TY - JOUR T1 - Widespread gaps in the quality of care for primary biliary cholangitis in UK JF - Frontline Gastroenterology JO - Frontline Gastroenterol SP - 32 LP - 38 DO - 10.1136/flgastro-2020-101713 VL - 13 IS - 1 AU - Mathuri Sivakumar AU - Akash Gandhi AU - Eathar Shakweh AU - Yu Meng Li AU - Niloufar Safinia AU - Belinda Claire Smith AU - Aileen Marshall AU - Lucy Turner AU - Ashis Mukhopadhya AU - Hasan Nadim Haboubi AU - Rebecca Vincent AU - Huey Kuan Tan AU - Laith Alrubaiy AU - David E J Jones Y1 - 2022/01/01 UR - http://fg.bmj.com/content/13/1/32.abstract N2 - Objective 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 national, pilot audit that assesses the quality of care and adherence to guidelines.Design Data were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results 790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).Conclusion Our findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.All data relevant to the study are included in the article or uploaded as supplementary information. ER -