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Journal article
Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial)
BMC Health Services Research, Vol.25(1), pp.1-13
2025
PMID: 40121480
Abstract
Background: With the high burden of Metabolic dysfunction-associated steatotic liver disease (MASLD), (previously known as Non-Alcoholic Fatty Liver Disease - NAFLD) in the community, current models of care that require specialist review for disease risk stratification overwhelm hospital clinic capacity and create inefficiencies in care. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) randomised trial compared usual care to a community-based nurse delivered liver risk assessment. This study evaluates the implementation strategy of the LOCATE model.
Methods: The evaluation used mixed methods (quantitative trial data and qualitative framework analysis of semi-structured interviews) to explore the general practitioner (GP) and patient perspectives of acceptability (Acceptability Framework), and factors associated with reach, effectiveness, adoption, implementation, and maintenance (RE-AIM framework) of the LOCATE model of care.
Results: The LOCATE model was considered highly acceptable by both patients and GPs. The model of care achieved appropriate reach across the participating health services, reaching high-risk patients faster than usual care and with predominantly positive patient experiences. A notable reduction in anxiety and stress was experienced in the intervention group due to the shorter waiting times between referral and assessment. There was an overall perception of confidence in nursing staff capability to perform the community-based screening and GPs indicated confidence in managing low-risk MASLD without the need for specialist review. Challenges to implementation, adoption and maintenance included variable prioritisation of liver disease assessment in complex cases, the need for further GP training in MASLD assessment and treatment pathways, available funding and referral pathways for community screening, and accessibility of effective diet and exercise professional support.
Conclusion: Nurse delivered community-based liver screening is highly acceptable to GPs and patients and has shown to be an effective mechanism to identify high risk patients. Adoption and maintenance of the model of care faces significant challenges related to affordable access to screening, prioritisation of liver disease in complex patient cohorts, and unresolved difficulties in prescribing effective strategies for sustained lifestyle intervention in the primary care setting.
Details
- Title
- Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial)
- Authors
- Michelle J. Allen (Corresponding Author) - Queensland University of TechnologyRuth Tulleners - Queensland University of TechnologyDavid Brain - Queensland University of TechnologyJames O'Beirne - University of the Sunshine CoastElizabeth E. Powell - Translational Research InstituteAdrian Barnett - Queensland University of TechnologyPatricia C. Valery - QIMR Berghofer Medical Research InstituteSanjeewa Kularatna - Duke-NUS Medical SchoolIngrid J. Hickman - The University of Queensland
- Publication details
- BMC Health Services Research, Vol.25(1), pp.1-13
- Publisher
- BioMed Central Ltd.
- Date published
- 2025
- DOI
- 10.1186/s12913-025-12580-5
- ISSN
- 1472-6963
- PMID
- 40121480
- Copyright note
- © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
- Data Availability
- Data collected for this process evaluation has either been provided within the manuscript or supplementary information, or is available on reasonable request with ethical approval, except for raw audio files and transcripts as these are potentially re-identifiable.
- Organisation Unit
- School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 991127004902621
- Output Type
- Journal article
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