Acceptability of an integrated care program to identify patients at risk of advanced chronic liver disease in Australian primary care settings.

BACKGROUND: The prevalence of advanced chronic liver disease (ACLD) is increasing globally and represents a growing public health challenge. General practice is well positioned to identify patients at risk, initiate timely assessment, and coordinate long-term management of ACLD. However, many general practitioners (GPs) report uncertainty about appropriate diagnostic tests and their role in early detection pathways. This study examined the feasibility and acceptability of the Liver Toolkit (LTK), an integrated care program piloted in Sydney, Australia, designed to support early detection and management of ACLD in general practice. METHODS: A qualitative study was conducted involving semi-structured interviews with general practice and hospital staff engaged in the program. Data were analysed using the Theoretical Framework of Acceptability (TFA), which guided exploration of constructs including affective attitude, coherence, burden, perceived effectiveness, and self-efficacy. RESULTS: Thematic analysis revealed mixed levels of acceptability across the TFA constructs. Many participants recognised the LTK's potential to improve early detection and enhance collaboration with specialist services. However, concerns emerged about coherence, with uncertainty around how the program aligned with existing workflows and priorities. Self-efficiency was limited, as GPs reported low confidence in using the associated software and interpreting outputs independently. The program was also perceived as burdensome, with time demands and the number of indicators highlighted as barriers. Despite these challenges, hospital led support, training, and special input were viewed as important enablers that facilitated participation and built trust in the program. CONCLUSIONS: Although the LTK demonstrated promise in improving early identification and management of ACLD, further refinements are needed before broader implementation in general practice. Key improvements include simplifying design features, reducing the number of indicators, and strengthening GP knowledge and skills. With targeted development and sustainable integration, the LTK program holds the potential to reduce the burden on individuals, primary care, and the health system.