When Do Clinicians Follow-up Abnormal Liver Tests in Primary Care?

Area of Science:

• Hepatology
• Clinical Medicine
• Health Services Research

Background:

• Guidelines recommend repeat testing for abnormal liver chemistries like bilirubin, transaminases, and alkaline phosphatase.
• The actual timing of repeat testing by clinicians remains largely unknown.

Purpose of the Study:

• To investigate the time to repeat liver chemistry testing in adult patients within a patient-centered medical home (PCMH).
• To identify factors associated with the time to follow-up liver function tests.

Main Methods:

• Retrospective study of 9,545 adult PCMH patients with abnormal liver tests (2007-2016).
• Analysis included demographic and clinical variables, with a focus on the number and degree of initial abnormalities.
• Cox proportional hazards model used to assess predictors of repeat testing time.

Main Results:

• 68% of patients had repeat liver tests within 1 year; 80% within 2 years.
• Patients with multiple abnormal liver tests and higher abnormality degrees showed shorter intervals to repeat testing.

Conclusions:

• A significant proportion of patients with abnormal liver tests do not undergo repeat testing within a year.
• The number and severity of initial liver chemistry abnormalities are key predictors for timely follow-up testing.