P218\u2005The management of primary biliary cholangitis (PBC) across UK hospitals: does care differ?

Abstract

Introduction 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 multicentre, national audit which assesses the quality of care and adherence to guidelines. Methods A retrospective audit of all adult patients with PBC was undertaken in 11 NHS trusts in England, Wales and Scotland between January 2017 and March 2020. Data on patient demographics, ursodeoxycholic acid (UCDA) dosing and key guideline recommendations was captured from medical records. Results from each trust were evaluated against national guidelines for target achievement and analysed using Chi-square analysis for variation in guideline adherence between trusts. Results A total of 790 patients with a diagnosis of PBC were identified across 11 national health trusts. The mean age was 62.1 years (SD, 13.16) and the cohort was predominantly female (94.2%). The data demonstrated that the majority of trusts did not meet all of the recommended EASL standards, set at 80% or 90%. There were significant variations in the following standards across the trusts: optimal prescription of UDCA (range: 15.8% - 88.8%) and assessment of biochemical response at one year (range: 53.3% - 100%), assessment of bone density (range: 22.2% - 77.4%), assessment of clinical symptoms (pruritus and fatigue) (range: 12.2% - 80%) (all p Conclusions This is the first UK-wide PBC audit that provides a unique insight into the care received by PBC patients across the UK. Our findings identify a gap in the care of patients with PBC and suggest the need for an intervention to improve guideline adherence. This has important implications in improving symptom control, preventing end stage liver disease and accessing novel therapies. These findings have been used to develop a PBC Review tool and we recommend its incorporation into clinical practice. As the first audit of its kind, it will be refined for a wide-scale re-audit.