015 Achieving consensus on overused tests : the example of hepatic steatosis

Metabolic Associated Steatotic Liver Disease (MASLD), previously known as ‘’Fatty Liver’’, has emerged as a common clinical entity and is a source of overdiagnosis. Recent European and American specialist guidelines incite screening, active case finding and follow-ups of this condition in primary care. Benefits of these extensive diagnostic workups are often not evidence based. Few studies show any positive impact on morbidity or mortality and most recommendations are ‘Expert Opinion’. Screening for MASLD is quickly becoming a driver for time consuming low-value care in busy outpatient clinics. In response to a clinician-identified struggle to provide high-value, evidence-based care, a panel was formed to tackle the current evidence behind the guidelines, the impact of their full application on a primary care practice and expected repercussions on clinical-decisions and patient-important outcomes. The panel was composed of primary care physicians working in hospital and community settings and a nurse practitioner in adult care. Each member sought out evidence-based literature in medical databases to answer PICO questions focused on the impact of MASLD screening, follow-up and treatment. Furthermore, the panel critically appraised the two recent guidelines, using tools such as G-Trust. Information gathered was discussed and analyzed as a group to form recommendations created by and for primary care. This seminar aims to describe the panel’s findings. We will review the definition of MASLD and reasons behind why it has become a major health focus in many developed countries. Current European and American guidelines will be presented and critically appraised. We use the concept of time needed to treat and a clinical decision making 1000-person-tool to highlight the resource-consuming impact the guidelines can have on primary care workloads, particularly in the context of doubtful patient expected benefits. The seminar will conclude with four ‘Choosing Wisely’ recommendations and two algorithms to assist primary care clinicians in dealing with case-findings of liver steatosis and abnormal hepatic enzymes. By the end of this seminar participants will: Identify how MASLD is a common source of overdiagnosis Appreciate how practice guidelines related to MASLD are based on little to no evidence Identify key recommendations for primary care physicians regarding MASLD to reduce overdiagnosis, as well as low-value testing and treatment

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