Five Health Systems, Five Pathways: How Europe Refers Patients for Portal Hypertension
Referral routes for portal hypertension surgery vary from one health system to the next. To compare them fairly, we surveyed 211 liver specialists in equal numbers across Germany, Spain, Italy, France and the UK.
A manufacturer wanted to map how patients with portal hypertension are referred for portal hypertension across Europe's five largest markets and what limits use of the procedure.
The study followed a two-phase design, first used in the US.
Phase 1 consisted of 10 double-blinded, 60-minute Zoom interviews with transplant hepatologists, hepatologists, and gastroenterologists. Physicians explored the referral pathway and reviewed the draft questionnaire to check it made sense in their health systems.
Phase 2 was an online survey of about 30 minutes, completed by 211 physicians:
133 gastroenterologists
54 hepatologists or liver specialists
24 transplant hepatologists
The sample was spread evenly across countries: Germany (44), Spain (44), Italy (43), France (42), and the UK (38).
Respondents came from transplant centers (81), specialist liver centers (81) and hospitals without specialist liver services (49). Half reported working across more than one institution.
That last group shaped the analysis. About a third of gastroenterologists worked in centers without a specialist liver service. These 47 physicians were analyzed separately where relevant to show attitudes outside academic and specialist centers.
Balanced country quotas allowed comparisons between markets, including differences in confidence managing advanced liver disease.
The results gave the client a quantified view of the European pathway and a direct comparison with the US.
