Offering simple liver tests combined with feedback, information and advice, resulted in a significant reduction in problem drinking in at-risk patients.

Patients aged 25-54 years from nine GP practices in the South West of England were sent an AUDIT questionnaire, the gold standard for identifying harmful and hazardous drinking.

Those who scored eight or more on the AUDIT questionnaire were offered a traffic light test comprising serum markers of liver fibrosis together with a platelet count as an indicator of portal hypertension. The results were analysed and interpreted as:

• Red (liver disease probable)

• Amber (liver disease possible)

• Green (liver disease unlikely)

A total of 9,836 AUDIT questionnaires were sent out, of which 4,630 were returned. Overall, 1,128 patients had an AUDIT score ≥ 8. Of these, 1,037 indicated that they were prepared to enter the study and were invited to a nurse-led liver screening clinic at their own surgery.

A total of 393 patients actually attended for testing of whom 45 (11%) had a red traffic light test, 157 (40%) amber and 191 (49%) green. Red and amber participants were informed that their test was abnormal. Patients were followed up with a further AUDIT questionnaire after around one year, of which 303 out of 393 were returned.

Overall 128 (42%) patients who returned the second AUDIT questionnaire had reduced their alcohol risk by at least one AUDIT grade, from harmful/dependent to hazardous of from hazardous to low risk. Eight individuals (2.6%) had increased their AUDIT grade.

Participants with a positive traffic light test (red or amber) were significantly more likely to have reduced their AUDIT grade than those in the green group, and 65% of those with higher-risk drinking at the start of the study (red/amber result) had reduced their AUDIT score by one grade.

Liver disease-related mortality in the UK has doubled over the past 15 years in parallel with increasing alcohol consumption. However, the majority of alcohol-related liver disease is not recognised until it is advanced. With Christmas fast approaching, GPs may be more aware of excessive alcohol use in their patients.

‘The study has demonstrated the feasibility of postal screening and liver health checks in primary care with promising results on behaviour change, and the results should be tested in a randomised controlled trial with economic analysis,’ the authors state.

Better diagnostic tools for GPs may help reduce the increasing burden of alcohol-related liver disease in the UK.

Dr Jez Thompson