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This conversation explores the implications of increased access to economically viable in-office screening, particularly when primary care practices begin to use the new scanning devices.

Roger Green begins this conversation by recalling a concern Naim Alkhouri expressed during S4 E50.3, that primary care reliance on FIB-4 can flood the pathways with many “wrong” patients, which might lead to confusion within the channels. Hannes Hagstrom describes a role for primary care at the top of the funnel if practitioners have clear guidance and training. Roger suggests this approach will make primary care providers triagists. The group agrees as long as primary care has clearer guidance based on a limited set of reliable, widely used tests and algorithms. In this context, Jörn Schattenberg suggests that while VCTE might be the first point-of-care test, perhaps EHR-based algorithms can be created and deployed to identify the optimal number and types of patients to bring into the system.

This reliance on algorithms can create another challenge. Hannes notes that many algorithms are being published but none are becoming the standards that will be key to primary care assuming a triage role. Louise Campbell feels that the fact that VCTE is fundamentally non-discriminatory between modes of action makes it a good tool as part of this, but we have lots of screening and education before bringing protocols or devices into a primary care setting. As the conversation wraps up, Hannes notes that we will need to keep some patients out of the pathway due to age or low level of disease to identify two qualifiers and that when we have multiple drugs and different lines of therapy or treatment patterns, that will recast the issue once again. algorithms are being published but none are becoming standards, and standards will be key to the primary care as triage approach. Louise Campbell feels that the fact that VCTE is fundamentally non-discriminatory between modes of action makes it a good tool as part of this, but that we have lots of screening and education to do before bringing protocols or devices into a primary care setting. As the conversation wraps up, Hannes notes that we will need to keep some patients out of the pathway due to age or low level of disease to identify two qualifiers and that when we have multiple drugs and different lines of therapy or treatment patterns, that will recast the issue once again.