGNOSIS, HEPATIC fibrosis, FIBROSIS, ELECTRONIC health records
Abstract

It remains unclear whether screening for advanced fibrosis in the community can identify the subgroup of people with nonalcoholic fatty liver disease (NAFLD) at higher risk for development of liver‐related complications. We aimed to determine the prognostic value of baseline noninvasive fibrosis tests for predicting liver‐related outcomes and mortality in patients with NAFLD from type 2 diabetes (T2D) clinics or primary care. Patients (n = 243) who were screened for NAFLD with advanced fibrosis by using NAFLD fibrosis score (NFS), fibrosis 4 score (FIB‐4), enhanced liver fibrosis (ELF) test, and liver stiffness measurements (LSMs) were followed up for clinical outcomes by review of electronic medical records. During a median follow‐up of 50 months, decompensated liver disease or primary liver cancer occurred in 6 of 35 (17.1%) patients with baseline LSM > 13 kPa, 1 of 17 (5.9%) patients with LSM 9.5‐13 kPa, and in no patients with LSM < 9.5 kPa. No patient with low‐risk NFS developed liver decompensation or liver‐related mortality. Following repeat NFSs at the end of follow‐up, all patients with a liver‐related complication were in the high‐risk NFS category. Patients who developed liver‐related complications were also more likely to have baseline high‐risk FIB‐4 scores or ELF test ≥9.8 compared to patients who did not develop liver outcomes. Conclusion: Liver fibrosis risk stratification in non‐hepatology settings can identify the subset of patients at risk of liver‐related complications. Although the rate of development of a decompensation event or hepatocellular carcinoma was low (2.1% per year) in our patients with compensated cirrhosis (LSM > 13 kPa), these events are projected to lead to a substantial increase in NAFLD‐related disease burden over the next decade due to the high prevalence of NAFLD in people with obesity and T2D. [ABSTRACT FROM AUTHOR]

Published
2022
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24. Nonalcoholic fatty liver disease: interface between primary care and hepatology clinics

Author

Elangovan, Harendran, Rajagopaul, Sashen, Williams, Suzanne, McKillen, Benjamin, Britton, Laurence J., McPhail, Steven, Horsfall, Leigh, Valery, Patricia, Hayward, Kelly L., Powell, Elizabeth, Elangovan, Harendran, Rajagopaul, Sashen, Williams, Suzanne, McKillen, Benjamin, Britton, Laurence J., McPhail, Steven, Horsfall, Leigh, Valery, Patricia, Hayward, Kelly L., and Powell, Elizabeth

Abstract

Primary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a major referral hospital, and to determine the severity of liver disease and patient pathway following evaluation in secondary care. New patients seen in the hepatology outpatient clinic (HOC) with a secondary care diagnosis of NAFLD were identified from the HOC scheduling database. PCP referrals for these patients were retrieved from the electronic medical records and reviewed by study clinicians, along with the hepatologists’ clinic notes and letters. Over a 14-month period, 234 new PCP referrals received a diagnosis of NAFLD, accounting for 20.4% of the total number of new cases (n = 1,147) seen in the HOC. The 234 referrals were received from 170 individual PCPs at 135 practices. Most patients with NAFLD (88.5%) were referred for investigation of abnormal liver enzymes or other clinical concerns, including abnormal iron studies, hepatomegaly, and abdominal pain. Only 27 (11.5%) referrals included an assessment of liver disease severity. Following evaluation in the liver clinic, 175 patients (74.8%) were found to have a low risk of advanced fibrosis, and most (n = 159; 90.9%) were discharged back to their PCP for ongoing follow-up in primary care. Conclusion: In addition to better access to noninvasive fibrosis tests, educational strategies to enhance awareness and recognition of NAFLD as a cause for many of the initial concerns prompting patient referral might improve risk stratification and increase the appropriateness of PCP referrals.

Published
2020

25. Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC)

Author

Valery, Patricia C., Bernardes, Christina M., Stuart, Katherine A., Hartel, Gunter F., McPhail, Steven M., Skoien, Richard, Rahman, Tony, Clark, Paul J., Horsfall, Leigh U., Hayward, Kelly L., Gupta, Rohit, Powell, Elizabeth E., Valery, Patricia C., Bernardes, Christina M., Stuart, Katherine A., Hartel, Gunter F., McPhail, Steven M., Skoien, Richard, Rahman, Tony, Clark, Paul J., Horsfall, Leigh U., Hayward, Kelly L., Gupta, Rohit, and Powell, Elizabeth E.

Abstract

Background: We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC). Methods: The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. Results: Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: “Psychosocial issues”, “Practical and physical needs”, “Information needs”, and “Lifestyle changes”. Cronbach's alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho −0.68; p<0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p<0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from −0.48 to −0.57; p<0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p<0.001), and hospital admission status (admitted vs not; p<0.001). Conclusion: These data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.

Published
2020

26. Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC)

Author

Valery,Patricia C, Bernardes,Christina M, Stuart,Katherine A, Hartel,Gunter F, McPhail,Steven M, Skoien,Richard, Rahman,Tony, Clark,Paul J, Horsfall,Leigh U, Hayward,Kelly L, Gupta,Rohit, Powell,Elizabeth E, Valery,Patricia C, Bernardes,Christina M, Stuart,Katherine A, Hartel,Gunter F, McPhail,Steven M, Skoien,Richard, Rahman,Tony, Clark,Paul J, Horsfall,Leigh U, Hayward,Kelly L, Gupta,Rohit, and Powell,Elizabeth E

Abstract

Patricia C Valery,1,2 Christina M Bernardes,1 Katherine A Stuart,3 Gunter F Hartel,1 Steven M McPhail,4 Richard Skoien,5 Tony Rahman,6 Paul J Clark,7 Leigh U Horsfall,2,3 Kelly L Hayward,2 Rohit Gupta,8 Elizabeth E Powell2,3 1QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; 2Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 3Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; 4Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; 5Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; 6Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia; 7Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia; 8Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, AustraliaCorrespondence: Patricia C ValeryQIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, AustraliaTel +61 7 33620376Email Patricia.Valery@qimrberghofer.edu.auBackground: We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC).Methods: The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools.Results: Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-i

Published
2020

27. Safe use of medication in patients with cirrhosis: pharmacokinetic and pharmacodynamic considerations

Author

Weersink, Rianne A., Burger, David M., Hayward, Kelly L., Taxis, Katja, Drenth, Joost P.H., and Borgsteede, Sander D.

Abstract

Introduction: The global burden of cirrhosis is rising, and clinicians increasingly face the challenge of safely prescribing medicines for complications of hepatic disease and comorbidities. Prescribing in patients with cirrhosis is complicated by alterations that can occur in the pharmacology of medicines. Areas covered: This paper provides an overview of current knowledge on the pharmacokinetics and pharmacodynamics of medicines in patients with cirrhosis. We describe the pathophysiological changes that occur and their consequences on pharmacokinetic parameters. We explain that the influence of cirrhosis on the pharmacokinetics depends on several drug and patient characteristics. Patients with cirrhosis also have an increased susceptibility to some toxicological effects of medicines, such as renal impairment and hematological toxicity, which we describe in detail. In addition, we discuss approaches to apply this knowledge in practice and improve safe medication use in patients with cirrhosis. Expert opinion: Tailored pharmacotherapy is needed to ensure safe and appropriate use of medicines in patients with cirrhosis. Clinicians are supported by freely available recommendations on safe drug use in cirrhosis published on a website. In addition, a regular evaluation of medication use in patients with cirrhosis could resolve and prevent medication-related problems.

Published
2019
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29. Reply

Author

Hayward, Kelly L., primary, Valery, Patricia C., additional, Cottrell, W. Neil, additional, Irvine, Katharine M., additional, Martin, Jennifer H., additional, and Powell, Elizabeth E., additional

Published
2019
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30. Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

Author

Hayward, Kelly L., primary, Patel, Preya J., additional, Valery, Patricia C., additional, Horsfall, Leigh U., additional, Li, Catherine Y., additional, Wright, Penny L., additional, Tallis, Caroline J., additional, Stuart, Katherine A., additional, Irvine, Katharine M., additional, Cottrell, W. Neil, additional, Martin, Jennifer H., additional, and Powell, Elizabeth E., additional

Published
2019
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31. Towards collaborative management of non‐alcoholic fatty liver disease: a ‘real‐world’ pathway for fibrosis risk assessment in primary care.

Author

Hayward, Kelly L., McKillen, Benjamin J., Horsfall, Leigh U., McIvor, Carolyn, Liew, Katerina, Sexton, Jo, Johnson, Amy L., Irvine, Katharine M., Valery, Patricia C., McPhail, Steven M., Britton, Laurence J., Rosenberg, William, Weate, Ingrid, Williams, Sue, and Powell, Elizabeth E.

Abstract

Background Aims Methods Results Conclusion The optimal strategy to support primary care practitioners (PCP) to assess fibrosis severity in non‐alcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear.To examine the feasibility of using a two‐step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis‐4 Index) with transient elastography (FibroScan) to streamline NAFLD referrals from a ‘routine’ primary care population to specialist hepatology management clinics (HMC).The two‐step ‘Towards Collaborative Management of NAFLD’ (TCM‐NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged ≥18 years with a new or established PCP‐diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at ‘high risk’ of clinically significant fibrosis to HMC for specialist review, and ‘low risk’ patients to receive ongoing management and longitudinal follow up in primary care.A total of 162 patient assessments between June 2019 and December 2020 were included. Mean age was 58.7 ± 11.7 years, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ± 6.9 kg/m2. A total 122 patients was considered ‘low risk’ for clinically significant fibrosis, two patients had incomplete assessments and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments.Implementation of the two‐step TCM‐NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost‐effective and targeted use of specialist hepatology resources. [ABSTRACT FROM AUTHOR]

Published
2021
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32. Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis

Author

Hayward, Kelly L, primary, Valery, Patricia C, additional, Martin, Jennifer H, additional, Karmakar, Antara, additional, Patel, Preya J, additional, Horsfall, Leigh U, additional, Tallis, Caroline J, additional, Stuart, Katherine A, additional, Wright, Penny L, additional, Smith, David D, additional, Irvine, Katharine M, additional, Powell, Elizabeth E, additional, and Cottrell, W Neil, additional

Published
2017
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34. Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

Author

Hayward, Kelly L., primary, Martin, Jennifer H., additional, Cottrell, W. Neil, additional, Karmakar, Antara, additional, Horsfall, Leigh U., additional, Patel, Preya J., additional, Smith, David D., additional, Irvine, Katharine M., additional, Powell, Elizabeth E., additional, and Valery, Patricia C., additional

Published
2017
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35. Alcohol Consumption in Diabetic Patients with Nonalcoholic Fatty Liver Disease

Author

Patel, Preya J., primary, Smith, David, additional, Connor, Jason P., additional, Horsfall, Leigh U., additional, Hayward, Kelly L., additional, Hossain, Fabrina, additional, Williams, Suzanne, additional, Johnson, Tracey, additional, Stuart, Katherine A., additional, Brown, Nigel N., additional, Saad, Nivene, additional, Clouston, Andrew D., additional, Irvine, Katharine M., additional, Russell, Anthony W., additional, Valery, Patricia C., additional, and Powell, Elizabeth E., additional

Published
2017
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37. Safe use of medication in patients with cirrhosis: pharmacokinetic and pharmacodynamic considerations

Author

Weersink, Rianne A., Burger, David M., Hayward, Kelly L., Taxis, Katja, Drenth, Joost P.H., and Borgsteede, Sander D.

Abstract

ABSTRACTIntroduction: The global burden of cirrhosis is rising, and clinicians increasingly face the challenge of safely prescribing medicines for complications of hepatic disease and comorbidities. Prescribing in patients with cirrhosis is complicated by alterations that can occur in the pharmacology of medicines.Areas covered: This paper provides an overview of current knowledge on the pharmacokinetics and pharmacodynamics of medicines in patients with cirrhosis. We describe the pathophysiological changes that occur and their consequences on pharmacokinetic parameters. We explain that the influence of cirrhosis on the pharmacokinetics depends on several drug and patient characteristics. Patients with cirrhosis also have an increased susceptibility to some toxicological effects of medicines, such as renal impairment and hematological toxicity, which we describe in detail. In addition, we discuss approaches to apply this knowledge in practice and improve safe medication use in patients with cirrhosis.Expert opinion: Tailored pharmacotherapy is needed to ensure safe and appropriate use of medicines in patients with cirrhosis. Clinicians are supported by freely available recommendations on safe drug use in cirrhosis published on a website. In addition, a regular evaluation of medication use in patients with cirrhosis could resolve and prevent medication-related problems.

Published
2020
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