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Widespread gaps in the quality of care for primary biliary cholangitis in UK
OBJECTIVE: Primary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on t...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666861/ https://www.ncbi.nlm.nih.gov/pubmed/34966531 http://dx.doi.org/10.1136/flgastro-2020-101713 |
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author | Sivakumar, Mathuri Gandhi, Akash Shakweh, Eathar Li, Yu Meng Safinia, Niloufar Smith, Belinda Claire Marshall, Aileen Turner, Lucy Mukhopadhya, Ashis Haboubi, Hasan Nadim Vincent, Rebecca Tan, Huey Kuan Alrubaiy, Laith Jones, David E J |
author_facet | Sivakumar, Mathuri Gandhi, Akash Shakweh, Eathar Li, Yu Meng Safinia, Niloufar Smith, Belinda Claire Marshall, Aileen Turner, Lucy Mukhopadhya, Ashis Haboubi, Hasan Nadim Vincent, Rebecca Tan, Huey Kuan Alrubaiy, Laith Jones, David E J |
author_sort | Sivakumar, Mathuri |
collection | PubMed |
description | OBJECTIVE: Primary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines. DESIGN: Data were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ(2) analysis for variation in performance between trusts. RESULTS: 790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297). CONCLUSION: Our findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit. |
format | Online Article Text |
id | pubmed-8666861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-86668612021-12-28 Widespread gaps in the quality of care for primary biliary cholangitis in UK Sivakumar, Mathuri Gandhi, Akash Shakweh, Eathar Li, Yu Meng Safinia, Niloufar Smith, Belinda Claire Marshall, Aileen Turner, Lucy Mukhopadhya, Ashis Haboubi, Hasan Nadim Vincent, Rebecca Tan, Huey Kuan Alrubaiy, Laith Jones, David E J Frontline Gastroenterol Liver OBJECTIVE: Primary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines. DESIGN: Data were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ(2) analysis for variation in performance between trusts. RESULTS: 790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297). CONCLUSION: Our findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit. BMJ Publishing Group 2021-03-09 /pmc/articles/PMC8666861/ /pubmed/34966531 http://dx.doi.org/10.1136/flgastro-2020-101713 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Liver Sivakumar, Mathuri Gandhi, Akash Shakweh, Eathar Li, Yu Meng Safinia, Niloufar Smith, Belinda Claire Marshall, Aileen Turner, Lucy Mukhopadhya, Ashis Haboubi, Hasan Nadim Vincent, Rebecca Tan, Huey Kuan Alrubaiy, Laith Jones, David E J Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title | Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title_full | Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title_fullStr | Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title_full_unstemmed | Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title_short | Widespread gaps in the quality of care for primary biliary cholangitis in UK |
title_sort | widespread gaps in the quality of care for primary biliary cholangitis in uk |
topic | Liver |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666861/ https://www.ncbi.nlm.nih.gov/pubmed/34966531 http://dx.doi.org/10.1136/flgastro-2020-101713 |
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