Abstract
Background: Hepatitis-related chronic liver diseases pose considerable public health challenges in New South Wales (NSW). These diseases are largely preventable through a connected, coordinated, and integrated care approach. However, fragmented services and limited data sharing delay treatment and ongoing surveillance, particularly in remote and underserviced areas. An integrated approach across public health, clinical services, and NGOs is essential to address patients’ medical, socioeconomic, and cultural needs.
Approach: In this qualitative study, 50 semi-structured interviews were conducted with key liver health service providers from public health services, nurses, and liver specialists across NSW to identify and review a wide range of hepatitis and liver health-related services and networks across Local Health Districts (LHDs). An inductive thematic analysis of the data was conducted, which highlighted the complexity and diversity in service delivery and approaches, the characteristics of the workforce, and the high demand for services with limited resources and chronic workforce shortages.
Service mapping aimed to capture the interactions between service providers, focusing on areas of overlap, referral pathways, and the roles each provider plays in chronic hepatitis and related liver disease management. Alternative options like remote prescribing and Telehealth were explored.
Results: Three distinct models of liver health services across NSW were identified, each with unique structures and challenges in terms of access and integration. In metropolitan areas, service models are often more structured, with dedicated liver clinics, hepatology nurses, and specialist teams available for community outreach and direct patient access. In contrast, rural and remote regions heavily depend on nurse-led teams, intermittent specialist visits, remote prescribing, and Telehealth services. Two major spheres of liver health services emerged from this analysis: community-based prevention services, typically led by public health service systems, and more specialised services such as nurse-led initiatives (in clinics or long-term surveillance) and clinical services managed by hepatologists and gastroenterologists. While these spheres address different aspects of care, collaboration varies significantly across the state, often relying on the funding scheme and commitment of key individuals, resulting in fragmented care pathways. General practitioners are largely absent from these collaborative efforts.
Implications: This study underscores the urgent need for integrated care models in liver health services across NSW. The lack of a unified approach and coherent pathway across service delivery results in disjointed care, delayed treatments, and high risks of disease progression. To improve patient outcomes and reduce the long-term burden of liver disease, a holistic and multidisciplinary approach is essential. An integrated care framework would connect the primary prevention efforts, primary care, and clinical services, enabling a continuum of care that addresses the long-term and complex nature of liver disease management. Addressing all stages of the disease, from early intervention to ongoing treatment and support, would enhance patient quality of life and optimise healthcare resources. By identifying and categorising existing service models, this study provides foundational knowledge for establishing an integrated and holistic liver care network that can adapt to the diverse care needs across NSW.