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Co-hosts Louise Campbell and Roger Green are joined by friend of the podcast, Naim Alkhouri, and new guest, Professor James O’Beirne, to discuss learning from liver disease in Australia and developing improved models for patient identification and risk stratification.

This conversation starts with an introduction to James both personally and professionally. A Consultant Hepatologist at the Sunshine Coast University Hospital, James describes how he came to his work and interests around risk stratification in liver disease, particularly in NAFLD, hepatocellular carcinoma and portal hypertension. From here Louise shares a bit about why she feels the LOCATE-NAFLD study is compelling and well-worth an investigation on the podcast. Among her notes, Louise praises the study for its integration and comparison of different pathways and outcomes. At the bottom of the session, James provides a high-level overview of the study:

Rationale
NAFLD is the most common type of chronic liver disease in Australia. NAFLD is associated with a reduction in health-related quality of life, and as the number of NAFLD cases increase, the health system will incur increased costs associated with its diagnosis, management and disease progression. Currently, many patients who present to primary care with abnormal liver function tests or steatosis on liver ultrasound are referred for assessment in secondary care. Due to the large number of patients with NAFLD, this results in long waits for clinical and fibrosis assessment, placing unnecessary burden on the public hospital system. The study proposes to introduce better and faster assessment and stratification of patients in the community. As a result, the study aims to significantly reduce referrals for hospital-based appointments, and improve surveillance of high-risk disease, resulting in enhanced management of complications that result in avoidable, high cost admissions.

Study Design
The LOCATE-NAFLD study is a 1:1 parallel randomized trial to compare two alternative models of care for NAFLD (usual care versus LOCATE-NAFLD).

Usual care group

• Patients will attend a specialist hepatology clinic for their care.

LOCATE-NAFLD group

• Patients will be assessed by a specialist study nurse in the primary care setting, such as local general practice clinic.
• The specialist nurse will assess patients using mobile transient elastography, using a FibroScan machine.
• Scan results will be reviewed by the specialist nurse and hepatologist
• Patients with low levels of liver scarring will be referred back to their GP for care
• Patients with high levels of liver scarring will be followed up in secondary care hepatology clinics

Quality of life will be assessed for all patients at baseline and at 12-month follow-up via a questionnaire. The study will analyse intervention costs, hospital outpatient clinic utilization, hospital admissions, hospital costs and patient death data.

If you have questions or comments around the LOCATE-NAFLD study or any other ideas addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!